Dissociation versus Alterations in Consciousness (Ch. 10 Dell)

Question 1

How has the definition of dissociation changed over time?

Answer 1

In the 19th and early 20th centuries:

• dissociation was an organized division of the personality.
• This division involves insufficient integration among two or more “systems of ideas and functions that constitute personality” -Janet.
• Each of these psychobiological systems has its own unique combination of perception, cognition, affect, and behavior; each has its own sense of self
• Division of the personality can be temporary or chronic

Since the 1980s: -the definition of dissociation has been broadened. It has been vaguely defined as a breakdown or disruption in usually integrated functioning

Question 2

What are examples of alterations in consciousness

Answer 2

absorption, altered time sense, spaciness, daydreaming, imaginative involvement, and trance-like behavior

Not all alterations in consciousness are normal. Alterations in consciousness are pathological when they are excessive, frequent, inflexible, and cannot be consciously controlled.

Question 3

Why is there serious conceptual confusion about dissociation?

Answer 3

alterations in consciousness do not necessarily derive from a dissociative organization of the personality. However, currently they are being considered as dissociative phenomena

Question 4

What is normal dissociation and pathalogical (structural) dissociation?

Answer 4

normal dissociation - the alterations in consciousness

pathalogical (structural) dissociation - symptoms that typically manifest from a division of the personality; e.g., identity alteration, dissociative amnesia

Question 5

This chapter addresses two essential questions. First, can alterations in consciousness reach pathological pro- portions? Second, are alterations in consciousness actu- ally dissociative?

Question 6

structural dissociation (i.e., a division of the personality) and alterations in consciousness are…

Answer 6

• 2 different but related phenomena
• proposed that both are caused by disruptions in integrative functioning

Question 7

What are Janet’s thoughts on integrative capacity and its relationship to structural dissociation?

Answer 7

Janet (1889, 1907) believed that structural dissociation of the personality results from an inability to successfully engage in integrative mental and physical actions

-can be due to exposure to highly stressful events.

Research supports Janet’s thesis that structural dissociation can emerge from insufficient integrative capacity to manage stressful events

-an individual’s integrative capacity varies person to person

According to Janet, such deficits in integrative capacity could cause other psychological disruptions (e.g., pathological alterations in consciousness, greater emotivity, and reactive behaviors and beliefs). Janet distinguished these phenomena from structural dissociation.

Question 8

What are action systems of the personality?

Answer 8

Personality involves a range of psychobiological motivational, behavioral, or emotional operating systems —also known as action systems

Two major categories of action systems shape our personalities.

• One category guides activities of daily living (e.g., work, play, learning, maintaining relationships, energy regulation [eating and sleep], and sexual behavior/reproduction).
• The second category mediates physical defense under threat (e.g., attachment cry, fight, freeze, submit).

Question 9

What are ANP and EP? (parts of the personality)

Answer 9

There are two prototypical dissociative parts of the per- sonality, each mediated by different action systems

We call parts that are mediated by action systems of daily life the Apparently Normal Parts of the Personality (ANP), and those mediated by the action systems of defense the Emotional Parts of the Personality (EP).

ANPs and EPs have at least a rudimentary sense of self; each retrieves memories that other parts do not (or do not retrieve in the same manner).

Dissociative parts vary in their degree of structural division from one another, in their autonomy, and in their sense of self (which may or may not include secondary elaborations such as ages, gender, names, etc.).

The number of dissociative parts also varies.

Dissociative parts can share episodic and semantic memories (or not)

Question 10

How are ANPs and EPs hypothesized to interact?

Answer 10

Dissociative parts that exert functions in daily life (ANPs) fear the retrieval or integration of traumatic memories; they prevent this via mental avoidance and escape strategies.

We hypothesize that these phobic mental actions involve the natural tendency of different action systems to inhibit one another to a varying degree.

• For example, the action systems of (physical) defense and play tend to completely inhibit one another.
• This implies that dissociative parts that focus on daily life (ANP) would be impaired in their ability to play and socialize whenever they are intruded upon by dissociative parts that are rooted in defensive action systems (EP).

Question 11

Describe dissociative symptoms

Answer 11

1. Dissociative symptoms are manifestations of structural dissociation
2. They are divided into negative and positive symptoms
   - Negative dissociative symptoms (losses) occur when a part is unable to retrieve mental contents (e.g., memories) or unable to execute normal functions (e.g., movement of an arm) that are still available to another part, at least in principle.
   - Positive dissociative symptoms (intrusions) occur when the mental contents (e.g., a traumatic memory) or functions (e.g., movement of an arm) of one part intrude into the functioning or consciousness of another part.
3. Negative and positive symptoms can be classified as either psychoform or somatoform.

