Week 7: Dissociative Disorders

What are Dissociative Disorders?

refers to a state in which the person experiences unprompted intrusions into awareness and behavior accompanied by losses of continuity in these subjective experiences, or an inability to control or access mental functions such as amnesias - It allows the mind to separate or compartmentalize selected memories (or thoughts) from normal consciousness. These disorders have gone under much scrutiny and been reworked over the various editions of the DSM. Some of the result from obvious signs of trauma and abuse. These are examples of disintegrated experience – or alterations in our relationship to our self, to our world, and/or to our memory processes.

What questions do dissociative disorders raise?

What happens when we cannot remember why we are in a certain place or who we are? What happens if we lose our sense that our surroundings are real?

What are the causes of dissociative disorders?

The causes are not really known, but if a person experiences a traumatic event, between 31% - 66% will experience dissociation. The majority of people who have experienced trauma do not suffer a dissociative DISORDER. The person who does, however, may have large gaps of time for which he/she cannot account – or the individual may relate many inconsistencies about his/her past.

What are the predictors of dissociative disorders?

Childhood trauma – a history of physical and/or sexual abuse as a child. Suggestibility – considered a personality trait, some people are more suggestible than others. In particular, people who are suggestible may use dissociation to defend against trauma. Biological factors – traits that are inherited, such as tension and responsiveness to stress, may increase a person’s vulnerability to the dissociative disorders. Head injury, seizure disorders, and sleep deprivation increase the likelihood of dissociative experiences.

What are characteristics of dissociative disorders?

A disruption of and/or discontinuity in the normal integration of: consciousness, memory, identity emotion, perception, body representation, motor control, and behavior.

What is the Symptom presentation of dissociative disorders?

Basic forms of this include: (Daydreaming is a common experience of how people can switch states of consciousness. Tuning out a lecture. To others, it may appear the person is listening and not day dreaming). Symptoms of the disorder, however, are experienced as a loss in connection - Parts of an identity are relegated to a separate compartment, but may reemerge suddenly and unexpectedly. One group of normal mental processes becomes separated from the rest; the person’s sense of identity changes along with a particular set of memories, feelings and perceptions. We might see a woman who was traumatized, so she partitions it to get through the experience. The alter can become more developed. Then when that alter doesn’t provide comfort, another alter can be created.

What can a closer look at dissociative disorder symtpoms tell us?

Entail a complicated process wherein people forget who the are, where they are, and what they have been doing. People lose their identity. In extreme cases people may acquire one or more distinct identities called “alters” - (Each alter represents a cohesive character with his/her own unique memories, attitudes, habits, facial expressions, gestures, and personal histories that are different and apart from the “host” individual they share & Typically, these “personalities” differ from each other along various dimensions including race, gender, age, and intelligence). The disorders share several common features: (they generally end suddenly; a profound disturbance of memory is noted (except in depersonalization/derealization disorder); and episodes are precipitated by psychological conflicts). We want to get to know the alters

What are Key symptoms of dissociative disorders?

Amnesia: Losing memory of one’s own identity, or the loss of periods of time in one’s past.

Depersonalization: Feeling detached from oneself or as an outside observer of one’s own self.

Derealization: Sensing that objects in one’s world are strange, unreal, or have suddenly changed dimension, appearance, or location (e.g., one’s home feels unfamiliar).

Identity confusion: Being unsure of one’s own identity, who one is.

Identity alteration: Behaving in a way that suggests one has assumed a new identity. People can take flight in a state.

What are Cultural Perspectives of dissociative disorders?

Dissociative experiences such as trance states, speaking in tongues, or spirit possession are widely accepted and practiced in many present-day cultures. The symptoms may appear to outsiders as evidence of dissociation, but insiders view the personality changes as attributable to a spirit or some other aspect of the belief system. Ataques de nervios – a commonly noted response to acute stress in Latin American and Hispanic cultures including uncontrollable crying, screaming, shouting, seizure-like behaviors, and a failure to remember the episode afterward. 

What do We need to pay attention to regarding culture and dissociative disorders?

Cultural identity of the individual, Cultural explanations of the person’s illness, Cultural and psychosocial environment, Cultural aspects of the relationship between the individual and the practitioner. 

What are the dissociative Disorders?

Dissociative Identity Disorder 300.14 (F44.81), Dissociative Amnesia 300.12 (F44.0), Depersonalization/Derealization Disorder

What is Dissociative Identity Disorder 300.14 (F44.81)?

Formerly known as Multiple Personality Disorder - Considered the most severe of all the DIDs. The most common alteration includes the presence of more than one discrete identity - Most studies indicate the average number of alters is 15! Usually traceable to traumatic events. Look for physical or sexual abuse – most often incest. The individual removes him/herself from the traumatizing situation. Multiple long and painful early-life medical procedures may also be reported. It is a way for the mind to handle to trauma so its not as crippling

What is important to remember with DID?

In all cases, remember that the individual learns as a young child to survive by fleeing into the dissociative process. This process includes a psychobiological mechanism that allows the mind to escape what the body is experiencing. Each time the child endures an abusive episode, he/she/they ‘learns’ better how to escape by recreating the haven of safety and ‘switching’ into his/her/their fantasy world. On some level, the child learns there is no limit to the variety of identities he/she/they can construct for protection from the abusive situation. The process of switching seems to decrease with age, and over time one of the personalities becomes more dominant that the others. Although the use of dissociation as a defense mechanism begins in childhood, the presence of a dissociated identity disorder is often undetected until adulthood.

