dissociation in clinical practice

1. DISSOCIATION IN CLINICAL PRACTICE
DR.EHAB ELBAZ
MBBcH, MSc.MD,MBA
CONSULTANT PSYCHIATRIST AT EGYPTIAN ARMED FORECES
LECTURER OF PSYCHIATRY, MILITARY MEDICAL ACADEMY
DIRECTOR OF PSYCHIATRY HOSPITAL, MAADI MILITARY MEDICAL COUMPOUND

2. Goal statement :
• To answer the following questions :
1. What is dissociation ?
2. What is the prevalence of dissociation and its disorders?
3. What are the types and continuum of dissociation ?
4. What are the neurobiological mechanisms of dissociation ?
5. What are the functions of dissociation?
6. How do psychological theories explain dissociation ?
7. What are the psychiatric disorders that contain dissociation as
a criterion for diagnosis in DSM 5 TR ?

3. What is dissociation ?
• Dissociative disorders are characterized by a
disruption of and/or discontinuity in the normal
integration of :
1. consciousness
2. memory
3. identity
4. emotion
5. perception
6. body representation
7. motor control
8. behavior.
(DSM 5, 2013)

4. The DSM-5 dissociative disorders (DD)
1) Dissociative Identity Disorder (DID);
2) Dissociative Amnesia (DA);*
3) Depersonalization/Derealization Disorder (DPDRD);
4) Other Specified Dissociative Disorders (OSDD);
5) Unspecified Dissociative Disorder (UDD).
• *In DSM-5 Dissociative Fugue (DF) is now a subtype of Dissociative Amnesia (DA), and not a
separate disorder.
• The DSM-5 diagnostic criteria for Posttraumatic Stress Disorder (PTSD) now include a Dissociative
Subtype (PTSD-DS).
• Dissociative amnesia as a symptom is a diagnostic criterion for both DID and for PTSD.
• In DSM-5, the DD section is specifically placed after the Trauma-and-Stressor Related Disorders to
show their relationship to traumatic experiences.

5. What is the prevalence of dissociation and
its disorders?
lifetime prevalence rates around 10% in
clinical populations and in the community
Vedat Sar, "Epidemiology of Dissociative Disorders: An Overview", Epidemiology Research International, vol. 2011, Article
ID 404538, 8 pages, 2011. https://doi.org/10.1155/2011/404538

6. DID prevalence: The 12-month prevalence of dissociative identity
disorder among adults in a small U.S. community study was 1.5%.
Lifetime prevalence of dissociative identity disorder was 1.1% in a
representative sample of community-based women in mid-eastern
Turkey.
Dissociative Amnesia : 1.8 %
Depersonalization/Derealization Disorder: In general, approximately
one-half of all adults have experienced at least one lifetime episode of
depersonalization/derealization . However, symptomatology that meets
full criteria for depersonalization/derealization disorder is markedly less
common than transient symptoms. One-month prevalence in the United
Kingdom is approximately 1%–2%.

7. HOW CAN WE
UNDERSTAND
DISSOCIATION? Dissociation
Ego
defense
mechanism
symptoms
Disorder
Personality
trait
Normal
experience

8. EXAMPLES OF COMMON DISSOCIATION
DAYDREAMING HIGHWAY
HYPNOSIS
“GETTING
LOST” IN A
BOOK
MOVIE
ALL OF WHICH INVOLVE “LOSING
TOUCH” WITH AWARENESS OF ONE’S
IMMEDIATE SURROUNDINGS.

10. CONTINUUM OF AWARENESS
(BASK MODEL Braun,1988)
FULL
AWARENESS
SUPRESSION DENIAL REPRESSION DISSOCIATION

11. THE STRESS
RESPONSE

12. THE STRESS RESPONSE

13. MODELS OF
DISSOCIATION
IN PTSD

16. ‫الخبرات‬ ‫مقياس‬
‫االنشقاقية‬
(
‫القريشى‬
2009
)

17. ASSESSMENT
TOOLS

18. Take home
message :
• Dissociation is common
psychological experience in
clinical settings
• Having the ability to identify
dissociation in clinical settings
and differentiate normal
dissociation from pathological
one is important.
• Dissociation presents in a
continuum.
• Dissociation is often associated
with traumatic stress.