Dissociative

Disorders
Dissociation

 A disruption in the normally integrated

functions of identity, consciousness, memory,
and perception
 Not due to the effects of a substance or a
general medical condition
 Results in amnesia, depersonalization,
and/or multiple personalities in the same
individual
 Common Dissociative Experiences in
Everyday Life
 Daydreaming
 Missing parts of conversations
 Vivid fantasizing
 Forgetting part of drive home
 Calling one number when intending to call another
 Driving to one place when intending to drive elsewhere
 Reading an entire page & not knowing what you read
 Not sure whether you’ve done something or only thought
about doing it
 Seeing oneself as if looking at another person
 Remembering the past so vividly you seem to be reliving it
 Not sure if an event happened or was just a dream
Possible Causes of
Dissociation
 Fatigue
 Sleep deprivation
 Stress
 Binge drinking
 Drug use
 Confronting a new environment
 Feeling preoccupied or conflicted
 Engaging in certain religious or cultural rituals
or events
Making a Diagnosis
 Dissociative symptoms are only concerning when they become
chronic and defining features of people’s lives

 Quantity (frequency) & quality of dissociative experiences

 Cultural influences – are dissociative states accepted as part of
religious or social experiences in a culture?
 Mood swings or changes
Differential diagnosis

 Substance Intoxication
 Psychosis
 Depression
 Personality Disorders
 Malingering
Dissociative Amnesia

 This disorder is characterized by a blocking

out of critical personal information, usually of
a traumatic or stressful nature because of
emotional conflicts or external stressors.

 The onset is sudden.

Types of Amnesia
 Anterograde amnesia: the inability to form new
memories after the condition producing the amnesia
occurred; dissociative amnesia seldom involves
anterograde amnesia
 Retrograde amnesia: loss of memory for events that
occurred before the onset of the amnesia and the
condition that caused it; dissociative amnesia usually
involves retrograde amnesia for personal, rather than
general, info
 Psychogenic Amnesia: amnesia due to a traumatic or
extremely stressful event(s)
 Organic Amnesia: brain injury due to disease, drugs,
accident, or surgery
Dissociative Amnesia:
Diagnostic Criteria
 1 or more episodes of an inability to recall
important personal information
 Can’t be attributed to ordinary forgetfulness
 Gaps in memory are most commonly
related to a traumatic or extremely stressful
event(s)
Patterns of Dissociative
Amnesia
 Localized: inability to remember all events occurring during
a circumscribed period of time
 Selective: inability to remember specific events occurring
during a circumscribed period of time
 Generalized: loss of memory encompasses everything,
including one’s identity
 Continuous: occurs when patients have no memory of
events up to and including the present time. This means
that patients are alert and aware of their surroundings but
are not able to remember anything.
 Systematized: inability to recall memories related to a
certain category of information, e.g. memories related to
an individual’s father
Etiology of Dissociative
Amnesia
 Typically occurs following traumatic events:
 May involve motivated forgetting of traumatic
events
 Poor storage of information during traumatic
events due to overarousal
 Avoidance of emotions during traumatic
events, as well as emotional reactions to the
events afterward
 Dissociation during traumatic events
 Extreme life stress in the present
Treatment for Dissociative
Amnesia
 Goals:
 Help the person to remember forgotten or traumatic

events in a controlled way & to accept & integrate them

 Resolve distressing situations

 Strengthen coping skills

 Interventions:
 Involvement of family member/significant other to

remember what happened

 Hypnosis
 Dissociative Fugue:
Symptoms & Characteristics
 Person suddenly moves away from home and
assumes a new identity, with little or no memory of
one’s previous identity or past
 A person travels away from home abruptly and
unexpectedly
 Is unable to recall some or all of his/her past
 Is confused about his/her identity (some
disintegration of identity)
 May assume a partially or completely new identity
 May seem “normal” to people who don’t know him/her
previously
 Prevalence: very rare – 0.2%
Etiology of Dissociative
Fugue
 Stressor or traumatic event (most common):
person may be physically and mentally
escaping a threatening environment or
intolerable situation

