Chapter 8 Dissociative disorder

Overview of Dissociation and Somatic Symptoms

  • This chapter discusses the connection between stress and psychological issues, particularly focusing on dissociation and somatic symptoms as responses to traumatic experiences.

Definitions and Models

Post-Traumatic Model

  • Holds that somatic and dissociative symptoms are connected to stressful or traumatizing events (Traumagenic Position).

  • Suggests that both symptoms emerge as methods of coping with emotional distress.

Differentiating Symptoms

  • Dissociation:

    • Involves a disconnection from feelings and experiences.

    • May lead to feelings of unreality (depersonalization, derealization) or significant memory loss (amnesia).

  • Somatic Symptoms:

    • Characterized by physical symptoms with psychological origins (e.g., unexplained pain, fatigue).

    • Reflect underlying emotional conflicts but can be medically unexplained.

Case Examples

Lauren

  • 25-year-old woman seeking therapy for memory gaps, indicating dissociation.

  • Experiences a sudden change in identity (Bix) with distinct behavior and memories.

Paul

  • 35-year-old man with diverse physical ailments but no identifiable causes, indicating somatic symptoms.

  • Burdened by a complex medical history and dissatisfaction without understanding his symptoms.

Tiyu

  • Military pilot grounded due to unexplained numbness in her hands, leading to emotional suppression and stress.

  • Physical health problem links to psychological trauma from her experiences in missions.

Isabelle

  • 39-year-old businesswoman feeling overwhelmed by work stress, resulting in high blood pressure.

  • Seeking therapy in addition to treating her physical health issues, indicating psychosomatic interaction.

Exploring Dissociation

Nature of Dissociation

  • Common forms include daydreaming and being absorbed in tasks, which are normal and mild.

  • Severe dissociation may manifest as:

    • Amnesia about distressing events.

    • Identity confusion and alteration when profound dissociative experiences occur.

Identifying Dissociative States

  • Can result in detachment from self or environment leading to altered perceptions.

  • Pathological dissociation occurs as a response to trauma, such as abuse or war, and is utilized as a coping mechanism.

Somatic Symptoms

Definition and Distinction

  • Somatic Complaint: Physical symptoms that are experienced or worried about without clear medical explanation.

  • Psychosomatic Symptom: Physical symptoms exacerbated by psychological stress; exists as a genuine medical condition.

    • Example: Isabelle’s high blood pressure worsened by work pressure.

  • Somatization: The presentation of psychological distress in physical terms without medical explanations (e.g., Tiyu's hand numbness).

Diagnosis and Classification

DSM and ICD Perspectives

  • Different terminologies and classifications for dissociative and somatic disorders.

    • DSM-5 defines various dissociative disorders, while ICD-11 refers to symptoms of bodily distress differently.

  • Table 8.1 compares names and categories in DSM and ICD, showing the fluidity of terminology over time.

Dissociative Amnesia

  • Difficulty recalling personal, often traumatic, events.

  • Can result in complete identity loss in rare cases (dissociative fugue).

Depersonalization Derealization Disorder

  • Episodes of feeling detached from oneself (depersonalization) or the surroundings (derealization).

  • Affect mental health conditions like anxiety and depression; triggers often include trauma.

Dissociative Identity Disorder (DID)

  • Formerly known as multiple personality disorder; characterized by having two or more distinct identities.

  • Symptoms include memory gaps about personal information and experiences.

  • Difficulties persist for years before a diagnosis is typically made.

  • Case of Lauren illustrates symptoms of DID, maintaining multiple identities and struggling with discordant memories.

Case Study

Rachel's Experience

  • Rachel describes intense experiences of dissociation, including losing time and not recalling actions.

  • Dialogue with her therapist reveals the complex nature of coping with trauma, leading to a potential diagnosis of DID.

  • The healthcare provider's reassurance and clarity about DID creates a pathway for Rachel to begin understanding her experiences.

Conclusion

  • The exploration of dissociation and somatic symptoms reveals the intricate relationships between trauma, psychological distress, and physical health issues.

  • Therapeutic interventions aim to provide understanding and coping strategies for individuals experiencing these complex symptoms.