Dissociative Disorders
Introduction
• Dissociative disorders are characterized by a disruption of and/or
discontinuity
in the normal integration of;
• Consciousness
• Memory
• Identity
• Emotion
• Perception
• Body representation
• Motor control
• Behavior
• Dissociative symptoms can potentially disrupt every area of
psychological functioning.
Introduction Cont..
• Dissociative disorders are frequently found in the
aftermath of;
• Trauma
• Embarrassment
• Confusion about the symptoms or a desire
to hide them
Introduction Cont..
• Dissociative identity disorder
• Dissociative amnesia
• Depersonalization/derealization disorder
• Other specified dissociative disorder
• Unspecified dissociative disorder.
Etiology
Dissociative Amnesia
• Amnesia and Extreme Intrapsychic Conflict;
– the psychological environment is massively conflictual
– Pts experiences intolerable emotions of;
• Guilt
• Despair
• Rage
• Desperation
– This results from conflicts over unacceptable urges or
impulses eg
• Sexual
• Suicidal
• Violent compulsions
Etiology Cont..
Dissociative Amnesia
• Betrayal trauma
– Explains amnesia by the intensity of trauma and by the
extent that a negative event represents a betrayal by a
trusted, needed others
– This betrayal influences the way by which the event is
processed and remembered
Etiology Cont..
Depersonalization/derealization disorder
• Psychodynamic
– Disintegration of the EGO
– Affective response in defense of the EGO
– Painful and Conflictual impulses trigger this
• Traumatic Stress
– Stress
– Fatigue
• Neurobiological theories
– Depletion of L-tryptophan; a precusor of 5-HT
– Disorders in NMDA
Etiology Cont..
Dissociative Identity Disorder
• Early childhood trauma;
– Maltreatment
– Physical abuse
– Sexual abuse
Dissociative Identity Disorder
• Marked discontinuity in;
– sense of self
– sense of agency
– alterations in affect
– Behavior
– consciousness
– Memory
– Perception
– Cognition
– sensory-motor functioning
Dissociative Identity Disorder Cont..
• Recurrent gaps in the recall of everyday events, important
personal information, and/or traumatic events that are
inconsistent with ordinary forgetting
• The symptoms cause clinically significant distress or
impairment in social, occupational, or other important
areas of functioning
• The disturbance is not a normal part of a broadly accepted
cultural or religious practice
• R/O: SUD, and medical condition
Dissociative Amnesia
• An inability to recall important autobiographical information,
usually of a traumatic or stressful nature, that is inconsistent
with ordinary forgetting
Note: Dissociative amnesia most often consists of
localized or selective amnesia for a specific event or events; or
generalized amnesia for identity and life history
• The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning
• R/O: SUD, other medical condition or Mental disorders
Depersonalization/Derealization Disorder
• 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
• During the depersonalization or derealization experiences, reality testing remains
intact
• The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning
• R/O: SUD, other mental disorder
Treatments
• CBT
• Hypnosis
• Amobarbital, diazepam: DA
• Group therapy; DA
• SSRI; D/R Disorders, DID
• Mood stabilizers; D/R Disorders
• Psychodynamic
• Psychotherapy
• MAO, B-Blockers, antipsychotics; DID
• ECT: DID
