Dissociative Disorders

Common Dissociative Experiences in Everyday Life

Daydreaming Missing parts of conversations Vivid fantasizing Forgetting part of drive home Calling one number when intending to call another Driving to one place when intending to drive elsewhere Reading an entire page & not knowing what you read Not sure whether you’ve done something or only thought

about doing it Seeing oneself as if looking at another person Remembering the past so vividly you seem to be reliving

it Not sure if an event happened or was just a dream

Definition

According to Richard P. Kluft, Dissociative Identity Disorder “is a complex, chronic, posttraumatic dissociative psychopathology characterized by disturbances of memory and identity.”

QualificationsYears in Practice: 30+ Years School: Harvard Medical SchoolYear Graduated: 1968 License No. and State: MD-011120-E Pennsylvania

Dissociative Disorders

This is an extremely rare disorder.

It occurs to 1% of the general population, but recent 2012 statistics estimate an average of 7% that have not been diagnosed properly with the disorder.

History

ｷｷ The first published description of Dissociative Identity Disorder was made by Petetain in 1787.

ｷｷ In the 20th century, DID was put under the rubric of schizophrenia. Because of this the use of the diagnosis of DID dropped

significantly, and people almost stopped studying it

altogether.ｷ

History

ｷｷ In the 1980’s, feminism really helped to bring back interest in DID.

ｷｷ Most of what we know about DID come from studies made in 1980-1985. 1984 marked the beginning of annual international conferences on DID.

Between 1930 to 1960 the diagnosis was only 2 percent

Since it made it to DSM in 1980’s the reported cases has jumped to 20,000

Number of personalities mushroomed from 3 to 12 per patient

This disorder is unknown in Japan and India

DID Critics

DID Critics

Critics’ Arguments

1. Role-playing by people open to a therapist’s suggestion.

2. Learned response that reinforces reductions in anxiety.

When is Dissociation a problem?

Loss of overall, integrative control Unable to access information Loss of a coherent sense of self

Causes

Traumatic experiences. Mainly experienced during childhood.

Possible Causes of Dissociation

Fatigue Sleep deprivation Stress Binge drinking Drug use Confronting a new environment Feeling preoccupied or conflicted Engaging in certain religious or cultural

rituals or events

Symptoms

One of the most common known symptoms are the different identities, also known as the “alters”.

What are the diagnostic criteria for Dissociative Amnesia?

• Cannot recall important personal information—usually of a traumatic or stressful nature—and too extensive to be explained by ORDINARY FORGETFULLNESS

• Not due to– Dissociative Identity Disorder– Dissociative Fugue– Somatization Disorder– Posttraumatic Stress Disorder– Acute Stress Disorder– Substance use– Neurological or General Medical Condition

• Causes significant impairment in social or occupational functioning

Other Specified Dissociative Disorder

Establishes itself securely during early childhood, and is thought to be caused by child abuse, that resulted in a lack of a secure attachment with a primary caregiver.

An absence of secure attachment in childhood, among repeated abuse, eventually resulted in an accumulation of unresolved trauma, causing structural dissociation

Dissociative Disorders

Types of Dissociative Disorders

Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder Depersonalization Disorder

Dissociative Amnesia

Partial or total forgetting of past experience without a biological cause

Almost always anterograde – blocking out a period of time after psychogenic cause (e.g. stress / trauma)

Memory loss is often selective Relative indifference to loss of memory Remain well oriented to time and place

Dissociative Amnesia

Impairment is reversible and usually reported retrospectively (in past tense).

Types of disturbance: Localized – affects a few hours around a

traumatic event. Selective – affects some but not all events

during a period of time, or some categories. Generalized – affects entire past. Continuous – a specific time up to the present

Dissociative Fugue

Amnesia + sudden, unexpected trip away from home

Often involves the creation of a new identity

Fugue state usually ends abruptly – then amnesic for events during the fugue

Dissociative Identity Disorder

Sense of self, or personality breaks up into two or more distinct identities which take turns “controlling” behavior

At least one “personality” is amnesic for the experiences of the others

“Alter” often coconscious with the host

Dissociative Identity Disorder

Identities are often polarized Often each identity specializes in

different areas of functioning, encapsulates different memories

Very high proportion report significant trauma in childhood – possible strategy that children use to distance themselves from trauma

Controversy re. cause of DID

Faking - malingering Induced by therapy - iatrogenic Social Role Hypnotizability “False Memory Syndrome”

Depersonalization Disorder

Disruption in identity without amnesia Sense of strangeness or unreality in

oneself Derealization Reduced emotional responsiveness

How can you keep these patients straight?

