6.4 Dissociative Amnesia, Fugue, and Depersonalization/Derealixation Disorder Dissociative Disorders Study Notes

Dissociative Disorders Overview

Dissociative disorders are characterized by an individual becoming split off, or dissociated, from their core sense of self. Memory and identity experience disturbances that have a psychological, rather than physical, cause. According to the DSM-5, the dissociative disorders include:

  • Dissociative Amnesia

  • Depersonalization/Derealization Disorder

  • Dissociative Identity Disorder

Key Definitions

  • Dissociative Disorders: A group of psychological disorders marked by the breakdown of memory, identity, or consciousness.

Dissociative Amnesia

Dissociative Amnesia is defined as the partial or total inability to recall important personal information, typically following extremely stressful or traumatic experiences. Examples of such experiences include:

  • Combat

  • Natural disasters

  • Victimization of violence

Characteristics

  • The memory impairments are distinct from ordinary forgetting.

  • A notable study indicated that approximately 1.8% of individuals in certain upstate New York communities experienced dissociative amnesia within the previous year (Johnson, Cohen, Kasen, & Brook, 2006).

Dissociative Fugue

Some individuals with dissociative amnesia may also experience Dissociative Fugue, characterized by sudden, unplanned travel away from home, confusion about personal identity, and sometimes the adoption of a new identity (Cardeña & Gleaves, 2006).

  • Duration: Episodes can last from a few hours to several weeks or even months. Individuals generally have no recollection of events during the fugue state.

  • Prevalence: It is estimated that 0.2% of the general population may experience dissociative fugue.

  • Onset: Typically occurs in adolescence or early adulthood, often triggered by traumatic or stressful life events.

  • Associated Factors: Previous history of child abuse, neuropsychological cognitive dysfunctions, and genetic predispositions.

Recovery and Controversies

Recovery from dissociative fugue may be complete or gradual, and concerns about the validity of dissociative amnesia have been raised (Pope et al., 1998). Some researchers characterize it as lacking empirical support (McNally, 2003).

  • A notable spike in scientific publications regarding dissociative amnesia occurred during the 1980s, peaking in the mid-1990s, followed by a decline by 2003. By then, only 13 cases of dissociative amnesia were documented worldwide (Pope et al., 2006).

  • Historical research indicates that there were no recorded descriptions of individuals exhibiting dissociative amnesia after trauma prior to the year 1800 (Pope et al., 2006).

  • A psychiatric outpatient study found that nearly 10% of subjects met the criteria for dissociative amnesia, suggesting potential underdiagnosis in clinical environments (Foote et al., 2006).

Depersonalization/Derealization Disorder

Depersonalization/Derealization Disorder features recurring episodes of depersonalization, derealization, or both.

Definitions

  • Depersonalization: This is defined as feelings of unreality or detachment from, or unfamiliarity with, one's entire self or certain aspects of the self (APA, 2013, p. 302). Individuals might feel:

    • Their thoughts and feelings are not their own.

    • Robotic, lacking control over their speech or movements.

    • A distorted sense of time.

    • Out-of-body experiences.

  • Derealization: Conceptualized as a sense of unreality or detachment from the world, which may include people, objects, or surroundings (APA, 2013, p. 303). Symptoms may manifest as:

    • A feeling of being in a fog or a dream.

    • The surrounding world seeming artificial or unreal.

Clinical Implications

Patients with depersonalization/derealization disorder often struggle to articulate their experiences and may believe they are losing their sanity.

The Post-Traumatic Model (PTM)

One primary interpretation of the origins of dissociative disorders suggests that they are a direct response to traumatic experiences. This framework is known as the Post-Traumatic Model (PTM).

Theoretical Framework

  • Post-Traumatic Model (PTM): This model posits that dissociative symptoms are mental strategies utilized to cope with or avoid the impacts of extremely aversive experiences.

  • Individuals may rely on dissociation as a defensive mechanism to escape from painful memories, leading to habitual responses that can be triggered even by minor stressors.

  • Pierre Janet (1899-1973) is noted for correlating dissociation with psychological trauma.

Empirical Debate

Despite its prominence, the PTM has been debated rigorously; notably, it does not explain the mechanism through which trauma produces dissociative symptoms. As a result, clinicians and researchers have sought alternative explanations related to sleep experiences and how they relate to dissociation.

Treatment of Dissociative Disorders

Common Treatment Approaches

The primary treatment for dissociative disorders typically involves psychotherapy, which concentrates on addressing the dissociative psychopathology as well as the associated trauma or stressors. Various forms of psychotherapy can include:

  • Psychodynamic therapy

  • Cognitive-Behavioral therapy (CBT)

  • Supportive therapy

  • Hypnotherapy

  • Free association

  • Drug-assisted therapy

Treatment Strategies

  • Stability is critical during treatment to help mitigate disabling symptoms of dissociation. Early skill-building interventions are instrumental in assisting patients to cope with distressing feelings and traumatic recollections.

  • Recovery Time: Patients with dissociative amnesia or fugue usually recover swiftly—especially if the episode is short-lived—and may prevent symptoms with removal from triggering trauma or stressor.

  • Dissociative amnesia treatment aims to restore lost memories while therapy for dissociative fugue focuses on recovering memories of identity and pre-fugue events.

  • Common techniques for treatment include cognitive therapy, psychodynamic therapy, hypnotherapy, and drug-assisted interviews to facilitate memory recovery.

Pharmacological Considerations

The use of pharmacotherapy remains controversial in treating dissociative disorders, as most common medications (e.g., antidepressants, anxiolytics) are aimed at managing co-occurring anxiety and mood symptoms, rather than directly addressing dissociative symptoms. Currently, there are no medications validated to effectively reduce dissociation or produce positive outcomes, emphasizing the limitations in research and absence of definitive treatment guidelines.