|Symptoms||Disruption of memory, awareness, identity, or perception|
|Types||Dissociative identity disorder|
Other specified dissociative disorder
Unspecified dissociative disorder
|Risk factors||Psychological trauma|
|Differential diagnosis||Effects of medication, sleep disorders, PTSD, acute stress disorder, diseases of the nervous system|
Dissociative disorders (DD) are a group of mental disorders that involve disruption or breakdown of memory, awareness, identity, or perception. Symptoms may include lose of memory (amnesia), different personality states, or feelings of experiences being not real. The symptoms are not under voluntary control and occur to a degree that functioning is disrupted. These conditions often are associated with psychological trauma.
- Dissociative identity disorder (DID) is characterized by the maintenance of at least two distinct and relatively enduring personality states. It is accompanied by memory gaps beyond what would be explained by ordinary forgetfulness. The personality states alternately show in a person's behavior, however presentations of the disorder vary.
- Dissociative amnesia is the temporary inability to recall specific memories that one should generally be able to recall. Often the memories relate to a stressful event and the inability to remember applies to only certain aspects of what occurred.
- Depersonalization-derealization disorder (DPDR) is recurrent episodes of feeling like one is observing themselves from outside (depersonalization) or like ones experiences are not real (derealization).
- The prior category of dissociative disorder not otherwise specified was split into two: other specified dissociative disorder and unspecified dissociative disorder. These categories are used for forms of dissociation that do not fully meet the criteria of the other specified disorders.
Diagnosis involves ruling out other possible causes such as the effects of medication, sleep disorders, PTSD, acute stress disorder, and diseases of the nervous system. The ICD-11 classifies conversion disorder as a dissociative disorder, while the DSM-V classifies it as a somatic symptom and related disorder. DID effects about 1.5% of people, dissociative amnesia about 1.8%, and DPDR about 2%. While dissociative amnesia is more common in females, DID and DPDR occur equally frequently in both sexes.
Dissociative identity disorder
Dissociative identity disorder is caused by ongoing childhood trauma that occurs before the ages of six to nine. People with dissociative identity disorder usually have close relatives who have also had similar experiences.
A way to cope with trauma. Dissociative fugue is now subsumed under the dissociative amnesia category. It is described as reversible amnesia for personal identity, usually involving unplanned travel or wandering, sometimes accompanied by the establishment of a new identity. This state is typically associated with stressful life circumstances and can be short or lengthy.
Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to chronic physical, sexual or emotional abuse or, less frequently, a home environment that is otherwise frightening or highly unpredictable; however, this disorder can also acutely form due to severe traumas such as war or the death of a loved one.
Diagnosis can be made with the help of structured clinical interviews such as the Dissociative Disorders Interview Schedule (DDIS) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R), and behavioral observation of dissociative signs during the interview. Additional information can be helpful in diagnosis, including the Dissociative Experiences Scale or other questionnaires, performance-based measures, records from doctors or academic records, and information from partners, parents, or friends. A dissociative disorder cannot be ruled out in a single session and it is common for patients diagnosed with a dissociative disorder to not have a previous dissociative disorder diagnosis due to a lack of clinician training. Some diagnostic tests have also been adapted or developed for use with children and adolescents such as the Adolescent Dissociative Experiences Scale, Children's Version of the Response Evaluation Measure (REM-Y-71), Child Interview for Subjective Dissociative Experiences, Child Dissociative Checklist (CDC), Child Behavior Checklist (CBCL) Dissociation Subscale, and the Trauma Symptom Checklist for Children Dissociation Subscale.
There are problems with classification, diagnosis and therapeutic strategies of dissociative and conversion disorders which can be understood by the historic context of hysteria. Even current systems used to diagnose DD such as the DSM-IV and ICD-10 differ in the way the classification is determined. In most cases mental health professionals are still hesitant to diagnose patients with Dissociative Disorder, because before they are considered to be diagnosed with Dissociative Disorder these patients have more than likely been diagnosed with major depression, anxiety disorder, and most often post-traumatic disorder.
