dissociative disorders

A disconnection between mind, body, and reality
- Examples: highway hypnosis, absorption into a video game, book, movie, etc.
It becomes maladaptive when it includes distress, dysfunction, deviance, or danger and causes problems in life

Disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, body, emotion, perception, body, representation, motor control

Inability to recall important info, usually of an upsetting nature, about one’s life
Often, the amnesia episode is triggered by an upsetting situation
Criteria:
- An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other drugs of abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, other neurological condition).
- The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder
types of dissociative amnesia
- localized
- most common; loss of all memory of events occurring within a limited period
- selective
- loss of memory for some, but not all, events occurring within a period
- generalized
- loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends
- continuous
- forgetting continues into the future; quite rare in cases \n of dissociative amnesia

a more extreme version of dissociative amnesia
causes people to forget their personal identities and details of their past, and even flee to an entirely different location and create an entirely new life/persona
- can be a result of war trauma for example

Criteria for DID:
- The person experiences a disruption to his or her identity, as reflected by at least two separate personality states or experiences of possession
- The person repeatedly experiences memory gaps regarding daily events, key personal information, or traumatic events, beyond ordinary forgetting
- Leads to significant distress or impairment
- The disturbance is not a normal part of a broadly accepted cultural or religious practice
- Symptoms are not caused by a substance or medical condition
two or more distinct personality types that dominate a person’s functioning
- primary or host personality present
- each has a unique set of memories, behaviors, thoughts, and emotions
- sudden movement from one personality to another (switching) is usually triggered by stress
women are diagnosed three times more often than men
how do subpersonalities interact?
- three kinds of relationships:
- mutual amnesic
  - unaware of other personalities
- mutually cognizant
  - both aware of other personalities
- one-way amnesic
  - some personalities are aware or present, some are not
how do subpersonalities differ?
- subpersonalities often display dramatically different characteristics such as:
- identifying features
- abilities and preferences
- physiological responses
DID is fairly common
explanations for DID
- early childhood trauma, retraumatization

caused by repression
people fight off anxiety by unconsciously preventing painful memories or thoughts

state-dependent learning
your mind is going elsewhere, and you are being conditioned to respond that way in the future

psychodynamic therapy - guides clients to search their unconscious mind and bring forgotten experiences into consciousness
hypnotic therapy - hypnotized and guided to recall forgotten events
drug therapy - intravenous injections of barbiturates are sometimes used to help patients regain lost memories
people with DID usually do not recover without treatment (unlike dissociative amnesia or fugue)

depersonalization: experiences unreality, detachment, or being an outside observer with respect to oneself’s thoughts, feelings, sensations, body, or actions
derealization: unreality or detachment with respect to surroundings
- individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted
goes hand-in-hand with trauma; are due to a past trauma; can be triggered by trauma
- betrayal trauma: occurs when the people or institutions on which a person depends for survival significantly violate that person’s trust or well-being
- shame also commonly leads to dissociation through trauma
criteria:
- presence of persistent/recurrent experiences of depersonalization, derealization, or both
- reality testing remains intact during an episode of depersonalization/derealization
- significant distress or impairment
- not caused by a substance
- not caused by a medical condition
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