Dissociative Disorders

Dissociative Disorders

Overview

  • Dissociative Disorders are characterized by a disconnection between thoughts, identity, consciousness, and memory.

  • Typically occur following significant adverse experiences or trauma.

  • Serve as unconscious defense mechanisms that allow individuals to protect themselves from overwhelming anxiety through emotional separation.

  • Results in disturbances of memory, consciousness, self-identity, and perception.

Symptoms

  • Items from the Dissociative Experience Scale include:

    • Did not remember all or part of a car or bus trip

    • While listening, did not hear all or part of a conversation

    • Found self in a place but have no memory of having got there

    • Found new items among belongings but do not remember buying them

    • Dressed in clothes but do not remember putting them on

    • Approached by strangers who said they know the individual

    • Felt and watched self as if looking at another person

    • No memory of some important personal events

    • Stared into space, thought of nothing, unaware of time

    • Evidence of doing something but no memory of doing it

    • People and objects appeared distant and unclear, seen through a fog

Types of Dissociative Disorders

  1. Depersonalization/Derealization Disorder

  2. Dissociative Amnesia

  3. Dissociative Identity Disorder

Depersonalization/Derealization Disorder

  • Depersonalization: Focus on self, feelings of being detached from one’s body or mental processes.

  • Derealization: Focus on the outside world, feeling that one's surroundings are unreal or distant.

Dissociative Amnesia

  • Definition: Inability to recall important personal information, often traumatic or stressful in nature.

  • Dissociative Fugue: A subtype characterized by sudden, unexpected travel and inability to recall one’s identity.

Dissociative Identity Disorder (DID)

  • Presence of two or more distinct personality states (alters):

    • Each alter has its own distinct pattern of perceiving, relating to, and thinking about the self and the environment.

    • Alters may differ in sex, race, or religion.

    • Each alter possesses its own memories, behaviors, and relationships.

    • Often develops as a result of severe childhood abuse.

    • Transitions between alters may occur during times of stress.

Assessment of Dissociative Identity Disorder

  • History: 90% of individuals with DID reported experiencing childhood abuse or neglect.

  • Impact on Patient and Family: Patients may experience severe psychological distress.

  • Suicide Risk: Approximately 70% of individuals diagnosed with DID have attempted suicide.

  • Identifying Alters:

    • Assessing a patient's ability to identify themselves involves more than just asking for their name.

    • Changes in behavior, voice, dress may indicate another personality state.

    • Referring to oneself using another name, speaking in the third person, or using "we" instead of "I" may suggest a new identity.

Treatment Planning for Dissociative Disorders

  1. Phase 1: Establishing safety, stabilization, and symptom reduction.

  2. Phase 2: Confronting, working through, and integrating traumatic memories.

  3. Phase 3: Identity integration and rehabilitation.

Effects of Depersonalization/Derealization Disorder

  • Patients may experience extreme discomfort feeling as though they are observing their own body or mental processes.

  • Feelings may include unreality, detachment, or unfamiliarity with oneself.

  • Visual Distortions: Blurriness, changes in visual field, altered size of objects.

  • Auditory Distortions: Muting or heightening of sound, contributing to a sense of disconnection from reality.