Dissociative Disorders

Dissociative Disorders

Splitting off of thoughts, feelings, or behaviors ordinarily connectedTemporary alteration in normally integrative functions of:

ConsciousnessIdentityMemory

Dissociation:

Historical DevelopmentPsychological DevelopmentInfluence of the timesSkepticism of MHPControversy

Historical Development

19 the CenturyHysterical Neurosis-Dissociative typeDerived from cultural factors of timeTheatricality, puritanical ethos which fostered repressionMechanism of defense/neurotic safeguard

Psychological Development

Janet: dissociation= split in consciousness

Result of of neuropsychological weakness

Freud: repression= unconscious thoughts used to ward off painful effects

Psychological over organic explanation

Psychological Development (cont’d)

Prince: different conscious states could co-exist without awareness

• Freud & Prince high influence on later researchers & theorists.

• Belief in split of conscious, not organic etiologies

• Disappearance explained by change in culture

Recent Trends

60’s: “me’ &“now” generation,shift to narcissistic ethos

Skepticism (confusion of lumping)DSM approach: diagnosis based on similarities of sign/symptoms rather than postulation

Core concept: Temporary disruption in memory, identity, or consciousness

May lead to amnesia, depersonalization or multiple personalities

Current Trends(last 20+ years)

Existence is rare Increase in # of cases

Resurgence of Interest: Inappropriate diagnosis

Split in MH Profession

Ex. I Never Promised You a Rose Garden

Normalcy of Disassociation

Not necessarily psychopathologyPhenomena may occur spontaneously

Can be soughtCan be induced for therapeutic purposes

Society supports & reinforces to some degreeRelated to phenomenon underlying hypnotizabilityContinuous rather than singular/discrete phenomenon

Commonplace Dissociative Events

DaydreamingAbsorption in reverieExamples:

Driving past one’s expressway exitNot hearing your name called by instructor3-yr old having imaginary playmate“Self” accepted by public; supported in literature & arts

Conflict, diversity, & disparity within self-structure is central to being human

As Pathological

When complex behavior takes place outside awareness of predominant consciousnessEtiologies usually functional or psychologicalCan be organic

Interferes with memory, identity, or consciousness

Etiologies

Periods of amnesia can be caused by

alcohol or substance intoxication

Head traumaTemporal lobe epilepsy/partial complex seizures

Synopsis of Dissociative DO

Dissociative AmnesiaOne or more episodes of inability to recall personal information.Traumatic or stressful nature, too extensive to be explained by ordinary forgetfulness.Extensive memory loss, but usually doesn’t travel from home.Transitional, usually no treatment.

Dissociative FugueSudden & unexpected (uncommon) travel from home or work; enabling recall of past, have confusion about personal identity, & may assume identity.“Exit” from personality, usually temporary.

Synopsis of Dissociative DO (cont’d)

Depersonalization DisorderRecurrent feelings of detachment from thoughts or body.Reality testing remains intact

Dissociative Disorder Not Otherwise Specified

Dissociative disoder present, but no specific criteria met

Dissociative Identity Disorder (DID)

Hallmark – failure to integrate identity, memory & consciousness2 or more distinct identities/personality states

with relatively enduring pattern of perceiving, relating to, & thinking a/O environment & self

Fluctuating clinical course tending toward chronicity & recurrence

Helpful Movies & Books

MoviesThree Faces of EveWhen Rabbits HowlsTrudy Chase StorySybil

BooksTry to Remember (Kotter)The First Sin of Ross Michael Carlson (Weissberg)SybilWhen Rabbit Howls