DISSOCIATIVE
DISORDER
DISSOCIATION???
‘Dissociation is one type of defense
mechanism whereby the person will
be protected from traumatic events
by allowing the mind to forget or
remove itself from painful situation
or memory’.
DISSOCIATIVE DISORDER
Dissociative disorders are a
disturbance in the ordinarily
organized functions of the
conscious awareness, memory and
identity
TYPES OF DISSOCIATIVE
DISORDERS
Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder or Multiple
Personality Disorder
Trance and possession disorder
Other dissociative disorders
INCIDENCE
Common in women and among first
degree biological relatives
In adolescence or early adulthood,
but any age it can occur.
ETIOLOGY
PSYCHODYNAMIC THEORY
The ego defense mechanism
involved are repression,
dissociation and conversion.
Individual does not have to face
the unacceptable wish.
Symptoms are related to the
ETIOLOGY
BEHAVIOR THEORY
The symptoms are learnt from
surrounding environment
Symptoms bring psychological relief
by avoidance of stress.
It is more common in person with
histrionic personality trait.
ETIOLOGY
Psychological stress or conflicts or
frustrations
Childhood trauma or sexual abuse
Lack of attachment
Drug abuse (like alcohol, barbiturates,
benzodiazepines, hallucinogen).
Traumatic life events-rape, kidnapping,
abuse, threats of death, physical
violence
witness to violence
PSYCHODYNAMICS
The disturbance is not under
voluntary control
Clients will benefit by both
Primary and Secondary gains
Primary gain is obtaining relief
from anxiety by keeping an
internal need or conflict out of
awareness
Secondary gain is support from the
environment that a person obtains
as a result of being sick
PSYCHODYNAMICS
Clients will suffer with more
number of problems in their
private life.
Absence of medical and
neurological abnormalities or
organic deformities
Amnesia related to a traumatic
event
Alteration in memory,
PSYCHODYNAMICS
Interrupted family processes related to
amnesia or other changing behavior.
Symptoms of depersonalization
Substance abuse
Dysfunction in usual patterns of
behavior
Feeling of absence of control over
memory, behavior, awareness
Unable to explain the actions or
behavior in altered state.
DISSOCIATIVE AMNESIA
Impairment of integration of memories
will occur, it is a form of psychogenic
amnesia, common form of dissociative
disorders.
It usually follows a trauma or stressful
life situation
Sudden inability to recall important
personal information particularly
concerning the stressful life events.
CLINICAL MANIFESTATION
Usually alert, a brief period of
disorganization or clouding of
consciousness
Sudden inability to recall important
personal information or loss of memory
of recent events
Depressive symptoms
Memories still exist, but are deeply
buried within the person's mind and
cannot be recalled
CLINICAL
MANIFESTATION
Depersonalization
Significant distress
Regression.
TYPES OF AMNESIA
GENERALIZED AMNESIA
LOCALIZED AMNESIA
SELECTIVE AMNESIA.
GENERALIZED AMNESIA
Unable to recall information about
their entire life time.
LOCALIZED AMNESIA
Unable to remember all events of a
circumscribed period (few hours to
few days), the loss of memory is
localized within a specific window of
time, e.g. death of a loved person
SELECTIVE AMNESIA.
The ability to remember some events
but not others for a short period, e.g.
remembering the stressful events but
not remembering the loss of people
during that specific stressful situation
DISSOCIATIVE FUGUE
It is characterized by a sudden
unexpected travel away from home or
work place with the assumption of new
identity and an inability to recall past.
New identity may be maintained for few
days, following recovery, they will not be
able to recollect the events that took
place during fugue and leads simple life
Onset is sudden, often in the presence of
severe stress
DISSOCIATIVE IDENTITY
DISORDER
A condition in which 2 or more
distinct identities or personality
states alternate in controlling the
patients consciousness and
behavior’.
In multiple personality disorder, the
person is dominated by 2 or more
personality of which only one is
manifest at a time.
One personality will not be
aware of the other personality
suddenly one form to other
form will change and the
behavior in each personality
will be contrast of other
CAUSES
An innate ability to dissociate
easily.
Repeated episodes of severe
physical or sexual abuse in
childhood
Lack of supportive or comforting
person
Influence of other relatives with
dissociative symptoms or
CAUSES
Absence of situational support
Intolerable terror-producing event.
Absence of adaptive coping ability
Intense anxiety
Negative role models
Rigid religious beliefs
Isolation from the community
MANIFESTATIONS
Inadequate defenses to handle the
intense anxiety
The sub personality learns to deal
with emotional feelings which will
overwhelm the primary personality.
When individual is facing with
anxiety producing situation, one of
the sub personality takes over to
protect the primary personality
from disintegration and
disorganization
MANIFESTATIONS
Usually the primary personality is
religious and moralistic
Sub personality are aggressive, pleasure
seeking.
Sometimes the dominance will be
changing, voice will have different
sounds and intelligence level varies
Transition from one personality to
another often occurs during time of
stress.
TRANCE AND
POSSESSION
DISORDERS
Very common in India
Temporary loss of both the sense
of personal identity and the full
awareness of the persons
surroundings.
Narrow attention
DEPERSONALIZATION
DISORDER
Depersonalization is a dissociative
symptom in which the patient feels
that his/her body is unreal, is
changing or is dissolving.
DISSOCIATIVE STUPOR
Aware of surroundings
Motionless and mute
Will not respond to stimulation
TREATMENT
Free association
Hypnosis
Abreaction therapy
Behavior therapy
