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Disorders of Dissociation. Assessment & Diagnosis SW 593. Introduction. Dissociation refers to instances in which the normally integrated aspects of cognitive functioning are disrupted. Consciousness Memory Identity Perception

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disorders of dissociation

Disorders of Dissociation

Assessment & Diagnosis

SW 593

  • Dissociation refers to instances in which the normally integrated aspects of cognitive functioning are disrupted.
    • Consciousness
    • Memory
    • Identity
    • Perception
  • Dissociative symptoms might be present in a number of other diagnoses (PTSD).
dissociative amnesia
Dissociative Amnesia
  • Client has one or more episodes in which they cannot remember important personal information.
  • Forgotten material is too extensive to be attributed to normal forgetfulness.
  • Material forgotten is of a traumatic or stressful nature.
  • Symptoms must be associated with distress or psychosocial impairment.
dissociative fugue
Dissociative Fugue
  • Also unable to recall some or all of their personal history.
  • Sudden and unexpected travel that removes the person from their home/usual surroundings occurs.
  • Has some degree of confusion about their identity and may actually assume a new identity.
dissociative fugue1
Dissociative Fugue
  • The episode may not be part of Dissociative Identity Disorder or be a result of substance abuse or some general medical condition.
  • Significant distress and/psychosocial impairment is experienced.
dissociative identity disorder
Dissociative Identity Disorder
  • Two or more distinct identities or personalities are present and recurrently take control of the individual’s behavior.
  • There is an inability to recall personal information while the client is in at least one of the distinct identities.
  • The situation is not due to substance abuse or a general medical condition.
dissociative identity disorder1
Dissociative Identity Disorder
  • Results in distress and/or psychosocial impairment.
  • Formerly known as Multiple Personality Disorder.
  • Clients will have a primary identity that carries the individual’s legal name.
  • Each alternative frequently has a different name and can vary from the primary identity in terms of age, gender, knowledge, and affect.
dissociative identity disorder2
Dissociative Identity Disorder
  • Each identity has an enduring pattern of viewing and relating to the environment and the self.
  • The primary and alternative identities may or may not be aware of the existence or experiences of one another.
  • Persons with this disorder may have frequent gaps in memory for both recent and remote events.
depersonalization disorder
Depersonalization Disorder
  • Depersonalization is characterized by feeling detached or estranged from one’s self.
  • Described as feeling outside the self as if viewing a movie.
  • Reality testing must remain intact during the episodes.
  • Brief instances of depersonalization are not unusual or may be associated with another mental disorder.
depersonalization disorder1
Depersonalization Disorder
  • Depersonalization is the major symptom necessary in order to meet the diagnostic criteria.
  • Causes distress and/or psychosocial impairment.
  • The first clue that a dissociative disorder is occurring is “holes” or unaccounted periods of time.
  • Careful history focused around times of stress can be particularly informative.
  • Several psychometric instruments can be utilized including:
    • Dissociation Questionnaire (DIS-Q)
    • Child Dissociative Checklist (CDC)
cultural considerations
Cultural Considerations
  • Dissociative experiences, particularly fugue-like states, may occur within a number of cultural groups as an accepted expression of cultural activities or religious practices.
  • No clinical distress or psychosocial impairment occurs.
  • Dissociative Identity Disorder is diagnosed much more frequently in women than men.
cultural considerations1
Cultural Considerations
  • Men with this disorder tend to have fewer distinct identities.
  • In children, the data suggests that the occurrence is more evenly distributed between the sexes.
  • “Spells” are not diagnosable according to the DSM.
  • Spells is a trance-like state in which the individual may communicate with deceased relatives.
cultural considerations2
Cultural Considerations
  • Another condition seen around the world is that of “zar”.
  • Zar episodes are characterized by persons appearing to be in a dissociative state where they may shout, cry, laugh, sing, or hit their heads against a wall.
  • The belief is that they are possessed by a spirit, and the state is not considered pathological.
cultural considerations3
Cultural Considerations
  • Scott (1999) suggests that persons experiencing dissociative disorders are individuals who are unable to resolve past histories of childhood trauma, pain, ritualized physical and sexual abuse.