Dissociation and Somatic Complaints

Question 1

What is dissociation and what are the different types of dissociative disorders?

Answer 1

Dissociation refers to disconnecting from feelings and experiences or compartmentalizing different feelings from one another. This can include feeling nothing in an emotionally charged situation or only feeling one emotion, like anger, during an emotionally charged situation.
There are several types of dissociative disorders, including:
Dissociative amnesia, which can be localized (forgetting events in a certain period of time), selective (forgetting some elements of a traumatic memory), or generalized (forgetting all life events). This type of amnesia follows trauma or stress.
Dissociative fugue, which involves a loss of personal identity and memory and a flight from a person’s usual place of residence. This can involve leaving home, traveling to a new location, and establishing a new identity there. It can last for short periods or even years.
Depersonalization disorder, which involves a disconnection from self.
Derealization disorder, which involves a disconnection from the world.
Dissociative identity disorder (DID), which is extremely controversial and involves establishing a new identity.

Question 2

Why are dissociative disorders sometimes defined under PTSD Trauma- and Stressor-Related Disorders in DSM-5-TR?

Answer 2

Dissociation is generally found in people with PTSD and is generally related to the presence of trauma, which is why it is sometimes defined under PTSD Trauma- and Stressor-Related Disorders in DSM-5-TR.

Question 3

What is the difference between amnesia and dissociative amnesia?

Answer 3

In both cases, the person has an inability to recall important information.
However, amnesia occurs after a medical condition or event, while dissociative amnesia follows trauma or stress.

Question 4

What are the different types of dissociative amnesia?

Answer 4

There are three types of dissociative amnesia that are traumatic in nature:
localized amnesia (forgetting events in a certain period of time),
selective amnesia (forgetting some elements of a traumatic memory),
and generalized amnesia (forgetting all life events).

Question 5

What is dissociative fugue?

Answer 5

Dissociative fugue involves a loss of personal identity and memory, and it includes a flight from a person’s usual place of residence.
This can involve leaving home, traveling to a new location, and establishing a new identity there. It can last for short periods or even years.

Question 6

How are dissociative disorders diagnosed in DSM-5 and ICD-11?

Answer 6

In DSM-5 and ICD-11, dissociative disorders are diagnosed when a person is unable to recall information about themselves and their life, and this forgotten information is typically associated with trauma or stress (more than just everyday forgetfulness).
A person can be diagnosed with or without dissociative fugue.
However, in ICD-10, dissociative amnesia and dissociative fugue are divided into two separate disorders.

Question 7

What is Depersonalization/Derealization Disorder? What are the symptoms of Depersonalization/Derealization Disorder?

Answer 7

Depersonalization/Derealization Disorder is a mental health condition characterized by feelings of detachment or disconnection from one’s body or mind.
Depersonalization refers to feeling as if one is an external observer of one’s own behavior
derealization refers to feeling as if the world around the person is unreal.
include feelings of being detached or disconnected from one’s body or mind, altered or unreal experiences, and feelings of detachment from one’s physical and interpersonal environment.
DSM/ICD: Depersonalization/Derealization Disorder– Having repeated depersonalization, derealization or both

Question 8

What is Dissociative Identity Disorder (DID)? What are the symptoms of Dissociative Identity Disorder?

Answer 8

Dissociative Identity Disorder, formerly known as multiple personality disorder, is a mental health condition in which a person experiences the presence of two or more distinct personality states or alters, each with its own pattern of perceiving, relating to, and thinking about the environment and self.
Symptoms of Dissociative Identity Disorder include the presence of two or more distinct personality states, difficulty remembering daily events or personal information, and past traumas, and the subpersonalities may have different names, reactions, capacities, and brain activity patterns.

Question 9

What causes Dissociative Identity Disorder?

Answer 9

The exact cause of Dissociative Identity Disorder is not known, but it is believed to be related to severe and chronic childhood trauma, such as abuse or neglect.

Question 10

How are subpersonalities in Dissociative Identity Disorder related to each other?

Answer 10

Subpersonalities in Dissociative Identity Disorder can have:
mutually amnesic relationships, where they have no awareness of one another
mutually cognizant relationships, where each subpersonality is aware of the rest
one-way amnesic relationships, where some subpersonalities are aware of others, but the awareness is not mutual.
They can also have different relationships with each other, some getting along well while others do not.
Subpersonalities are very different from each other
Different personalities
Different names
Different reactions
Different capacities (one can speak a different language, play an instrument vs others cannot)
Different brain activity patterns
A person can have 100s of different subpersonalities

Question 11

How is Dissociative Identity Disorder diagnosed?

