Transcript Dissociative Disorders

Dissociative Disorders
Dissociation
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Psychogenic disruption in conscious
awareness
Complex mental activity that is
independent from or not integrated
within conscious awareness
Automatisms
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Accomplishing a task with little or no
conscious awareness
Much of our life involves nonconscious mental activity (both
perception and memory)
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Automatic, non-deliberate, not selfmonitored
When is Dissociation a problem?
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Loss of overall, integrative control
Unable to access information
Loss of a coherent sense of self
Dissociative Disorders
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Splitting apart of components (identity,
memory, perception) of a persons
personality that are usually integrated
Types of Dissociative Disorders
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Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder
Depersonalization Disorder
Dissociative Amnesia
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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:
Patterns of Memory Loss
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Localized amnesia
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Selective amnesia
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All events in a circumscribed period
Forget only certain events that occur
during a circumscribed period
Generalized amnesia
Continuous amnesia
Systematized amnesia
Dissociative Fugue
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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
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Sense of self, or personality breaks up
into two or more distinct identities
which take turns “controlling”
behaviour
At least one “personality” is amnesic
for the experiences of the others
“Alter” often coconscious with the host
Dissociative Identity Disorder
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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
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Faking - malingering
Induced by therapy - iatrogenic
Social Role
Hypnotizability
“False Memory Syndrome”
Depersonalization Disorder
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Disruption in identity without amnesia
Sense of strangeness or unreality in
oneself
Derealization
Reduced emotional responsiveness
Explaining Dissociative
Disorders
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Most theories assume that dissociation
is a way of escape from situations that
are beyond coping powers
Psychodynamic Perspective
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Janet (1929)
Anxiety relief
Dissociative amnesia = repression
Fugue and DID also involve acting out
of repressed wish
Treatment: safety, awareness*,
integration
Behavioural and Sociocultural
Perspective
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Behavioural: Learned coping response
– symptoms are rewarded and / or
relieve stress
Sociocultural: Adopting a “social role”,
often see iatrogenic forces as part of
cause
Treatment = non-reinforcement
Cognitive Perspectives
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Disorders of memory
State dependent memory
Neuroscience Perspective
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Undiagnosed epilepsy
Stress induced damage to
Hippocampus – which brings different
sensory modalities back together
during recall
Disruptions in serotonin