Dissociative Disorders

dissociation is an old concept which is still used today

see evidence in literature and history gives some evidence to the validity of this condition, example, hulk.

RARE: 1/1000 people. possibility of feigning (faking the disorder) 19% of criminal offenders(evan, mezey & Ehlers 2009)

depersonalization/derealization disorder:

• derealization: sense of the reality of the outside world is temporarily lost

• depersonlization: sense of oneself and one’s own reality is temporarily lost

• most common dissociative disorder

• 23% general population → only diagnosed when interferes with behavior

dissociative amnesia:

• partial or total loss of important personal information; may occur suddenly after stressful traumatic event

  • retrograde amnesia

  • anterograde amnesia

• 3 different styles: how they deal with traumatic memory → they dont deal with it

  • localized = events

    • loses memories of some events → is someone was molested by relative, stopped remembering times that it occurred

  • systematized = category

    • if someone was traumatized by school forgets everything about school

  • selective = specific details

    • doesnt remember specific details

• fugue state: person goes on a journey and creates a whole new identity

dissociative identity disorder(DID)→ use to be multiple personality disorder(MPD)

• most extreme

• whats in the name

  • MPD: focus on pathology + assumes personalities are real

  • DID: focus on health individual who dissociates → personalities fill the void

• personalities

  • 2-100

  • unique characteristics

  • host and alter personalities

• amnesia → when they have one personality in control, they have no memory of what is going on

  • ex: fight club, Hulk

• alternate personality state may appear to help deal with difficult situations faced by the primary personality

• diagnostic controversy of DID

  • characteristics have changed over time

  • very psychoanalytical oriented

  • hard to validate

• etiology of dissociative disorders:

  • disruptions in memory encoding due to acute stress

    • atypical brain functioning has been documented

    • differences in temporal lobe activity and the hippocampus → causation or correlation

  • permanent structural changes in brain due to trauma may play a role

    • reduction in amygdalar volume

• psychodynamic dimension of dissociative disorders

  • psychodynamic theory: repression protects the individual from painful memories or conflicts (splitting)

    • splitting: a form of dissociation that results from a conflict that can affect the ego (splitting of the ego) or its objects (splitting of the object)→ according to freud

  • contemporary theory: post-traumatic model of DID

    • personality split develops because of the traumatic experience and the inability to deal with the experience

• social and sociocultural dimensions of dissociative disorders:

  • sociocognitive model

    • individuals learn about DID through mass media and being to act out its rules

  • iatrogenic disorder

    • condition unintentionally produced by a therapist through mechanisms placed on the client

  • personality theory:

    • individuals who report dissociations score higher on fantasy proneness and fantasy susceptibility

• treatment of dissociative disorders:

  • symptoms tend to lessen spontaneously for dissociative amnesia or fuge

    • depersonalization/derealization→ more slowly

  • depression often associated

  • reasonable approach: alleviate depression and stress

    • antidepressants, cognitive behavioral therapy, and stress management techniques

    • behavioral therapy

      • reinforcement of appropriate responses

  • trauma-focused therapy

    • help individual develop healthier ways of dealing with stressors

    • major goal is integration of personalities → get ride of unconscious

    • example of steps:

      • working on safety issues, stabilization, and symptom reduction

      • reducing cognitive disortations

      • developing healthy relationships and practicing self care