 Chronic stress

 Depression
Treatment of Dissociative
Fugue
 Fugue states usually end rather abruptly on
their own
 Following the episode, person may or may
not recall events that took place during the
fugue
 Supportive psychotherapy to help person
identify & resolve stressors leading to fugue
state and to learn better coping skills, so that
fugue does not happen again
Depersonalization Disorder:
Characteristics
 1 or more episodes of depersonalization
 Depersonalization: feeling detached or
estranged from your thoughts or body; e.g.
feeling like an outside observer, a robot; feeling
like you’re in a dream, watching a movie
 Derealization: lose sense of external world; e.g.
people seem mechanical or dead; things seem
dreamlike, or seem to change size &/or shape
 Reality testing remains intact during periods of
depersonalization
Depersonalization Disorder

 Occasional experiences of depersonalization are

common – ½ of all adults have a single brief
episode of depersonalization

 Must be so severe, persistent, and frequent that

they cause significant distress or impairment in
functioning
Depersonalization Disorder:
Research Findings
 Very little is known about this disorder and its
treatment
 50% have additional anxiety and mood disorders
 Demonstrated cognitive deficits on measures of
attention, short-term memory, and spatial
reasoning
 Demonstrated deficits in emotional responding:
tendency to inhibit emotional expression;
dysregulation in the HPA axis
Dissociative Identity Disorder:
Diagnostic Criteria
 This condition, formerly known as multiple personality
disorder, is characterized by "switching" to alternate
identities when under stress.
 Caused by severe childhood trauma and severe sexual
abuse
 The onset is insidious
Dissociative Identity Disorder:
Characteristics
 2 or more distinct identities or personalities (alters), each
with its own pattern of perceiving, relating, and thinking, as
well as unique behaviors, memories, relationships, and
personal History
 Alters are often unaware of each other
 Transitions between alters (switches) are usually abrupt &
are often triggered by stress or external cues
 Self-mutilation, post traumatic stress, conversion
symptoms, & suicidal behaviors are common
 The alters may even differ in "physical" properties such as
allergies, right-or-left handedness, or the need for
eyeglass prescriptions. These differences between alters
are often quite striking.
DID: Facts & Figures
 Prevalence: 0.5% -1.0% in nonclinical samples; 3-6% of
severely disturbed inpatients
 Onset: almost always in childhood
 Gender Differences:
 3-9 more frequent in women

 Women tend to have more identities than men (15 vs. 8)

 Course: tends to last a lifetime in the absence of Treat

 High incidence of comorbid psychological disorders, e.g.
substance abuse, depression, anxiety, eating disorders,
borderline personality disorder
 Age: frequency of switching may decrease with age
 Biological Correlates: demonstrated changes in optical
functioning in alter identities
Etiology of DID
 Alters are created under conditions of extreme
childhood trauma, e.g. severe physical or sexual
abuse
 Dissociation represents a natural tendency to escape
from unbearable emotional or physical pain, a
defense against extreme trauma
 Personality characteristics: suggestible, imaginative
 Lack of social support during or after the abuse
 Chaotic, non-supportive family environment
 Developmental window of vulnerability for DID closes
at approximately 9 years of age
Treatment of DID
 Goal: to integrate the alters into 1 coherent personality
 Identify each personality, and its function, roles, &
concerns
 Negotiate with personalities to fuse into 1 personality
 Trauma work: identify cues/triggers that provoke memories
of trauma &/or dissociation; neutralize emotional charge
the memories hold via desensitization; reliving/re-
experiencing
 Help person develop adaptive strategies for dealing with
stress
 Use of hypnosis is common, but controversial
 Usually long term psychotherapy is indicated
 Antidepressants & antianxiety drugs may be used
 Do no harm! Don’t encourage disintegration!
DID: continued

 People with this disorder is above average

intelligence and highly creative

 Famous people
Lindsey Lohan
Britney Spears
Courtney Love
 Other specified dissociative disorder

Dissociative trance

 Unspecified Dissociative Disorder