Dissociative disorders.ppt

 Dissociative disorders
Course instructor : MS Aneeqa Kaiser
Department of Psychology
University of Lahore
Sargodha campus
© 2012 John Wiley & Sons, Inc. All rights reserved.

 Dissociative disorders are characterized by a
disruption or discontinuity
in the normal integration of consciousness,
memory, identity, emotion, perception, body
representation, motor control, and behavior.
Dissociative symptoms can potentially disrupt
every area of psychological functioning

Dissociation
• Some aspect of cognition or experience becomes
inaccessible to consciousness
 Avoidance response
Sudden disruption in the continuity of:
• Consciousness
• Emotions
• Motivation
• Memory
• Identity

Dissociative disorders usually develop as a
way to cope with trauma. The disorders most
often form in children subjected to long-term
physical, sexual or emotional abuse or, less
often, a home environment that's frightening
or highly unpredictable. The stress of war or
natural disasters also can bring on
dissociative disorders.

Personal identity is still forming during
childhood. So a child is more able than an
adult to step outside of himself or herself
and observe trauma as though it's happening
to a different person. A child who learns to
dissociate in order to endure an extended
period of youth may use this coping
mechanism in response to stressful
situations throughout life.

Risk factors
People who experience long-term physical,
sexual or emotional abuse during childhood are
at greatest risk of developing dissociative
disorders.
Children and adults who experience other
traumatic events, such as war, natural disasters,
kidnapping, torture, or extended, traumatic,
early-life medical procedures, also may develop
these conditions.
.

 Biologically, some people may have a greater tendency to
dissociate, or they may have organic problems in the
brain which makes it harder for them to integrate
(or associate, as opposed to dissociate) their
experiences.
 Young children’s brains are less mature than adults, and
they are more susceptible to develop a dissociative
personality because their sense of self and their
personality are not very cohesive — they are still
developing. They are less able than adults to cope with
and integrate traumatic experiences. So the younger a
person is when they experience trauma, the more likely
they are to develop a dissociative disorder.

 Children who lack emotional and social support are more
likely to develop trauma-related dissociative disorders. If
they are growing up in a toxic or neglectful family
environment where they are not supported to cope with
difficult feelings and situations, they are more likely to use
dissociation as a way of dealing with trauma. It is less
likely that they will be able to ‘integrate’ it into their
autobiographical narrative (the story of their life), if they
have neither the words to talk about it, nor anyone who is
willing to listen and to care for them in it. Traumatic
events are therefore likely to remain ‘out of mind’, or in
other words dissociated.

People with dissociative disorders are at
increased risk of complications and
associated disorders, such as:
Self-harm.
Suicidal thoughts and behavior.
Sexual dysfunction.
Alcoholism and drug use disorders.
Depression and anxiety disorders.
Post-traumatic stress disorder.
Personality disorders.

Inability to recall important personal
information
• Usually about a traumatic experience
• Not ordinary forgetting
• Not due to physical injury
• May last hours or years
• Note: Dissociative amnesia most often consists of
localized or selective amnesia for a
specific event or events; or generalized amnesia for
identity and life history

 The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas
of functioning.
 Localized amnesia, a failure to recall events during a limited
period of time, is the most common form of dissociative
amnesia. Localized amnesia may be broader than amnesia
for a single traumatic event (e.g., months or years
associated with child abuse or intense war). In selective
amnesia, the individual can recall some, but not all, of the
events during a limited period of time. Thus, the individual
may remember part of a traumatic event but not other parts.
Some individuals report both localized and selective
amnesias.

Generalized amnesia, a complete loss of
memory for one's life history, is rare.
Individuals with generalized amnesia may
forget personal identity. Some lose previous
knowledge about the world (i.e., semantic
knowledge) and can no longer access well-
learned skills (i.e., procedural knowledge).

