What are DISSOCIATIVE DISORDERS

Dissociative Disorders are psychological disorders that are characterized by severance or disruption in the normal integration of consciousness, emotions, memory, behaviour, perception, body representation and motor control. The discontinuity with oneself is at a great extent and disrupts the everyday activities of the individual. The dissociative disorders are often a result of traumatic experiences.

 

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Symptoms of Dissociative Disorders

The symptoms of each type of dissociative disorder vary, but it may include-

• Loss of memory
• Sense of detachment
• An unclear sense of identity
• Altered sense of time
• Individuals or objects may seem dreamlike, foggy, lifeless
• Emotional or physical numbing
• Perceptual alterations
• Experience of flashbacks

 

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Types of Dissociative Disorders-

There are three main types of dissociative disorders-

1. Dissociative Identity Disorder-

This disorder is characterized when a person alters between two or personality states. In some cultures, it may be described as the experience of being possessed. It includes an inability to recall day-to-day events, personal information and stressful events, which are not common as ordinary forgetting. A history of childhood abuse is found to be associated with a majority of cases.

Risk and Prognostic Factors-

Environmental factors– Interpersonal physical abuse, sexual abuse, childhood abuse, neglect, war, terrorism, childhood medical and surgical procedures, childhood prostitution.

Course modifiers– A continuing abuse, later life re-traumatization, co-morbid diagnoses, delay in treatment.

Prevalence-

The prevalence of this disorder was found to be 1.5% in a small US community 12- month study and the prevalence among genders was found to be 1.6% for males and 1.4% for females, in the study.

Suicide Risk-

Suicide has been attempted by 70% of outpatients suffering from dissociative identity disorder, with frequent self-injurious behaviours as well as multiple attempts to suicide.

Differential Diagnosis-

• Major depressive disorders
• Bipolar disorders
• Post-traumatic stress disorders
• Psychotic disorders
• Personality disorders
• Seizure disorders 

 

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2. Dissociative Amnesia-

This disorder is characterized by an inability to recall personal and autobiographical details, that are commonly not forgotten. The amnesia is not caused by physiological reasons.

The amnesia maybe-

Localized– In this case, the individual is unable to recall a particular event or a particular period of time.

Selective– The individual can recall parts of a particular event and forgets some parts.

Generalized– Individuals suffering from generalized amnesia may forget their identity as well as life history. Some individuals may find it difficult to perform previously known tasks or recall learned knowledge.

Systemized– In this case, a specific category of information is forgotten.

Continuous– The individuals suffering from this forget each new event as it occurs.

Dissociative Fugue–

It is a phenomenon that occurs with dissociative amnesia in some individuals. It is characterized by a sudden, unpredictable, purposeful travel away from home and bewildered wandering.

Risk and Prognostic Factors-

Environmental– Single or multiple traumatic experiences of war, childhood abuse, natural calamities, genocide, physical abuse, sexual abuse

Course modifiers– Removal from traumatic circumstances may return the memory or onset of PTSD symptoms may diminish the localized, selective, systemized amnesia, possibly in the form of flashbacks.

Prevalence–

The prevalence was found to be 1.8% in a small US community 12-month study and the prevalence across genders was found as 1% for males and 2.6% for females.

Suicide Risk–

Self-destructive behaviours and suicidal tendencies are common in individuals with dissociative amnesia, mainly when the amnesia remits and overwhelms the individual with the memories.

Differential Diagnosis-

• Dissociative identity disorders
• Post-traumatic stress disorders
• Neurocognitive disorders
• Catatonic stupor
• Substance-related disorders
• Factitious disorder and malingering

 

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3. Depersonalization/Derealization Disorder-

This disorder is characterized when there is a recurrent or persistent experience of depersonalization, derealization or both.

Depersonalization– This involves an experience of being detached from one’s own body, sensation, thoughts, feelings and action. It is a recurring sense of being an observer or outsider to their own self.

Derealization– This involves an experience of being detached from one’s surroundings. The people and the world around may seem unreal.

Risk and Prognostic Factors-

Temperamental– Harm-avoidant temperament, contorted defence mechanisms, over connection or disconnection schemata.

Environmental– Emotional abuse, emotional neglect, interpersonal traumas of childhood, physical abuse, witnessing domestic abuse, sudden death or suicide of a close friend or family member.

Prevalence- 

In the US and other countries, the lifetime prevalence of the disorder was found to be approximately 2% and the gender ratio was found to be 1:1.

Differential Diagnosis-

• Major depressive disorder
• Obsessive-compulsive disorders
• Anxiety disorders
• Psychotic disorders
• Substance/medication-induced disorders
• Other dissociative disorders

 

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Treatment-

There is no specific treatment for the dissociative disorder but with the help of medication and counselling, an individual may manage to reduce the symptoms and diminish the distress and impairment caused in social, occupational and other important areas of functioning.

The treatment may include:

Psychotherapy–

Various therapies that may help find the cause of the dissociation and reduce the symptoms are:

Cognitive Behavioral therapy- This is designed to change the negative thoughts and behaviors of the individual.

Hypnotherapy– This technique uses relaxation and extreme attention to help the individual achieve an enhanced state of consciousness, and sooner process their memories in that relaxed state.

Phasic Trauma treatment- It can help the individual reduce their suicidal thoughts and self-destructive behaviours. It can also slowly process the traumatic memories and help them in the reintegration of their identities.

Dialectical Behavior Therapy- This treatment focuses on skills training of the client and making them well-equipped to solve their problems and cope with the difficulties.

Eye movement desensitization and reprocessing– This technique is usually paired with cognitive behavioural therapy. It uses visual exercises to help the individual work through traumatic memories and thereby reducing the nightmares and flashbacks.

Medication- 

Antidepressants, mood stabilizer or drugs for anxiety or sleep difficulties may be prescribed.

 

 

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Myths

Some common myths about dissociative disorders are-

• The dissociative disorders are easy to understand.
• People diagnosed with dissociative disorders are dangerous.
• Individuals with the dissociative disorder do not require treatment.
• Dissociative disorders are rare.
• Psychotic disorders and dissociative disorders are similar to each other.
• Medication can treat dissociative disorders.

 

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Conclusion

Dissociation disorders are difficult to identify, diagnose, treat and even harder to live with. We can make a small effort by making ourselves aware of the challenges faced by them and diminishing the environmental difficulties we may bring upon them.

References 

DSM-V Manual

https://www.msdmanuals.com/professional/psychiatric-disorders/dissociative-disorders/overview-of-dissociative-disorders

https://www.webmd.com/mental-health/dissociation-overview#3-6