Dissociative Disorders
Jan 18, 2016
Dissociative Disorders
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
Definition
According to Richard P. Kluft, Dissociative Identity Disorder “is a complex, chronic, posttraumatic dissociative psychopathology characterized by disturbances of memory and identity.”
QualificationsYears in Practice: 30+ Years School: Harvard Medical SchoolYear Graduated: 1968 License No. and State: MD-011120-E Pennsylvania
Dissociative Disorders
This is an extremely rare disorder.
It occurs to 1% of the general population, but recent 2012 statistics estimate an average of 7% that have not been diagnosed properly with the disorder.
History
キキ The first published description of Dissociative Identity Disorder was made by Petetain in 1787.
キキ In the 20th century, DID was put under the rubric of schizophrenia. Because of this the use of the diagnosis of DID dropped
significantly, and people almost stopped studying it
altogether.キ
History
キキ In the 1980’s, feminism really helped to bring back interest in DID.
キキ Most of what we know about DID come from studies made in 1980-1985. 1984 marked the beginning of annual international conferences on DID.
Between 1930 to 1960 the diagnosis was only 2 percent
Since it made it to DSM in 1980’s the reported cases has jumped to 20,000
Number of personalities mushroomed from 3 to 12 per patient
This disorder is unknown in Japan and India
DID Critics
DID Critics
Critics’ Arguments
1. Role-playing by people open to a therapist’s suggestion.
2. Learned response that reinforces reductions in anxiety.
When is Dissociation a problem?
Loss of overall, integrative control Unable to access information Loss of a coherent sense of self
Causes
Traumatic experiences. Mainly experienced during childhood.
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
Symptoms
One of the most common known symptoms are the different identities, also known as the “alters”.
What are the diagnostic criteria for Dissociative Amnesia?
• Cannot recall important personal information—usually of a traumatic or stressful nature—and too extensive to be explained by ORDINARY FORGETFULLNESS
• Not due to– Dissociative Identity Disorder– Dissociative Fugue– Somatization Disorder– Posttraumatic Stress Disorder– Acute Stress Disorder– Substance use– Neurological or General Medical Condition
• Causes significant impairment in social or occupational functioning
Other Specified Dissociative Disorder
Establishes itself securely during early childhood, and is thought to be caused by child abuse, that resulted in a lack of a secure attachment with a primary caregiver.
An absence of secure attachment in childhood, among repeated abuse, eventually resulted in an accumulation of unresolved trauma, causing structural dissociation
Dissociative Disorders
Types of Dissociative Disorders
Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder Depersonalization Disorder
Dissociative Amnesia
Partial or total forgetting of past experience without a biological cause
Almost always anterograde – blocking out a period of time after psychogenic cause (e.g. stress / trauma)
Memory loss is often selective Relative indifference to loss of memory Remain well oriented to time and place
Dissociative Amnesia
Impairment is reversible and usually reported retrospectively (in past tense).
Types of disturbance: Localized – affects a few hours around a
traumatic event. Selective – affects some but not all events
during a period of time, or some categories. Generalized – affects entire past. Continuous – a specific time up to the present
Dissociative Fugue
Amnesia + sudden, unexpected trip away from home
Often involves the creation of a new identity
Fugue state usually ends abruptly – then amnesic for events during the fugue
Dissociative Identity Disorder
Sense of self, or personality breaks up into two or more distinct identities which take turns “controlling” behavior
At least one “personality” is amnesic for the experiences of the others
“Alter” often coconscious with the host
Dissociative Identity Disorder
Identities are often polarized Often each identity specializes in
different areas of functioning, encapsulates different memories
Very high proportion report significant trauma in childhood – possible strategy that children use to distance themselves from trauma
Controversy re. cause of DID
Faking - malingering Induced by therapy - iatrogenic Social Role Hypnotizability “False Memory Syndrome”
Depersonalization Disorder
Disruption in identity without amnesia Sense of strangeness or unreality in
oneself Derealization Reduced emotional responsiveness
How can you keep these patients straight?
