Ch. 6 -- Dissociative Disorders

Introduction

= “characterized by a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior” 

  • Frequently found in the aftermath of a wide variety of… traumatic experiences”

  • Not due to “the physical impact that can cause traumatic brain injury” (DSM, p. 330)

  • Once thought rare, may be more prevalent than thought

  • Onset: late adolescence to early adulthood

  • High comorbidity w/ 
      * PTSD (DID & Dissociative Amnesia)
      * Depressive Disorders

Etiology  

Heritability: 50-60%

Neurological links:

  • Frontal lobes
  • Hippocampus

Influence of mass media

Child abuse, neglect, abandonment

Not many treatment options because: 
  1. Spontaneous recovery
  2. Low prevalence disorders

Dissociative Identity Disorder

Criterion #1:

  • “Presence of two more distinct personality states or an experience of possession” (p. 143)

- Overt vs covert 

Criterion #2:

  • “a gap in the recall of events, information, or trauma due to the switching of personalities” (p. 143)

Criterion #3:

  • “The disturbance is not a normal part of a broadly accepted cultural or religious practice” (DSM,  p. 331)

70% have attempted suicide

Prevalence = 1.5%

  • mostly women

Treatment goal = “integration of subpersonalities to the point of final fusion” (p. 151)

Methods:

  1. Psychoeducation
  2. Raising awareness of subpersonalities

Fusion

= when two or more alternate identifies join 

Dissociative Amnesia

= “The inability to recall important autobiographical information, usually of a traumatic or stressful nature” (p. 144)

Different from permanent amnesia because: 

  1. memory retrieval problem

   
   1. possibly a reversible memory retrieval deficit

  1. No neurobiological cause

3 types of amnesia primarily involved:

  1. Localized

= “inability to recall events during a specific time period”

  1. Selective

= “can recall some, but not all, of the details during a specific period”

  1. Systematized

= not recalling a specific category of important information

In rare cases, generalized dissociative amnesia

= “complete loss of memory for most or all of an individual’s life history” (p. 144)

Can include dissociative fugue (or fugue state)

= “sudden, unexpected travel away from one’s home with an inability to recall some or all of one’s past” (www.britannica.com)

Prevalence = 1.8%

Treatment

  • Often memory regained without treatment
  • Hypnosis?
  • Barbiturates (“truth serums”)

Depersonalization/Derealization Disorder

Depersonalization 

= Feeling of unreality or detachment from oneself

Derealization 

= Feeling of unreality or detachment from world

Episodes range from few hours to months

Onset sudden, triggered by intense stress or trauma

~50% of adults have experienced at least 1 episode

Treatment:

  • Diagnosis
  • SSRIs
  • Cognitive-behavioral therapy