Question 12

What does the term consciousness mean?

Answer 12

We use the term consciousness to mean conscious aware- ness of internal and external stimuli.

Question 13

What are the field and level of consciousness?

Answer 13

Field and level are inherent features of consciousness.

-Low levels of consciousness can coincide with either a wide or narrow field of consciousness.

Field of consciousness

• The quantity of internal and external stimuli held in con- scious awareness at a given time.
• Some changes in our field of consciousness are voluntary (e.g., intentional concentration, guided imagery, meditation); other changes are involuntary (e.g., inability to concentrate or selectively attend when we are tired or stressed).

Level of consciousness

• The quality of consciousness. The quality of our mental functioning is largely dependent on the level of consciousness. Usually a lowering of consciousness impairs mental functioning.
• Common forms of lowered consciousness include temporary mental relaxation, daydreaming, and concentration problems due to fatigue, stress, or illness. Less common forms of lowered consciousness include depersonalization and derealization. Stupor and coma are extreme forms of lowered consciousness.

We maintain that the quantity and quality of consciousness are essentially different from the manifestations of structural dissociation.

Question 14

a

Answer 14

In short, we disagree with the idea that normal and pathological dissociation lie on a single dimension, with alterations in consciousness representing the “normal” end of that dissociative continuum. Alterations in field and level of consciousness can be quite pathological in and of themselves.

Question 15

b

Answer 15

It should be noted, however, that the field of consciousness of dissociative parts is usually much more retracted than that of healthy individuals. The atten- tional focus of dissociative parts is typically restricted by the limited range of the action systems on which they are based. For example, ANPs generally focus exclusively on daily life activities; they avoid traumatic reminders. EPs, on the other hand, focus almost exclusively on physical defense against perceived threat to life—and are unable to deal appropriately with normal life.

Different dissociative parts of the personality often have different fields and levels of consciousness in the same moment in time. While one part has a very low level of consciousness, a second part may be completely deactivated, a third part may be alert and responsive, and a fourth part may be narrowly focused on threat cues.

Question 16

What can one observe with a lowering of the level of consciousness?

Answer 16

Lowering of the level of consciousness often, but not always, accompanies a switch. When the change is slow, one may easily observe the abasement of mental activ- ity; the patient pays no more attention to exterior events; he understands less and less what you tell him, and he answers with difficulty, is absent-minded, works more slowly, or interrupts his work.

Question 17

There are high and low levels of consciousness during threat. Why is there low levels?

Answer 17

There is also a place for low levels of consciousness during threat: total submission is adaptive when escape is impossible and physical resistance would only evoke (further) violence. The submission action system is characterized by a very low level of awareness, which inhibits movement and protects against pain and suffering.

Hyperalertness and hyperarousal during a traumatic experience may exhaust the individual and bring about a significant drop in the level of consciousness

Question 18

What is definition/ description of depersonalization?

Answer 18

Depersonalization has been described as

(1) the existence of an observing and experiencing ego or part of the personality
(2) detachment of con- sciousness from the self or body (i.e., feelings of strange- ness or unfamiliarity with self, out-of-body experiences);
(3) detachment from affect (i.e., numbness);
(4) a sense of unreality such as being in a dream; and
(5) perceptual alterations or hallucinations regarding the body

The primary difficulty in depersonalization may be a disruption in the focus of attention (i.e., alterations in consciousness;

Depersonalization occurs with intact reality testing.

Question 19

Is depersonalization a structural dissociation or an alteration of consciousness or both?

Answer 19

Although depersonalization and derealization have long been held to be dissociative symptoms, we believe that many (but not all) manifestations of depersonalization and derealization are alterations in consciousness and therefore not dissociative.

We believe that the presence of an “observing ego,” observing part of the personality, or out-of-body experience is a hallmark of structural dissociation.

Question 20

Persons with DPD and persons with structural dissociation share what neurobiological correlates?

Answer 20

Persons with DPD and persons with structural dissociation share some neurobiological correlates: HPA axis dysregulation and disturbances of serotonergic, endogenous opioid, and glutamatergic NMDA pathways

Question 21

Research supports the idea that retraction and lowering of consciousness may accompany, but are different from, structural dissociation.

Answer 21

structurally dissociated persons typically display alterations in consciousness, but few persons with alterations in consciousness are structurally dissociated.

“pathological” dissociation (i.e., structural dissociation) is associated with exposure to highly stressful events, but that “nonpathological” dis- sociation (i.e., alterations in consciousness) is not.

evidence that “detachment” (a form of altered consciousness) and “compartmentalization” (structural dissociation) are qualitatively distinct phe- nomena.