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Dissociative disorders. Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder. Dissociation. “Disruption in the usually integrated functions of consciousness memory identity perception of the environment” (DSM-IV, p.477). Other occurrences of dissociative symptoms.

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dissociative disorders

Dissociative disorders

Dissociative Amnesia

Dissociative Fugue

Dissociative Identity Disorder

dissociation
Dissociation
  • “Disruption in the usually integrated functions of
    • consciousness
    • memory
    • identity
    • perception of the environment” (DSM-IV, p.477)
other occurrences of dissociative symptoms
Other occurrences of dissociative symptoms
  • Other disorders
    • Acute Stress and Posttraumatic Stress
    • Somatization Disorder
    • Conversion Disorder
  • Cultural expression or activity
  • Religious experiences
  • Dissociation is not inherently pathological
dissociative amnesia
Dissociative Amnesia
  • Important personal information cannot be recalled
  • Usually related to trauma or stress
  • Beyond normal forgetting
  • Usually reported as gaps in otherwise intact memories of a person’s own life
what is lost
What is lost?
  • Victim memories: Trauma or stress
  • Perpetrator memories
    • Violence
    • Suicide attempts
    • Self-mutilation
types of dissociative amnesia
Types of Dissociative Amnesia
  • More common:
    • Localized amnesia: Period of time
    • Selective amnesia: Certain events selected from a series
  • Less common:
    • Generalized amnesia: Entire life
    • Continuous amnesia: From an event on
    • Systematized amnesia: Categorical
dissociative fugue
Dissociative Fugue
  • Sudden relocation (fugue) with amnesia
  • May assume a new identity, and function well. May seem more healthy than before the fugue.
  • Upon recovery, may be amnesic for the fugue episode
amnesia fugue and the law
Amnesia, fugue, and the law
  • Sometimes claimed as a criminal defense
    • Persists through hypnosis, barbiturate interviews
    • No available test to distinguish it from malingering
  • Consider the gain produced by the symptom
  • Crime due to true dissociation is irrational or produces no secondary gain
dissociative identity disorder
Dissociative Identity Disorder
  • Two or more distinct personalities
    • Host and alters
    • Median: 10 personalities (women:15, men:7)
    • Range: 2 to >100
  • Control of behavior rotates among personalities
    • Often cued by stressors, switch in seconds
    • Some personalities appear rarely
more did features
More DID features
  • At least some of the personalities are unaware of the others, and demonstrate amnesia
  • Sometimes the voices of alters are experienced as hallucinations
  • Some alters are supportive
  • Others are the voice of the perpetrator
etiological validity of did
Etiological validity of DID
  • 90% of cases are women
  • Memory loss for extended periods of time in childhood is common
  • Repeated, severe, usually sexual abuse is common
  • Posttraumatic symptoms are sometimes seen
cultural context of did
Cultural context of DID
  • Highest rates in U.S.A. and Australia
    • Is child abuse highest here?
    • Is DID a media creation?
    • Is DID iatrogenic?
depersonalization disorder
Depersonalization Disorder
  • Repeated or enduring feelings that one is detached from one’s body or self
  • May feel like an automaton or a detached observer
  • May feel loss of control of actions or speech
  • May coexist with derealization
  • Reality testing remains intact
dissociative disorder nos
Dissociative Disorder NOS
  • Subclinical DID
  • Derealization without depersonalization
  • Dissociation due to coercion
    • Brainwashing
    • Cult indoctrination
  • Dissociative trance disorders: Culture-bound
  • Ganser syndrome