Memory loss?Memory loss?YeYess

NoNo

Travel to Travel to another place?another place?

Altered senseAltered senseof self or reality?of self or reality?

DepersonalizationDepersonalizationDisorderDisorder

YeYess

NoNo

DissociativeDissociativeFugueFugue

Evidence ofEvidence ofmore thanmore than

one identity?one identity?

YeYess

NoNo

DissociativeDissociativeIdentity DisorderIdentity Disorder

DissociativeDissociativeAmnesiaAmnesia

YeYess

Dissociative Disorders 2

Common Dissociative Experiences in Everyday Life

Daydreaming Missing parts of conversations Vivid fantasizing Forgetting part of drive home Calling one number when intending to call

another Driving to one place when intending to

drive elsewhere

Historical Roots

Hysteria: “wandering uterus” physical symptoms without a known cause term dates back to Hippocrates and

Egyptians

Neurosis: emotional distress due to underlying unconscious conflicts, anxiety, and implementation of defense mechanisms

The Evolution of the Concept

Three Theorist Pierre Janet

One or more automatisms could split off from the rest, thus functioning outside of awareness, independent of voluntary control or both.

Neodissociation (Hilgard) Links within the brain would be disrupted or isolated

from phenomenal awareness and the experience of intentionality.

Woody and Bowers The phenomena of dissociation reflect the failure of

these modules (i.e., conscious & unconscious) to be integrated at higher levels of the system.

Dissociation is a natural state, to some degree.

When is Dissociation a problem?

Loss of overall, integrative control Unable to access information Loss of a coherent sense of self

Dissociative Amnesia

Person is unable to recall important personal information Usually related to a

traumatic or stressful event

Variations Generalized Localized Selective

24

Dissociative Fugue

Person suddenly leaves home and work and assumes a new identity Usually triggered by

stress or trauma

Depersonalization Disorder

Person’s perception or experience of the self is disconcertingly and disruptively altered Frequent episodes Reality does remain

intact during episodes No amnesia or new

identities

Defenses..

Frequently used in all dissociative disorders

Repression: Disturbing impulses are blocked from

consciousness Denial: external reality is ignored Dissociation: Separation & independent functioning of 1 group of

mental processes from others-(mental contents exist in parallel consciousness)

How Do Therapists Help Individuals With DID?

How Do Therapists Help Individuals With DID?

How Do Therapists Help Individuals With DID?

Quiz

True/False

1) Dissociative Identity Disorder is directly related to Schizophrenia.

Quiz

True/False

1) Dissociative Identity Disorder is directly related to Schizophrenia.

False: Schizophrenia is mainly characterized by hearing or seeing things that aren't real (hallucinations) and thinking or believing things with no basis in reality (delusions).

Quiz

True/False

2) One of the symptoms of DID is known as an “alter”.

Quiz

True/False

2) One of the symptoms of DID is known as an “alter”.

True

Quiz

True/False

3) Every one of us has experienced some mild form of dissociation.

Quiz

True/False

3) Every one of us has experienced some mild form of dissociation.

True

Quiz

Multiple Choice

1) Which of the following are NOT symptoms of DID?

a) mood swings

b) suicidal tendencies

c) eating disorders

d) hallucinations

Quiz

Multiple Choice

1) Which of the following are NOT symptoms of DID?

a) mood swings

b) suicidal tendencies

c) eating disorders

d) hallucinations

Quiz

Multiple Choice

2) Which of the following is a known treatment for DID?

a) psychotherapy

b) medication

c) hypnotherapy

d) all of the above

Quiz

Multiple Choice

2) Which of the following is a known treatment for DID?

a) psychotherapy

b) medication

c) hypnotherapy

d) all of the above

Quiz

Multiple Choice

3) Which of the following symptoms does NOT distinguish DID from other mental disorders?

a) delusions

b) memory disruption

c) separate identities

d) amnesia

Quiz

Multiple Choice

3) Which of the following symptoms does NOT distinguish DID from other mental disorders?

a) delusions

b) memory disruption

c) separate identities

d) amnesia

Questions?