Answer 11

Dissociative Identity Disorder is diagnosed based on the presence of two or more discrete personality states or alters, difficulty remembering daily events or personal information, and past traumas.
The ICD-10 defines it as multiple personality disorder. Symptoms generally persist for many years before a diagnosis is made, as the person is mostly unaware of the other personalities

Question 12

What are the different biological perspectives in dissociation treatment? Discuss the chemical aspects and treatment

Answer 12

There are several biological perspectives in dissociation treatment, including brain chemistry perspectives, brain structure and function perspectives, genetics, and evolution.
Generally, antidepressants, anxiolytics, and sometimes antipsychotics are prescribed, but they may not be useful for dissociation.
However, they might benefit accompanying symptoms such as depression and anxiety, and are not considered the primary treatment.

Question 13

Based in the biological perspective, what are the structural/ functional aspects of dissociation? Genetics? And finally, what is the evolutionary perspective?

Answer 13

enhanced hippocampal activity
Not clear cut conclusions – some researchers root for environment, others for genetic factors
Dissociation might be evolutionarily beneficial by preventing overwhelming flood of consciousness at the time of trauma (feeling too much emotions in an emergency situation would not be beneficial- some level of dissociation might be beneficial)

Question 14

How does stress impact a person?

Answer 14

Stress-Acute, short lasting stress boosts immune system functioning
Chronic stress depletes immune system functioning
The number and functioning of different white blood cells (lymphocytes : important for fighting off illness) are negatively influenced by stress
People under chronic stress: More susceptible to catch a cold/ other illnesses
Heal more slowly

Question 15

What is the psychodynamic perspective in dissociation treatment?

Answer 15

• According to the psychodynamic perspective, dissociation is an expression of unconscious conflicts, often as a response to trauma or negative events.
• Dissociation involves psychologically splitting from painful memories so that they are outside of conscious awareness.
• It is a defensive response to trauma to repress and disconnect oneself from memories of it.
• Treatment for dissociation under the psychodynamic perspective involves helping patients reintegrate dissociated memories, feelings, and identities by making unconscious conflicts conscious.
• Treatment methods include hypnotherapy and helping patients coherently verbalize what happened.

Question 16

What is the CBT perspective in dissociation treatment?

Answer 16

• The CBT perspective proposes that dissociation is a conditioned response, and forgetting about traumatic and painful experiences is a relief that is reinforced. (behavioural)
• Dissociation may also result from state-dependent learning, where the ability to recall something is related to psychological or emotional states. (cognitive)
• Treatment for dissociation under the CBT perspective includes helping patients restructure their thoughts and behaviors towards dissociation by addressing the underlying conditioning and state-dependent learning.

Question 17

What is the humanistic perspective in dissociation treatment?

Answer 17

• According to the humanistic perspective, dissociation is a meaningful and adaptive strategy.
• Patients can become aware of their dissociated experiences and the trauma responsible for it with the core conditions of person-centered therapy: empathy, genuineness, and unconditional positive regard.
• As awareness grows, the person will not need to dissociate. Showing empathy and not actively enforcing the client to accept a separate personality seems to work. However, more research is needed in this perspective

Question 18

What is the sociocultural perspective on dissociative identity disorder (DID)?

Answer 18

• The sociocultural perspective suggests that DID may not be a real disorder.
• According to the sociocognitive model of DID, therapists suggest the disorder to susceptible patients and can implant false memories of abuse.
  o The patient might receive more attention from the therapist for any DID symptoms, hence reinforced to have DID
• Media, such as movies, may also contribute to the increase in DID cases. DID may also be diagnosed when a person is receiving therapy for another disorder.
  o The DID cases increased after the movie Sybil in 1976 (a woman with 16 different personalities because of childhood abuse)
  o Diagnosis increased in 80s and 90s but decreased in 2000s – why?
  o Because there had been more movies about DID during this time, and decreased because media attention to DID decreased
• DID might be implemented during hypnosis
• Generally (but not always) DID is diagnosed when a person had been having therapy for another disorder

Question 19

What is the family systems perspective on DID?

Answer 19

• The family systems perspective suggests that caution should be exercised when using this approach. This is because the family member who was responsible for the abuse may be present, which could lead to further trauma for the patient.