Dissociative Disorders

Question 1

What are the DSM-V classifications of dissociative disorders?

Answer 1

Dissociative Identity Disorder
Dissociative Amnesia
With or without Dissociative Fugue
Depersonalization / Derealization Disorder
Other Specified Dissociative Disorder
Unspecified Dissociative Disorder

Question 2

What is the prevalence of dissociative disorders?

Answer 2

The disorders are rare.

According to DSM-V, life prevalence varies from .5 to 2.5 % in the general population

Question 3

How has the prevalence of dissociative disorders changed over the years?

Answer 3

2 cases of DID per decade 1930-1960
20,000 cases of DID from the 1980s to 2000
Back down again after that (back to being an infrequent diagnosis)

Question 4

What are the characteristics of Dissociative Identity Disorder?

Answer 4

A person must have at least two separate ego states (called ‘alters’) that exist independently of each other

Alters emerge and are in control at different times
Usually one primary ego state and two to four alters at time of diagnosis
Treatment sought by the primary alter
Gaps in memory occur in all cases
Existence of alters must be long-lasting and cause considerable disruption in one’s life
Often accompanied by headaches, substance abuse, phobias, hallucinations, suicide attempts, sexual dysfunction, and self-abusive behavior
and other dissociative symptoms such as amnesia and depersonalization

Question 5

What are the three ways that amnesia can manifest?

Answer 5

Gaps in remote memory of personal life events
Lapses in dependable memory (e.g. read, computer use, etc.)
Discovery of evidence for which they have no memory

Question 6

What are some elements of hypnotizability that seem related to dissociation?

Answer 6

the high eye-roll sign;
readiness to trust;
a relative suspension of critical judgment;
an ease of affiliation (connection) with new experiences;
a telescoped (contracted) time sense;
an easy acceptance of logical incongruities;
an excellent memory;
a capacity for intense concentration;
an overall, tractability (submissive, controllability) and, paradoxically, a rigid core of private beliefs.
Role-confusion and a subtle sense of inferiority are often evident.

Question 7

What are the different forms of amnesia?

Answer 7

Localized: a failure to recall during a circumscribed period of time
Selective: a failure to recall some of the events
Generalized: complete loss of memory for one’s life
Systematized: failure to recall a specific category of information
Continuous: failure to recall each new event as it occurs

Question 8

What is a dissociative fugue state?

Answer 8

Memory loss is very extensive
A person can take on a new name, new home, new job, and even new personality characteristics

The fugue is relatively brief and recovery usually complete

After recovery the person does not remember what happened during the fugue

No validation – scanty anecdotal evidence

Question 9

What is the prevalence of depersonalization/derealization?

Answer 9

Although infrequent, single episodes are common in the general population
Prevalence of pathological form is about 2%

Question 10

What does unreality/unfamiliarity refer to in relation to derealization and depersonalization?

Answer 10

Subjective state of feeling detached or disconnected from own being.
Sense of going through the motions, one part participating and another part observing.
Unusual sensory experiences
E.g., a person’s voice may seem strange to them, may feel not theirs.

Question 11

What does hypoemotionality refer to in relation to derealization and depersonalization?

Answer 11

Feeling detached from own emotions, numbed or blunted

Question 12

What are characteristics of derealization and depersonalization?

Answer 12

Unlike the other disorders, there is no disturbance of memory
Episodes are typically triggered by stress
People suddenly lose their sense of self
Usually begins in adolescence and can last a long time
Most common early disturbance related to emotional abuse

Personality disorders (Borderline, Avoidant, Obsessive-Compulsive, anxiety disorders, and depression) often comorbid

Seems linked to dissociative abilities triggered by stress

Question 13

What are some examples of Other Specified Dissociative Disorders?

Answer 13

Some changes in identity  following coercive event but no amnesia
Acute dissociative reaction to stressful events
Dissociative trance (not part of culture or religion)

Question 14

What are Other Specified Dissociative Disorders?

Answer 14

Used when some symptoms are present but not enough to fully qualify as a dissociative disorder

Question 15

What are the main problems with dissociation?

Answer 15

Has been confusion about dissociation as a symptom, a process, a pathology or an ability
Evaluated through standardized scales (e.g. DES) and clinical interview
Often used in a circular way

Now seen as a continuum between normality and pathology, but when is it one or the other?

More linked to imagination and absorption than trauma

Question 16

Why is the DSM-5 definition of dissociation problematic?

Answer 16

Using it as a causal link between abuse and dissociative reactions. DSM requires observable symptoms

Question 17

What is an Indexical state?

Answer 17

State when experience is believed to be his/her own
Doesn’t feel like me but must be me. Losing my mind?
If experience as involuntary, intrusive and ego-alien.

Question 18

What is an Autobiographical state?

Answer 18

State when experience as his/her own.

Yes, this is me.

Question 19

What is full dissociation?

Answer 19

total amnesia – actions are not in conscious awareness

Question 20

What is partial dissociation? Prevalence? What does this suggest?

Answer 20

Aware of involuntary, ego-alien intrusions into sense of self and executive functioning. Very distressing. Far more frequent. Suggests current understanding of DID is incorrect and misleading.

Question 21

What are the general symptoms of dissociation?

Answer 21

General memory problems – e.g., ongoing forgetfulness, sense that important events have been forgotten, poor memory creates problems in daily life. Not full amnesia.

Depersonalization – e.g., body feels strange, disconnected from body and actions.

Derealization - e.g., Environment is distant, foreign, time slows or stops, surrealistic.

Posttraumatic flashbacks – e.g., can occur in all senses and affective experiences.

Trance – Absence-like staring and unresponsiveness (observable)

Question 22

What are some examples of consciously experienced intrusions?

Answer 22

Child voices

Two or more voices, argue, comment etc.

Persecutory voices –harsh content, threaten, command self destructive actions

Speech insertion – experience as someone else speaking, not self.

Thought insertion or withdrawal

‘Made’ feelings and emotions – experience as if something/one has made to feel this way
‘Made’ impulses

‘Made’ actions

Temporary loss of knowledge or skills

Experiences of self-alteration – e.g., switching with acute sensation that ones body has become a small child, male, female and not ones own. Seeing ones appearance is different (haircut, hair color, clothing, etc.) with no memory of change.

Profound and chronic self-puzzlement –consequence of above intrusions

Question 23

What are some examples of fully dissociated intrusions?

Answer 23

Amnesia
Time loss
‘Coming to’
Fugues – purposeful travel that is fully dissociated
Being told of actions by others without memory
Finding things among possessions
Evidence of recent actions – e.g., completed task, kitchen painted. Or, presence of serious injury, suicide attempt