Dissociative disorders

Dissociative disorders in general

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.