Amnesia / flight and new identity
Sudden, unexpected travel with inability to
recall one’s past
• Assume new identity
 May involve new name, job, personality characteristics
• More often of brief duration

 Inability to remember important personal
information, usually of a traumatic or stressful
nature, that is too extensive to be ordinary
forgetfulness
 The amnesia is not explained by substances, or
by other medical or psychological conditions
 Specify dissociative fugue subtype if:
• the amnesia includes inability to recall one’s past,
confusion about identity, or assumption of a new identity,
and
• sudden, unexpected travel away from home or work

 Memory deficits in explicit but not implicit memory
 Explicit memory
• Involves conscious recall of experiences
 e.g.mom’s birthday party
 Implicit memory
• Underlies behaviors based on experiences that cannot be
consciously recalled
 e.g., playing tennis, writing a check

Prevelence
The 12-month prevalence for dissociative amnesia
among adults in a small U.S. community study was
1.8% (1.0% for males; 2.6% for females)
Suicide Risk
Suicidal and other self-destructive behaviors are
common in individuals with dissociative
amnesia. Suicidal behavior may be a particular risk
when the amnesia remit suddenly
and overwhelms the individual with intolerable
memories.
.

Perception of self is altered
• Triggered by stress or traumatic event
• No disturbance in memory
• No psychosis or loss of memory
• Often comorbid with anxiety, depression
• Typical onset in adolescence
• Chronic course

 Depersonalization
• Lose sense of self
• Unusual sensory experiences
 Limbs feel deformed or enlarged
 Voice sounds different or distant
• Feelings of detachment or disconnection
 Watching self from outside
 Floating above one’s body
 Derealization
• World has become unreal
 World appears strange, peculiar, foreign, dream-like
 Objects appear at times strangely diminished in size, at times flat
 Incapable of experiencing emotions
 Feeling as if they were dead, lifeless, mere robot or machine

 Depersonalization: Persistent or recurrent experiences of
detachment from one’s mental processes or body, as
though one is in a dream, despite intact reality testing, or
 Derealization: persistent or recurrent experiences of
unreality of surroundings
 Symptoms are not explained by substances, another
dissociative disorder, another psychological disorder, or
by a medical condition
• Note: Changes from DSM-IV-TR are italicized

Prevalance
Lifetime prevalence in U.S. and
non-U.S. countries is approximately 2%
(range of 0.8% to 2.8%). TÎie gender ratio for
the disorder is 1:1.

 Two or more distinct and fully developed personalities
(alters)
• Each has unique modes of being, thinking, feeling, acting,
memories, and relationships
• Primary alter may be unaware of existence of other alters
 Most severe of dissociative disorders
• Recovery may be less complete
 Typical onset in childhood
• Rarely diagnosed until adulthood
 More common in women than men
 Often comorbid with:
• PTSD, major depression, somatic symptoms
 Has no relation to schizophrenia
• No thought disorders or behavioral disorganization

 A. Disruption of identity characterized by two or more distinct
personality states (alters) or an experience of possession, as
evidenced by discontinuities in sense of self, cognition,
behavior, affect, perceptions, and/or memories. This disruption
may be observed by others or reported by the patient
 B. At least two of the alters recurrently take control of behavior
 C. Inability of at least one of the alters to recall important
personal information
 D. Symptoms are not part of a broadly accepted cultural or
religious practice, and are not due to drugs or a medical
condition
• Note: The DSM-IV-TR criterion A is less detailed. It specifies the presence of
two or more identities or personality states (each with its own relatively
enduring pattern of perceiving, relating to, and thinking about the
environment and self)

Prevalence
The 12-month prevalence of dissociative
identity disorder among adults in a small
U.S.community study was 1.5%. The
prevalence across genders in that study was
1.6% for males and 1.4% for females.

Posttraumatic Model
• DID results from severe psychological and/or sexual
abuse in childhood
Sociocognitive Model
• DID a form of role-play in suggestible individuals
 Occurs in response to prompt by therapists or media
 No conscious deception

 Evidence raised in theory debate
• DID can be role-played
 Hypnotized students prompted to reveal alters did so (Spanos,
Weekes, & Bertrand, 1985)
• DID patients show only partial implicit memory deficits
 Alters “share” memories (Huntjen et al., 2003)
• DID diagnosis differs by clinician
 A few clinicians diagnose the majority of DID cases
• For many, symptoms emerge after therapy begins

Most treatments involve:
• Empathic and supportive therapist
• Integration of alters into one fully functioning
individual
• Improvement of coping skills
Psychodynamic approach adds:
• Overcome repression
• Use of hypnosis
 Age regression

Psychotherapies such as cognitive behavioral
therapy (CBT).
Medications such as antidepressants can treat
symptoms of related conditions.

Dissociative disorders.ppt

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