Disorders of
Dissociation
Assessment & Diagnosis
SW 593
Introduction
Dissociation refers to instances in which
the normally integrated aspects of
cognitive functioning are disrupted.
Consciousness
Memory
Identity
Perception
Dissociative symptoms might be present
in a number of other diagnoses (PTSD).
Dissociative Amnesia
Client has one or more episodes in
which they cannot remember important
personal information.
Forgotten material is too extensive to be
attributed to normal forgetfulness.
Material forgotten is of a traumatic or
stressful nature.
Symptoms must be associated with
distress or psychosocial impairment.
Dissociative Fugue
Also unable to recall some or all of their
personal history.
Sudden and unexpected travel that
removes the person from their
home/usual surroundings occurs.
Has some degree of confusion about
their identity and may actually assume a
new identity.
Dissociative Fugue
The episode may not be part of
Dissociative Identity Disorder or be a
result of substance abuse or some
general medical condition.
Significant distress and/psychosocial
impairment is experienced.
Dissociative Identity Disorder
Two or more distinct identities or
personalities are present and recurrently
take control of the individual’s behavior.
There is an inability to recall personal
information while the client is in at least
one of the distinct identities.
The situation is not due to substance
abuse or a general medical condition.
Dissociative Identity Disorder
Results in distress and/or psychosocial
impairment.
Formerly known as Multiple Personality
Disorder.
Clients will have a primary identity that carries
the individual’s legal name.
Each alternative frequently has a different name
and can vary from the primary identity in terms
of age, gender, knowledge, and affect.
Dissociative Identity Disorder
Each identity has an enduring pattern of
viewing and relating to the environment
and the self.
The primary and alternative identities
may or may not be aware of the
existence or experiences of one another.
Persons with this disorder may have
frequent gaps in memory for both recent
and remote events.
Depersonalization Disorder
Depersonalization is characterized by feeling
detached or estranged from one’s self.
Described as feeling outside the self as if
viewing a movie.
Reality testing must remain intact during the
episodes.
Brief instances of depersonalization are not
unusual or may be associated with another
mental disorder.
Depersonalization Disorder
Depersonalization is the major symptom
necessary in order to meet the
diagnostic criteria.
Causes distress and/or psychosocial
impairment.
Assessment
The first clue that a dissociative disorder
is occurring is “holes” or unaccounted
periods of time.
Careful history focused around times of
stress can be particularly informative.
Several psychometric instruments can
be utilized including:
Dissociation Questionnaire (DIS-Q)
Child Dissociative Checklist (CDC)
Cultural Considerations
Dissociative experiences, particularly
fugue-like states, may occur within a
number of cultural groups as an
accepted expression of cultural activities
or religious practices.
No clinical distress or psychosocial
impairment occurs.
Dissociative Identity Disorder is
diagnosed much more frequently in
women than men.
Cultural Considerations
Men with this disorder tend to have fewer
distinct identities.
In children, the data suggests that the
occurrence is more evenly distributed between
the sexes.
“Spells” are not diagnosable according to the
DSM.
Spells is a trance-like state in which the
individual may communicate with deceased
relatives.
Cultural Considerations
Another condition seen around the world
is that of “zar”.
Zar episodes are characterized by
persons appearing to be in a dissociative
state where they may shout, cry, laugh,
sing, or hit their heads against a wall.
The belief is that they are possessed by
a spirit, and the state is not considered
pathological.
Cultural Considerations
Scott (1999) suggests that persons
experiencing dissociative disorders are
individuals who are unable to resolve
past histories of childhood trauma, pain,
ritualized physical and sexual abuse.
