Dissociative Disorders

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Dissociative Disorders: Include

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dissociative identity disorder (DID), dissociative amnesia, depersonalization/derealization disorder, other specified dissociative disorder, and unspecified dissociative disorder.

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DID: Why does it develop?

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Dissociation initially arises as a defense against physical and emotional trauma and has the function of removing oneself from the pain of the traumatic experience.

commonly observed during adolescence or early adult life for individuals, if they have been abused as children.

associated with sexual abuse in children in over 90% of cases

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DID: Def and dx

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Dissociative identity disorder (DID) is defined as the presence of two or more distinct personalities or identity states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and the self

personalities are typically of a different sex than the client as well as different ages

There are additional essential features combined consider the DID diagnosis.

1. disruption in identity in terms of a sense of self and a sense of agency. At least two of the personalities recurrently take control of the person’s behavior. The disruption is evidenced by alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning

2. Criterion B states there are recurrent episodes of amnesia (gaps in memory of everyday activities, personal information and traumatic events) and are inconsistent with everyday memory.

3. Criterion D states that the disturbance is not attributable to cultural or religious practice

4. Criterion E states that the symptoms of DID are not attributable to the direct effects of a substance or general medical condition

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DID: Assessment

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The symptom of amnesia is the most common dissociative defense and occurs in dissociative amnesia, dissociative fugue (specifier), and dissociative identity disorder. Dissociative amnesia is characterized by the inability to recall information, most generally about stressful or traumatic events, and is the most common symptom of the dissociative disorders. DID Criterion A has been modified and now may be observed or reported and everyday gaps in memory may be a symptom

the mental health professional must determine the accuracy of the diagnosis and not confuse it with disorders which may have some similar characteristics, such as bi-polar disorder, intermittent explosive disorder, borderline personality disorder, schizophrenia, and post-traumatic stress disorder.

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DiD: Incidence

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reported numbers of DID patients has risen dramatically over the past 5 decades.

found that it takes an average of 6.8 years after first entry into the mental health system before the typical DID client is accurately diagnosed.

Although epidemiological data for these disorders are limited they seem to occur more often in women.

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DID: Instrumentation

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1. The Dissociative Disorders Interview Schedule

2. Structured Clinical Interview for DSM-IV Dissociative Disorders

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DID: Treatment

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Individual Psychology, Psychodynamic Psychotherapy, Hypnosis

*helping the client reduce reliance on dissociation by acquiring new, flexible, and adaptive coping resources

* identify and gain control over or rapport with one or more of the ‘persecutor’ personalities to prevent ‘them’ from sabotaging the therapy.

* gain cooperation with the ‘protector’ personality (ies) in order to protect the ‘victim’ personality and counteract the persecutor(s).

* The goal of therapy, ideally, is ‘integration’ of all personality fragments, which is generally not achieved.

***Integration is more attainable

Integration: process of fusion between some personalitites and elimination of others possibly

(Cl have less relapseif they achieve and sustain integration)

Other considerations

-consistent and slow pace

-Therapists should know that Cl eagerness to purge toxic past traumatic memories can result in flooding of such experiences

-Therapist should encourage Cl to build coping resources before moving too quickly

-Therapist should be interested in Cl as a person

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Dissociative Amnesia (DA): Def, Sx

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a disturbance characterized by one or more episodes during which times individuals are unable to recall important personal information that isn’t explained by ordinary forgetfulness

. An individual with DA can be expected to report gaps, retrospectively, in his or her own personal history, frequently associated with one or more traumatic or stressful events

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Dissociative Fugue (DF): Def

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a specifier of dissociative amnesia and is a disturbance characterized by sudden, unexpected travel away from home with the inability to recall one’s past

accompanied by confusion about one’s identity or adopting a new identity

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Depersonalization/Derealization Disorder (DD)

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the essential features of depersonalization disorder are persistent or recurrent episodes depersonalization, derealization or both

The client’s symptoms are characterized by a feeling of detachment from one’s self (depersonalization)

or surroundings (derealization).

The individual may have the experience of feeling like an “automaton”, “living in a dream or movie” or feeling like an observer of one’s body or parts of one’s body. During these experiences, reality testing remains intact.