Dissociative Disorders
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Dissociative Disorders Presentation Transcript

  • 1. Dissociative Disorders Theodore M. Godlaski College of Social Work University of Kentucky
  • 2. Things to Keep in Mind
    • Dissociative states are not uncommon or, in themselves, pathological
      • In some cultures they are sought after and valued
      • They have been a part of religious ritual and spiritual practice
      • They are only considered disordered when they lead to significant impairment or distress.
  • 3. Things to Keep in Mind
    • At the base of all these disorders is the human ability to mentally and emotionally separate oneself from painful or traumatic experience.
    • This is accomplished by simply forgetting that the event ever occurred or by believing that it occurred to someone else.
    • Individuals who suffer from Dissociative Disorders share the common feature of being highly suggestible.
  • 4.  
  • 5. Some General Considerations
    • The four diagnoses are hierarchical and only one can be used at any given time
      • Dissociative Identity Disorder
      • Dissociative Fugue
      • Dissociative Amnesia
      • Depersonalization Disorder
  • 6. Dissociative Amnesia
    • This is perhaps the best known of these disorders due to “recovered memories” of childhood sexual abuse forming the basis for numerous prosecutions and law suits in recent years.
    • There is serious debate about the validity of such “recovered memories”
  • 7. Dissociative Amnesia
    • The predominant disturbance is one or more episodes of inability to recall important personal information, usually of a term addict or stressful nature, that is too extensive to be explained by ordinary forgetfulness.
    • The disturbance does not occur exclusively during the course of Dissociative Identity Disorder, Dissociative Fugue, Post-Traumatic Stress Disorder, Acute Stress Disorder, or Somatization Disorder and is not due to the direct physiologic effect of a substance or to a neurological or other general medical condition.
    • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • 8. Dissociative Amnesia
    • Most clinicians are cautious about using this diagnosis for lost childhood memories in adults and reserve it for inability to remember recent events.
    • Individuals experiencing it seem remarkably undistressed by their inability to remember.
    • In most cases memories returned, at first in fragmented form, over a relatively brief period of time.
  • 9. Dissociative Fugue
    • This disorder is extremely rare and most clinicians have never encountered an actual case.
    • In assessing an apparent case careful evaluation should look at the possibility of delirium, dementia, or substance intoxication.
    • This disorder tends to occur primarily in men who have been experiencing high levels of distress arising primarily from conflicts in personal and professional identity.
    • The disorder has also been observed in natural disasters and military combat.
  • 10. Dissociative Fugue
    • The predominant disturbance is sudden, unexpected travel away from home or once customary place of work, with inability to recall one's past.
    • Confusion about personal identity or assumption of a new identity.
    • The disturbance does not occur exclusively during the course of Dissociative Identity Disorder and is not due to direct physiologic effects of a substance or a general medical condition.
    • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • 11. Dissociative Identity Disorder
    • This disorder enjoyed some notoriety during the Victorian era and once again came to prominence in the late 20th century.
    • It was formerly referred to as Multiple Personality Disorder.
    • It is a rare disorder in which the individual appears to have more than one identity, or personality.
    • Often the predominant personality is completely oblivious to alternate identities, while some alternate personalities or identities have access to the memories of the predominant identity.
  • 12. Dissociative Identity Disorder
    • The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
    • At least two of these identities or personality states were currently take control of the person's behavior.
    • Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
    • The disturbance is not due to the direct physiological effects of a substance or a general medical condition. Note: in children the symptoms are not attributable to an imaginary playmates or other fantasy play
  • 13. Dissociative Identity Disorder
    • Generally individuals who have this disorder are identified initially because they complained of having lost periods of time during which they apparently were doing something but have no recollection of what.
    • Long-term psychotherapy is the treatment of choice.
    • Therapy consists in attempt to uncover trauma which may underlie the establishment of alter identities and the reintegration of these alternative personalities are identities into the predominant identity.
  • 14. Depersonalization Disorder
    • Depersonalization is a surprisingly common experience especially among younger males.
    • Approximately 30% of individuals that had one or more episodes of depersonalization in their lifetimes.
    • Episodes of depersonalization usually become less frequent or disappear as the individual gets older.
    • The disorder is rarely diagnosed, however, because depersonalization is often considered either not pathological or part of another diagnosis.
  • 15. Depersonalization Disorder
    • Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream).
    • During the depersonalization experience, reality testing remains intact.
    • The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • The depersonalization experience does not occur exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder, Acute Stress Disorder, or other Dissociative Disorder, and is not due to the direct physiologic effects of a substance or a general medical condition.
  • 16. Depersonalization Disorder
    • Onset of this disorder usually occurs between the ages of 15 and 30 and has been noted in children as young as 10 years of age.
    • The course of the disease is generally chronic and stable.
    • Depersonalization Disorder is notoriously refractory to both psychotherapy and chemotherapy.