brief description on Dissociation disorder

1. DISSOCIATIVE DISORDERS

2. INTRODUCTION
• Categorized by a disruption
or/and discontinuity in the
normal integration of
consciousness, memory,
identity, emotion, perception,
body representation, motor
control and behavior.

4. THIS CHAPTER
INCLUDES
• Dissociative identity disorder.
• Dissociative amnesia.
• Depersonalization/ derealization disorder.
• Other specified dissociative disorders.
• Other unspecified dissociative disorders.

5. DISSOCIATIVE
SYPTOMS
Intrusions into awareness and
behavior.
Inability to access information
or control mental function
that normally are accessible
and controllable.

6. INFLUENCED
BY TRAUMA
Frequently found in the aftermath
of trauma.
Influenced by proximity to the
trauma. (including embarrassment
and confusion about the
symptoms or a desire to hide
them).

7. IN DSM-5
• They are placed next to, but are not part of, the
trauma and stressor related disorders.
• Both acute stress disorder and
posttraumatic stress disorder contain its
symptoms.
• Flashback, numbing and
depersonalization/derealization.

9. DEPERSONALIZATION/DEREALIZATION
DISORDER
• Characterized by clinically significant:
o Depersonalization (experiences of unreality from one's self).
o Derealization (experience of unreality from one's surroundings).
• Accompanied by intact reality testing.
• No evidence of any distinction.
• Individuals can have depersonalization, derealization or both.

10. DISSOCIATIVE AMNESIA
• Inability to recall auto-biographical information.
o Localized
o Selective
o Generalized
• Individuals are usually unaware.
• "AMNESIA FOR THEIR AMNESIA"

11. DISSOCIATIVE IDENTITY DISORDER
• Presence of two or more personality states.
• Episodes of amnesia.
• Individuals experience discontinuities in identities and
memory.

12. OTHER SPECIFIED AND UNSPECIFIED
DISSOCIATIVE DISORDER
• That approach, but fall short of, the diagnostic criteria for dissociative identity
disorder.
• SPECIFIED: Clinician chooses to communicate the reason that the presentation
doesn't meet the criteria for any specific dissociative disorder.
• UNSPECIFIED: Clinician chooses not to specify the reason that the criteria are
not met for a specific dissociative disorder.

13. DISSOCIATIVE IDENTITY
DISORDER

14. DIAGNOSTIC CRITERIA
A. Two or more distinct personality states. Alterations in affect,
behavior, consciousness, memory, perception, cognition, motor-
functioning.
B. Gaps in recall.
C. Clinically significant distress, social impairment.
D. Not a normal part of culture or religion.
E. Not physiological.

15. DEVELOPMENT AND
COURSE
• Overwhelming experiences,
traumatic events and/or
abuse in childhood.
• Dissociation in children,
memory, concentration, attachment.
• During adolescence may just appear:
adolescent turmoil.

16. PREVALENCE
• 12 months prevalence
• In adults in a US community was 1.5%.
o1.6% for males.
o1.4% for females.

17. RISK AND PROGNOSTIC FACTORS
RISK FACTORS POOR PROGNOSIS
• Interpersonal physical
and sexual abuse.
• Childhood medical
surgical procedures.
• War.
• Childhood prostitution.
• Terrorism.
• Ongoing abuse
• Later-life traumatization.
• Comorbidity with mental
disorder.
• Severe medical illness.
• Delay in proper treatment.

18. CULTURE RELATED DIAGNOSTIC ISSUES
• Medically unexplainable neurological symptoms:
o Non-epileptic seizures.
o Paralysis.
o Sensory-loss
• Where normative possession is common.
• Acculturation.
• Difference between possession-form DID and culturally accepted
possession.

19. GENDER RELATED DIAGNOSTIC ISSUES
Females with DID predominate in adult clinical settings.
Adult males deny their symptoms and histories.
Females present more acute dissociative states.
Males exhibit more violent behavior.

20. SUICIDE RISK
• 70% have attempted.
• Other self-injurious behavior.
• Maybe complicated when:
oThere's amnesia
oPresenting identity isn't suicidal.

21. FUNCTIONAL CONSEQUESCES
• The damage varies from minimal to profound.
• Symptoms may impair their relational, marital, family,
parenting functions more than
• Their occupational and professional life.
• With appropriate treatment:
o Many show marked improvement.
o Some remain highly impaired.

22. DIFFERENTIAL DISGNOSIS
• Major depressive disorder.
• Bipolar disorder.
• Posttraumatic stress disorder
• Psychotic disorders.
• Substance induced disorders.
• Personality disorders.
• Seizure disorders.

23. COMORBIDITY
• Many present with comorbidity.
• Most develop:
o PTSD
o Depressive disorders
o Trauma and stress related disorders.
o Eating disorders
o OCD
o Sleep disorders.

24. THANK YOU FOR
LISTENING :)