Dissociative Disorders

1. Dissociative Disorders

2. Dissociation • Psychogenic disruption in conscious awareness • Complex mental activity that is independent from or not integrated within conscious awareness

3. Automatisms • Accomplishing a task with little or no conscious awareness • Much of our life involves non-conscious mental activity (both perception and memory) • Automatic, non-deliberate, not self-monitored

4. When is Dissociation a problem? • Loss of overall, integrative control • Unable to access information • Loss of a coherent sense of self

5. Dissociative Disorders • Splitting apart of components (identity, memory, perception) of a persons personality that are usually integrated

6. Types of Dissociative Disorders • Dissociative Amnesia • Dissociative Fugue • Dissociative Identity Disorder • Depersonalization Disorder

7. Dissociative Amnesia • Partial or total forgetting of past experience without a biological cause • Almost always anterograde – blocking out a period of time after psychogenic cause (e.g. stress / trauma) • Memory loss is often selective • Relative indifference to loss of memory • Remain well oriented to time and place

8. Dissociative Amnesia: Patterns of Memory Loss • Localized amnesia • All events in a circumscribed period • Selective amnesia • Forget only certain events that occur during a circumscribed period • Generalized amnesia • Continuous amnesia • Systematized amnesia

9. Dissociative Fugue • Amnesia + sudden, unexpected trip away from home • Often involves the creation of a new identity • Fugue state usually ends abruptly – then amnesic for events during the fugue

10. Dissociative Identity Disorder • Sense of self, or personality breaks up into two or more distinct identities which take turns “controlling” behaviour • At least one “personality” is amnesic for the experiences of the others • “Alter” often coconscious with the host

11. Dissociative Identity Disorder • Identities are often polarized • Often each identity specializes in different areas of functioning, encapsulates different memories • Very high proportion report significant trauma in childhood – possible strategy that children use to distance themselves from trauma

12. Controversy re. cause of DID • Faking - malingering • Induced by therapy - iatrogenic • Social Role • Hypnotizability • “False Memory Syndrome”

13. Depersonalization Disorder • Disruption in identity without amnesia • Sense of strangeness or unreality in oneself • Derealization • Reduced emotional responsiveness

14. Explaining Dissociative Disorders • Most theories assume that dissociation is a way of escape from situations that are beyond coping powers

15. Psychodynamic Perspective • Janet (1929) • Anxiety relief • Dissociative amnesia = repression • Fugue and DID also involve acting out of repressed wish • Treatment: safety, awareness*, integration

16. Behavioural and Sociocultural Perspective • Behavioural: Learned coping response – symptoms are rewarded and / or relieve stress • Sociocultural: Adopting a “social role”, often see iatrogenic forces as part of cause • Treatment = non-reinforcement

17. Cognitive Perspectives • Disorders of memory • State dependent memory

18. Neuroscience Perspective • Undiagnosed epilepsy • Stress induced damage to Hippocampus – which brings different sensory modalities back together during recall • Disruptions in serotonin