Memory loss?Memory loss?YeYess
NoNo
Travel to Travel to another place?another place?
Altered senseAltered senseof self or reality?of self or reality?
DepersonalizationDepersonalizationDisorderDisorder
YeYess
NoNo
DissociativeDissociativeFugueFugue
Evidence ofEvidence ofmore thanmore than
one identity?one identity?
YeYess
NoNo
DissociativeDissociativeIdentity DisorderIdentity Disorder
DissociativeDissociativeAmnesiaAmnesia
YeYess
Dissociative Disorders 2
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
Historical Roots
Hysteria: “wandering uterus” physical symptoms without a known cause term dates back to Hippocrates and
Egyptians
Neurosis: emotional distress due to underlying unconscious conflicts, anxiety, and implementation of defense mechanisms
The Evolution of the Concept
Three Theorist Pierre Janet
One or more automatisms could split off from the rest, thus functioning outside of awareness, independent of voluntary control or both.
Neodissociation (Hilgard) Links within the brain would be disrupted or isolated
from phenomenal awareness and the experience of intentionality.
Woody and Bowers The phenomena of dissociation reflect the failure of
these modules (i.e., conscious & unconscious) to be integrated at higher levels of the system.
Dissociation is a natural state, to some degree.
When is Dissociation a problem?
Loss of overall, integrative control Unable to access information Loss of a coherent sense of self
Dissociative Amnesia
Person is unable to recall important personal information Usually related to a
traumatic or stressful event
Variations Generalized Localized Selective
24
Dissociative Fugue
Person suddenly leaves home and work and assumes a new identity Usually triggered by
stress or trauma
Depersonalization Disorder
Person’s perception or experience of the self is disconcertingly and disruptively altered Frequent episodes Reality does remain
intact during episodes No amnesia or new
identities
Defenses..
Frequently used in all dissociative disorders
Repression: Disturbing impulses are blocked from
consciousness Denial: external reality is ignored Dissociation: Separation & independent functioning of 1 group of
mental processes from others-(mental contents exist in parallel consciousness)
How Do Therapists Help Individuals With DID?
How Do Therapists Help Individuals With DID?
How Do Therapists Help Individuals With DID?
Quiz
True/False
1) Dissociative Identity Disorder is directly related to Schizophrenia.
Quiz
True/False
1) Dissociative Identity Disorder is directly related to Schizophrenia.
False: Schizophrenia is mainly characterized by hearing or seeing things that aren't real (hallucinations) and thinking or believing things with no basis in reality (delusions).
Quiz
True/False
2) One of the symptoms of DID is known as an “alter”.
Quiz
True/False
2) One of the symptoms of DID is known as an “alter”.
True
Quiz
True/False
3) Every one of us has experienced some mild form of dissociation.
Quiz
True/False
3) Every one of us has experienced some mild form of dissociation.
True
Quiz
Multiple Choice
1) Which of the following are NOT symptoms of DID?
a) mood swings
b) suicidal tendencies
c) eating disorders
d) hallucinations
Quiz
Multiple Choice
1) Which of the following are NOT symptoms of DID?
a) mood swings
b) suicidal tendencies
c) eating disorders
d) hallucinations
Quiz
Multiple Choice
2) Which of the following is a known treatment for DID?
a) psychotherapy
b) medication
c) hypnotherapy
d) all of the above
Quiz
Multiple Choice
2) Which of the following is a known treatment for DID?
a) psychotherapy
b) medication
c) hypnotherapy
d) all of the above
Quiz
Multiple Choice
3) Which of the following symptoms does NOT distinguish DID from other mental disorders?
a) delusions
b) memory disruption
c) separate identities
d) amnesia
Quiz
Multiple Choice
3) Which of the following symptoms does NOT distinguish DID from other mental disorders?
a) delusions
b) memory disruption
c) separate identities
d) amnesia
Questions?