Dissociative disorders

What causes the dissociation

 * psychogenic in origin: it requires a severe and prolonged stressor (early in childhood for DID)
 * some sort of emotional experience (spectrum) → the symptoms are believed to be psychogenic in origin

What is dissociated?
Integration of thought, memory, identity.. (derealization, depersonalization, fragmentation of identity, amnesia, altered consciousness)


 * think of it as a spectrum: depersonalization/derealization being on the lower end, dissociative amnesia in the middle and dissociative personality disorder at the upper end
 * Main diseases, that you can talk about

→ Dissociative amnesia +- fugue

→ Dissociative personality disorder

→ Depersonalization/derealization

→ other dissociative disorder, unspecified dissociative disorder

Clinical diagnosis in general

 * Clinical
 * Rule out malingering, rule out substance abuse (e.g. ecstasy)

Therapy

 * Psychotherapy (wanting to merge personalities, re-experiencing trauma and processing it)

Dissociative identity disorder (DID)

 * ≥ 2 distinct identities
 * Cause: a severe emotional trauma in childhood (often sexual abuse), that leads to the splitting of the personality
 * such patients have often over 8 different personalities, which are formed as a internal defense reaction toward that stressor
 * These personalities have their own identity -> dissociation of identity, memory, thoughts
 * These personalities can assume any type of gender and age, even if it is not conform with the biological realities of the patient

Dissociative amnesia

 * amnesia after a traumatic or stressful event → the patient can´t remember the event (e.g. rape) or everyday routines or entire autobiography (who am I?) (i.e. amnesia can be localized (single event or time period), selective (forgetting about a certain person or place), or generalized (e.g. autobiographical -> "who am I?")
 * symptoms cause significant social or occupational impairment and are not due to substance use or another psychiatric disorder (e.g. DID, PTSD)
 * Amnesia can be with or without fugue (travel)

Depersonalization/derealization

 * Derealization: from the environment (it does not feel real)
 * these patients have intact reality testing
 * occur in non-severe trauma

Other dissociative disorders according to the ICD-10
With difference to the DSM-V, "dissociative disorders" in the current ICD-Classification also includes conversion disorders, which are basically neurological symptoms caused by a psychogenic stressor (e.g. paralysis of the limbs, anesthesia, seizures, pain). In the DSM-V they are categorized seperately.