An important concern in the diagnosis of dissociative disorders in forensic interviews is the possibility that the patient may be feigning symptoms in order to escape negative consequences. Young criminal offenders report much higher levels of dissociative disorders, such as amnesia. In one study it was found that 1% of young offenders reported complete amnesia for a violent crime, while 19% claimed partial amnesia. There have also been cases in which people with dissociative identity disorder provide conflicting testimonies in court, depending on the personality that is present.[better source needed]
A number of controversies surround DD in adults as well as children. First, there is ongoing debate surrounding the cause of dissociative identity disorder (DID). The crux of this debate is if DID is the result of childhood trauma and disorganized attachment. A second area of controversy surrounds the question of whether or not dissociation as a defense versus pathological dissociation are qualitatively or quantitatively different. Experiences and symptoms of dissociation can range from the more mundane to those associated with posttraumatic stress disorder (PTSD) or acute stress disorder (ASD) to dissociative disorders. Mirroring this complexity, the DSM-5 workgroup considered grouping dissociative disorders with other trauma/stress disorders, but instead decided to put them in the following chapter to emphasize the close relationship. The DSM-5 also introduced a Dissociative subtype of PTSD.
A 2012 review article supports the hypothesis that current or recent trauma may affect an individual's assessment of the more distant past, changing the experience of the past and resulting in dissociative states. However, experimental research in cognitive science continues to challenge claims concerning the validity of the dissociation construct, which is still based on Janetian notions of structural dissociation. Even the claimed etiological link between trauma/abuse and dissociation has been questioned. An alternative model proposes a perspective on dissociation based on a recently established link between a labile sleep–wake cycle and memory errors, cognitive failures, problems in attentional control, and difficulties in distinguishing fantasy from reality."
As mentioned earlier, anti-anxiety, antidepressants and tranquilizers are treatment medications that do not cure, but may help control the symptoms of dissociative disorders.
Dissociative identity disorder
Long-term psychotherapy to improve a person's quality of life.
Psychotherapy (e.g. talk therapy) counseling or psychosocial therapy which involves talking about your disorder and related issues with a mental health provider. Psychotherapy often involves hypnosis (help you remember and work through the trauma); creative art therapy (using creative process to help a person who cannot express his or her thoughts); cognitive therapy (talk therapy to identify unhealthy and negative beliefs/behaviors); and medications (antidepressants, anti-anxiety medications or tranquilizers). These medications help control the mental health symptoms associated with the disorders, but there are no medications that specifically treat dissociative disorders. However, the medication Pentothal can sometimes help to restore the memories. The length of an event of dissociative amnesia may be a few minutes or several years. If an episode is associated with a traumatic event, the amnesia may clear up when the person is removed from the traumatic situation.
Psychotherapy is helpful for the person who has traumatic, past events to resolve. Once dissociative fugue is discovered and treated, many people recover quickly. The problem may never happen again.
Same treatment as dissociative amnesia, and same drugs. An episode of depersonalization disorder can be as brief as a few seconds or continue for several years.
The lifetime prevalence of dissociative disorders varies from 10% in the general population to 46% in psychiatric inpatients.
Dissociative disorders (DD) are widely believed to have roots in traumatic childhood experience (abuse or loss), but symptomology often goes unrecognized or is misdiagnosed in children and adolescents.[verification needed] There are several reasons why recognizing symptoms of dissociation in children is challenging: it may be difficult for children to describe their internal experiences; caregivers may miss signals or attempt to conceal their own abusive or neglectful behaviors; symptoms can be subtle or fleeting; disturbances of memory, mood, or concentration associated with dissociation may be misinterpreted as symptoms of other disorders.
In addition to developing diagnostic tests for children and adolescents (see above), a number of approaches have been developed to improve recognition and understanding of dissociation in children. Recent research has focused on clarifying the neurological basis of symptoms associated with dissociation by studying neurochemical, functional and structural brain abnormalities that can result from childhood trauma. Others in the field have argued that recognizing disorganized attachment (DA) in children can help alert clinicians to the possibility of dissociative disorders.
Clinicians and researchers also stress the importance of using a developmental model to understand both symptoms and the future course of DDs. In other words, symptoms of dissociation may manifest differently at different stages of child and adolescent development and individuals may be more or less susceptible to developing dissociative symptoms at different ages. Further research into the manifestation of dissociative symptoms and vulnerability throughout development is needed. Related to this developmental approach, more research is required to establish whether a young patient's recovery will remain stable over time.
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- Dissociative disorders—Mayo Clinic
- Depersonalization Disorder—Cleveland Clinic
- International Society for the Study of Trauma and Dissociation