Dissociative Disorders
Dr. MAHASIN KHALIFA
MBBS KU FM Sudan
Clinical MD Psychiatry SMSB
Consultant Psychiatrist –Alfashir
Teaching Hospital
Assistant Professor of Psychiatry FU
Definition
characterized by a disruption of and/or discontinuity
in the normal integration of consciousness, memory,
identity, emotion, perception, body representation,
motor control, and behavior. It includes:
Dissociative identity disorder
Dissociative amnesia
Depersonalization/derealization disorder
Other specified dissociative disorder,
Unspecified dissociative disorder.
Dissociative Identity Disorder
previously called multiple personality disorder
Characterized by the presence of two or more
distinct identities or personality states
Personalities take control of the individual's
behavior
Accompanied by an inability to recall important
personal information
The identities or personality states, sometimes
called alters, self-states, alter identities
Diagnostic Criteria
A. Disruption of identity characterized by two or
more distinct personality states
The disruption in identity involves marked
discontinuity in sense of self accompanied by related
alterations in affect, behavior, consciousness,
memory, perception, cognition, and/or sensory-
motor functioning.
These signs and symptoms may be observed
by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events,
important personal information and
or traumatic events that are inconsistent with
ordinary forgetting
C. The symptoms cause clinically significant
distress or impairment in social, occupational,
or other important areas of functioning
D. The disturbance is not a normal part of a
broadly accepted cultural or religious practice
E. The symptoms are not due to the physiological
effects of a substance
Over 70% of outpatients with the diosorder have
attempted suicide.
Dissociative Amnesia
an inability to recall important personal information,
usually of a traumatic or stressful nature,it could be;
localized –losses all memory within a period of time (most
common)
selective- remember some but not all
generalized- may forget identity
Continuous- unlike others there is not an end
Interference is primarily with episodic memory (ones
autobiographical memory) while semantic memory (facts)
remains intact
Diagnostic Criteria
• A. An inability to recall important autobiographical
information, usually of a traumatic or stressful nature,
B. The symptoms cause clinically significant distress or
impairment in social, occupational functioning.
C. The disturbance is not attributable to the physiological
effects of a substance or a neurological or other medical
condition or other neurological condition).
D. The disturbance is not better explained by dissociative
identity disorder, posttraumatic
stress disorder, acute stress disorder, somatic symptom
disorder.
Dissociative Fugue
Forget personal details, identity, and flee to an
entirely new location
Tend to end abruptly
Majority regain most of memories without a
recurrence
Must face consequences of their fugue
Illegal or violent activity etc…
Depersonalization/Dereallzation
Disorder
A. The presence of persistent or recurrent experiences
of depersonalization ,derealization or both,
1. Depersonalization: Experiences of unreality,
detachment, or being an outside observer with respect
to one’s thoughts, feelings, sensations, body, or
actions
2. Derealization: Experiences of unreality or
detachment with respect to surroundings
B. During the depersonalization or derealization
experiences, reality testing remains intact.
C. The symptoms cause clinically significant
distress or impairment in social, occupational,
functioning.
D. The disturbance is not attributable to the
physiological effects of a substance or another
medical condition
E. The disturbance is not better explained by
another mental disorder
Treatments for Dissociative
Amnesia and Fugues
Psychodynamic therapy
Hypnotic therapy
Drug therapy
Sodium pentobarbital (“truth serums”).
Medication decreases inhibitions making recall
more likely but may forget again upon awake.
All focus on uncovering memories
Treatment of Dissociative
Disorder
Three Major Goals
1) Help recognize fully the nature of their
disorder
2) Recover gaps in their memory
3) Integrate their personalities into one
functioning personality
Fusion- final merging of 2 or more alters
Goal is integration
Help each alter to understand they are
part of one person
Use alters names for convenience not to
confirm existence of separate autonomy
All alters should be treated with fairness
Encourage empathy amongst the alters
Gentleness and supportiveness are
needed in consideration of childhood
traumas