What is DID in adulthood?

The impairments stemming from severe childhood abuse experiences, which often lead to chronic intrapersonal and interpersonal difficulties and comorbid disorders such as the: (depressive disorders, trauma- and stressor-related disorders, personality disorders (especially avoidant and borderline), conversion disorder, somatic symptom disorder, eating disorders, substance-related disorders, obsessive-compulsive disorder and sleep disorders). Some say that DID is a very extreme subtype of PTSD. Make sure you treat both, though.

What is the DID prevalence?

Very small - about 1.5%

What is the DID Differential Assessment?

The distinguishing feature is the presence of two or more distinct personality states that in some cultures as an experience of possession. Each alter struggles for dominance. There is an obvious discontinuity in the person’s sense of self accompanied by alterations in affect, behavior, consciousness, memory, perception, cognition, and sensor-motor functioning. Most people with this are not forthcoming. They often fear they will be regarded as an exhibitionist or worse, as a freak. The signs and symptoms of this can be observed by others or reported by the individual. The person has trouble remembering everyday events, important personal information, or even traumatic events in a way that is very different from ordinary forgetting.

What is The “host” identity in DID?

that is, the person who comes in for counseling, is usually overwhelmed by efforts to hold various fragments of these personalities together. The symptoms cause significant distress or impairment in social/occupational/or other important area of a person’s functioning.

What does Evidence indicates in people with DID?

They tend to be very suggestible. A person’s alters may be created in order to respond to leading questions from practitioners! We need to consider accepted cultural or religious practices and whether the symptom picture differs from these customs and traditions.

What do we have to Remember to rule out in DID?

substance use disorders, seizure disorders, or malingering

What is Dissociative Amnesia, 300.12 (F44.0)?

Formerly known as psychogenic fugue. A completely reversible amnesia that is associated with some form of emotional, traumatic, or psychological stress. The person cannot remember important personal information.

What are the patterns of dissociative amnesia?

Localized: Unable to recall events that occurred during a particular time.

Selective: Only patchy recollections of an event come to mind, but other portions of time are forgotten.

Generalized: All of the experiences during a person’ entire lifetime are forgotten.

Continuous: Inability to remember all events from a given time up to an including the present time, while retaining memory prior to that given time.

Systematized: The person loses memory pertaining only to certain categories of information, such as information related to one’s family). The last three types are less common. Most of the symptoms of amnesia resolve without intervention. The supportive counseling offers security, though.

What is the Dissociative Amnesia Prevailing Pattern?

We don’t know much about family prevalence, demographic data, or etiology. The 12-month prevalence is relatively rare, 1.8%. People usually suffer their first bout at a young age.

What is the Dissociative Amnesia Differential Assessment?

A single episode of dissociative amnesia is the most common pattern - Multiple episodes are possible in situations where there are repeated experiences of extreme stress or trauma. The most often consists of selective type or generalized type. The symptoms cause significant distress and interpersonal difficulties in social, occupational, or some other important aspect of life. Rule out alcohol and other drugs, neurological and medical conditions, PTSD, acute stress disorder, somatic symptom disorder, or major/mild neurocognitive disorder.

What is One key point in Dissociative Amnesia?

The assessment is not made if the loss of recall is only around childhood memories; it must involve events that are more current, usually those following a psychologically traumatic event.

What is Dissociative Amnesia with Dissociative Fugue?

It is manifested by unexpected travel away from their home or work, suffer an inability to recall their past, assume a new identity, and cannot remember important personal details about their life. While in this state, the person does not remember his/her prior life - after this state the episode may or may not be remembered. The stimulus for this state usually involves the individual leaving behind some kind of difficult and troubling situations that on some level he/she finds intolerable. The person usually comes to the practitioner’s attention as a John or Jane Doe. The symptoms associated with dissociative fugue are the same as those for dissociative amnesia except for the sudden travel component. Consider, delirium, dementia, malingering, factitious disorder, and DID

What is Depersonalization/Derealization Disorder 300.6 (F48.1)?

A poorly studied and rarely seen disorder. Symptoms last for hours to days. The person experiences themselves or their surroundings as strange or unreal in some way - someone else in control or they’re in a dreamlike state. The individual reports feeling detached from his/her body and more like an observer.

What is depersonalizaiton?

Feeling cut off from oneself

What happens With derealization?

Felling cut off from the world. They might feel detached from their surroundings as if someone else is in control or like they are living in a dream or moving in slow motion. The individual remains in touch with reality; his/her symptoms may be persistent, recurrent, or seriously impair functioning.

What is the onset of Depersonalization/Derealization Disorder?

The first episode occurs during late adolescence or early adulthood and without warning.

What is localized amnesia?

Unable to recall events that occurred during a particular time.

What is selective amnesia

 Only patchy recollections of an event come to mind, but other portions of time are forgotten. 

What is generalized amnesia?

All of the experiences during a person’ entire lifetime are forgotten. 

What is continuous amnesia?

Inability to remember all events from a given time up to an including the present time, while retaining memory prior to that given time.

what is systematized amnesia?

The person loses memory pertaining only to certain categories of information, such as information related to one’s family).