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Dissociative disorders

Dissociative disorders. Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder. Dissociation. “Disruption in the usually integrated functions of consciousness memory identity perception of the environment” (DSM-IV, p.477). Other occurrences of dissociative symptoms.

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Dissociative disorders

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  1. Dissociative disorders Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder

  2. Dissociation • “Disruption in the usually integrated functions of • consciousness • memory • identity • perception of the environment” (DSM-IV, p.477)

  3. Other occurrences of dissociative symptoms • Other disorders • Acute Stress and Posttraumatic Stress • Somatization Disorder • Conversion Disorder • Cultural expression or activity • Religious experiences • Dissociation is not inherently pathological

  4. Dissociative Amnesia • Important personal information cannot be recalled • Usually related to trauma or stress • Beyond normal forgetting • Usually reported as gaps in otherwise intact memories of a person’s own life

  5. What is lost? • Victim memories: Trauma or stress • Perpetrator memories • Violence • Suicide attempts • Self-mutilation

  6. Types of Dissociative Amnesia • More common: • Localized amnesia: Period of time • Selective amnesia: Certain events selected from a series • Less common: • Generalized amnesia: Entire life • Continuous amnesia: From an event on • Systematized amnesia: Categorical

  7. Dissociative Fugue • Sudden relocation (fugue) with amnesia • May assume a new identity, and function well. May seem more healthy than before the fugue. • Upon recovery, may be amnesic for the fugue episode

  8. Amnesia, fugue, and the law • Sometimes claimed as a criminal defense • Persists through hypnosis, barbiturate interviews • No available test to distinguish it from malingering • Consider the gain produced by the symptom • Crime due to true dissociation is irrational or produces no secondary gain

  9. Dissociative Identity Disorder • Two or more distinct personalities • Host and alters • Median: 10 personalities (women:15, men:7) • Range: 2 to >100 • Control of behavior rotates among personalities • Often cued by stressors, switch in seconds • Some personalities appear rarely

  10. More DID features • At least some of the personalities are unaware of the others, and demonstrate amnesia • Sometimes the voices of alters are experienced as hallucinations • Some alters are supportive • Others are the voice of the perpetrator

  11. Etiological validity of DID • 90% of cases are women • Memory loss for extended periods of time in childhood is common • Repeated, severe, usually sexual abuse is common • Posttraumatic symptoms are sometimes seen

  12. Cultural context of DID • Highest rates in U.S.A. and Australia • Is child abuse highest here? • Is DID a media creation? • Is DID iatrogenic?

  13. Depersonalization Disorder • Repeated or enduring feelings that one is detached from one’s body or self • May feel like an automaton or a detached observer • May feel loss of control of actions or speech • May coexist with derealization • Reality testing remains intact

  14. Dissociative Disorder NOS • Subclinical DID • Derealization without depersonalization • Dissociation due to coercion • Brainwashing • Cult indoctrination • Dissociative trance disorders: Culture-bound • Ganser syndrome

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