Dissociative Disorders Study Notes

Overview of Dissociative Disorders

  • Severe alterations or detachments from reality, representing a disruption in the usually integrated functions of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.

  • Affect identity, memory, or consciousness, potentially leading to a profound sense of unreality regarding one's self (depersonalization) or the world around them (derealization).

Examples of Situations Involving Dissociation

  • Consider situations where dissociation may happen in daily life, such as highway hypnosis during long drives, feeling detached during stressful events, or being completely absorbed in a book or movie, momentarily losing track of one's surroundings.

  • Reflect on whether dissociation may be beneficial and/or adaptive as a temporary coping mechanism, for instance, in highly traumatic situations where psychological escape can reduce immediate emotional pain.

Dissociative Identity Disorder (DID)
Definition and Characteristics of DID

  • Presence of two or more distinct and fully developed personalities known as alters, which are not merely different sides of a single personality but rather separate entities with their own unique patterns of relating to the world.

  • Each alter has unique modes of being, thinking, feeling, acting, memories, and relationships, often with differing ages, genders, vocabularies, and even physical abilities or responses (e.g., allergies).

  • The primary alter, often referred to as the "host," may be unaware of other alters' existence or actions, leading to significant gaps in memory or confusion.

  • Recognized as the most severe form of dissociative disorders due to the profound disruption in personal identity and continuity.

  • Recovery from DID may be less complete partly due to the entrenched nature of the dissociative states and the complexity of integrating multiple personality fragments.

Diagnostic Criteria for Dissociative Identity Disorder

A. Disruption of identity characterized by two or more distinct personality states, sometimes described in some cultures as an experience of possession.

  • This disruption is marked by a noticeable discontinuity in sense of self and sense of agency, involving alterations in affect (emotional expression), behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.

  • These symptoms may be observed by others (e.g., sudden shifts in demeanor or speech) or reported by the individual (e.g., feeling like an alien presence is controlling their body).

B. Recurrent gaps in the recall of everyday events, important personal information (e.g., one's own history, skills), and/or traumatic events that are inconsistent with ordinary forgetting.

  • These gaps can range from everyday forgetfulness (e.g., not remembering driving somewhere) to profound amnesia for significant life events or skills.

C. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, such as difficulty maintaining relationships, holding a job, or performing daily tasks.

D. The disturbance is not a normal part of a broadly accepted cultural or religious practice (e.g., temporary trance states during religious ceremonies).

  • Note: In children, symptoms are not attributed to imaginary playmates or other fantasy play, which are normal developmental behaviors.

E. Symptoms are not due to physiological effects of a substance (e.g., blackouts from alcohol intoxication or drug use) or another medical condition (e.g., complex partial seizures or other neurological conditions).

  • Reference: American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

Epidemiology and Demographics

  • Rare Disorder through clinical diagnosis, though community prevalence may suggest it is more common than typically recognized.

  • Prevalence: Approximately 1.5\% in the general population across various studies.

  • Typical onset: Usually in childhood, often as a coping mechanism for severe trauma, but rarely diagnosed until adulthood due to the complexity of symptoms and potential misdiagnosis as other conditions (e.g., schizophrenia, borderline personality disorder).

  • More prevalent in women than men, possibly due to higher rates of reported childhood abuse in women or differences in symptom presentation.

  • Not related to schizophrenia and shows no thought disorders or behavioral disorganization characteristic of psychotic disorders.

Models of Etiology for DID

  1. Posttraumatic Model

    • Results from severe, chronic psychological and/or sexual abuse in childhood, often before the age of 9. The child dissociates as a defense mechanism to cope with unbearable pain, creating separate personality states to compartmentalize traumatic memories and emotions.

  2. Socio-cognitive Model

    • Describes it as a form of role-play in suggest