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Disorders of Dissociation

Disorders of Dissociation. Assessment & Diagnosis SW 593. Introduction. Dissociation refers to instances in which the normally integrated aspects of cognitive functioning are disrupted. Consciousness Memory Identity Perception

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Disorders of Dissociation

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  1. Disorders of Dissociation Assessment & Diagnosis SW 593

  2. Introduction • Dissociation refers to instances in which the normally integrated aspects of cognitive functioning are disrupted. • Consciousness • Memory • Identity • Perception • Dissociative symptoms might be present in a number of other diagnoses (PTSD).

  3. Dissociative Amnesia • Client has one or more episodes in which they cannot remember important personal information. • Forgotten material is too extensive to be attributed to normal forgetfulness. • Material forgotten is of a traumatic or stressful nature. • Symptoms must be associated with distress or psychosocial impairment.

  4. Dissociative Fugue • Also unable to recall some or all of their personal history. • Sudden and unexpected travel that removes the person from their home/usual surroundings occurs. • Has some degree of confusion about their identity and may actually assume a new identity.

  5. Dissociative Fugue • The episode may not be part of Dissociative Identity Disorder or be a result of substance abuse or some general medical condition. • Significant distress and/psychosocial impairment is experienced.

  6. Dissociative Identity Disorder • Two or more distinct identities or personalities are present and recurrently take control of the individual’s behavior. • There is an inability to recall personal information while the client is in at least one of the distinct identities. • The situation is not due to substance abuse or a general medical condition.

  7. Dissociative Identity Disorder • Results in distress and/or psychosocial impairment. • Formerly known as Multiple Personality Disorder. • Clients will have a primary identity that carries the individual’s legal name. • Each alternative frequently has a different name and can vary from the primary identity in terms of age, gender, knowledge, and affect.

  8. Dissociative Identity Disorder • Each identity has an enduring pattern of viewing and relating to the environment and the self. • The primary and alternative identities may or may not be aware of the existence or experiences of one another. • Persons with this disorder may have frequent gaps in memory for both recent and remote events.

  9. Depersonalization Disorder • Depersonalization is characterized by feeling detached or estranged from one’s self. • Described as feeling outside the self as if viewing a movie. • Reality testing must remain intact during the episodes. • Brief instances of depersonalization are not unusual or may be associated with another mental disorder.

  10. Depersonalization Disorder • Depersonalization is the major symptom necessary in order to meet the diagnostic criteria. • Causes distress and/or psychosocial impairment.

  11. Assessment • The first clue that a dissociative disorder is occurring is “holes” or unaccounted periods of time. • Careful history focused around times of stress can be particularly informative. • Several psychometric instruments can be utilized including: • Dissociation Questionnaire (DIS-Q) • Child Dissociative Checklist (CDC)

  12. Cultural Considerations • Dissociative experiences, particularly fugue-like states, may occur within a number of cultural groups as an accepted expression of cultural activities or religious practices. • No clinical distress or psychosocial impairment occurs. • Dissociative Identity Disorder is diagnosed much more frequently in women than men.

  13. Cultural Considerations • Men with this disorder tend to have fewer distinct identities. • In children, the data suggests that the occurrence is more evenly distributed between the sexes. • “Spells” are not diagnosable according to the DSM. • Spells is a trance-like state in which the individual may communicate with deceased relatives.

  14. Cultural Considerations • Another condition seen around the world is that of “zar”. • Zar episodes are characterized by persons appearing to be in a dissociative state where they may shout, cry, laugh, sing, or hit their heads against a wall. • The belief is that they are possessed by a spirit, and the state is not considered pathological.

  15. Cultural Considerations • Scott (1999) suggests that persons experiencing dissociative disorders are individuals who are unable to resolve past histories of childhood trauma, pain, ritualized physical and sexual abuse.

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