Dissociative disorders involve feelings of detachment from reality or oneself. They affect about 2% of the US population and are more common in women. Symptoms include amnesia, depersonalization, and derealization. Dissociative disorders often develop as a way to cope with trauma, and can be diagnosed through evaluating symptoms and history. Treatment involves therapies like cognitive behavioral therapy to help patients function better and reduce symptoms by addressing underlying causes.

1. Dissociative
disorder and
management

2. The term “dissociative disorders” describes a persistent mental state that is marked by feelings of
being detached from reality, being outside of one’s own body, or experiencing memory loss
(amnesia).
Dissociative or conversion disorders (ICD-10; hereafter referred to as dissociative disorders) are
characterized by disruption in the usually integrated functions of consciousness, memory, identity,
sensations and control of body movements
About 2% of the U.S. population experiences true dissociative disorders (not just momentary
feelings of dissociation). All age groups, racial, ethnic, and socioeconomic backgrounds are
affected. Women are more likely than men to be diagnosed.

3. Table 1: ICD-10 category of Dissociative (Conversion) Disorders
1 Dissociative amnesia
2 Dissociative fugue
3 Dissociative stupor
4 Trance and possession disorders
5 Dissociative motor disorders

4. 6 Dissociative convulsions
7 Dissociation anaesthesia and sensory loss
8 Mixed dissociative (conversion) disorders
9 Other dissociative disorders
10 Dissociative disorder, unspecified

5. Types of dissociative disorders
There are three primary types of dissociative disorders:
•Dissociative identity disorder
•Depersonalization/derealization disorder
•Dissociative amnesia
Acute stress disorder and post-traumatic stress disorder (PTSD) are closely related to
dissociative disorders, sharing such symptoms as memory loss, depersonalization, or
derealization.

6. SYMPTOMS AND CAUSES
Dissociative disorders often first develop as a way to deal with a catastrophic event or with
long-term stress, abuse, or trauma.
Mentally removing oneself from a traumatic situation — such as an accident, natural
disaster, military combat, being a crime victim, or repeated physical, mental or sexual
abuse — can be a coping mechanism that helps one escape pain in the short term

7. Symptoms of dissociative disorders
•Long-term gaps in memory concerning everyday events, personal information, or
traumatic events of the past.
•Problems in social settings, the workplace, or other areas of functioning in daily life. The
seriousness of such problems can range from minimal to significant.
Suicide attempts, self-mutilation, and other self-injuring behaviors are common among
those with dissociative identity disorder. More than 70% of outpatients with this condition
have attempted suicide.

8. Symptoms of depersonalization/derealization
disorder
One or both of the following conditions exist in the same person in a recurring pattern over
a long period of time:
•Depersonalization – Feelings of unreality or of being detached from one’s own mind,
body or self. It is as if one is an observer of rather than a participant in their own life
events.
•Derealization – Feelings of unreality or of being detached from one’s surroundings.
People and things may not seem real.

9. Symptoms of dissociative amnesia
There is no particular age of onset, and episodes can occur periodically throughout life.
There are three types of amnesia:
•Localized – Cannot remember an event or period of time (most common form of
amnesia)
•Selective – Cannot remember certain details of events about a given period of time.
•Generalized – Complete loss of identity of life history (rarest form).

10. How are dissoviative disorders diagnosed?
Diagnosis of dissociative disorders involves a review of symptoms and the person’s life
history.
Physical tests may be performed to rule out physical or medical conditions that could
cause symptoms such as memory loss or feelings of unreality.
The assessment of dissociative disorders involves a detailed psychiatric and developmental
history.
A comprehensive medical, neurological and mental status examination should be done

11. How are dissociative disorders treated?
ACUTE TREATMENT
• Assurance Relaxation Doctor
• Child and family relationship
• Restoration of communication in the family
• Realistic solution of the problems
• Reduction of sick role and secondary gains
• Promotion of positive behaviour
• Teaching heathy coping
• Treatment of comorbid psychiatric or physical disorders

12. Behavioural management
Reassuring the child that he/she is not seriously ill
Encouraging the child to gradually resume normal daily activities and functioning
Encouraging physical exercise and play
Relaxation exercises eg. deep and slow abdominal breathing
Paying attention to the child when normal without symptoms.
Engaging the child in age appropriate activity of interest like drawing, colouring, story
book reading etc.
Encouraging joint activities with parents Praise and appreciate for positive behaviour.

13. Aversion therapy for unwanted behaviour is not advised as it may harm the
patient, has a pejorative connotation equivalent to punishment. It may provide only
temporary benefits, if any
Abreaction is bringing to conscious awareness, thoughts, affects and memories
for the first time, with or without the use of drugs. This may be achieved by
hypnosis, free association, or drugs.

14. COGNITIVE BEHAVIOUR THERAPY -
The aim of CBT is to maximize functioning and reduce the dissociative symptoms.
The following are the principles of CBT in chronic dissociative states:
1. Give positive explanations for symptoms.
2. Persuade the child that change is possible, he or sheis not “damaged”, and they do have the
potential to recover.
3. Discuss the treatment rationale with the patient and the key family members.
4. Encourage engagement in daily routine activities.
5. Teach relaxation, and distraction away from unpleasant thoughts and the symptoms.

15. REFERENCE
• Sharma P, Chaturvedi SK. Conversion disorder revisited. Acta Psychiatrica Scand 1995;
92: 301-304.
• Malhi P, Singhi P. Clinical characteristics and outcome of children and adolescents with
conversion disorder. Ind Pediatrics 2002; 39: 747-752.

16. THANK YOU