Dissociative Disorders

Splitting off of thoughts, feelings, or behaviors ordinarily connected Temporary alteration in normally integrative functions of: Consciousness Identity Memory

Dissociation: Historical Development Psychological Development Influence of the times Skepticism of MHP Controversy

Historical Development 19 the Century Hysterical Neurosis-Dissociative type Derived from cultural factors of time Theatricality, puritanical ethos which fostered repression Mechanism of defense/neurotic safeguard

Psychological Development Janet: dissociation= split in consciousness Result of of neuropsychological weakness Freud: repression= unconscious thoughts used to ward off painful effects Psychological over organic explanation

Psychological Development (cont’d) Prince : different conscious states could co-exist without awareness Freud & Prince high influence on later researchers & theorists. Belief in split of conscious, not organic etiologies Disappearance explained by change in culture

Recent Trends 60’s: “me’ &“now” generation, shift to narcissistic ethos Skepticism (confusion of lumping) DSM approach: diagnosis based on similarities of sign/symptoms rather than postulation Core concept: Temporary disruption in memory, identity, or consciousness May lead to amnesia, depersonalization or multiple personalities

Current Trends (last 20+ years) Existence is rareIncrease in # of cases Resurgence of Interest: Inappropriate diagnosis Split in MH Profession Ex. I Never Promised You a Rose Garden

Normalcy of Disassociation Not necessarily psychopathology Phenomena may occur spontaneously Can be sought Can be induced for therapeutic purposes Society supports & reinforces to some degree Related to phenomenon underlying hypnotizability Continuous rather than singular/discrete phenomenon

Commonplace Dissociative Events Daydreaming Absorption in reverie Examples: Driving past one’s expressway exit Not hearing your name called by instructor 3-yr old having imaginary playmate “Self” accepted by public; supported in literature & arts Conflict, diversity, & disparity within self-structure is central to being human

As Pathological When complex behavior takes place outside awareness of predominant consciousness Etiologies usually functional or psychological Can be organic Interferes with memory, identity, or consciousness

Etiologies Periods of amnesia can be caused by alcohol or substance intoxication Head trauma Temporal lobe epilepsy/partial complex seizures

Synopsis of Dissociative DO Dissociative Amnesia One or more episodes of inability to recall personal information. Traumatic or stressful nature, too extensive to be explained by ordinary forgetfulness. Extensive memory loss, but usually doesn’t travel from home. Transitional, usually no treatment. Dissociative Fugue Sudden & unexpected (uncommon) travel from home or work; enabling recall of past, have confusion about personal identity, & may assume identity. “Exit” from personality, usually temporary.

Synopsis of Dissociative DO (cont’d) Depersonalization Disorder Recurrent feelings of detachment from thoughts or body. Reality testing remains intact Dissociative Disorder Not Otherwise Specified Dissociative disoder present, but no specific criteria met

Dissociative Identity Disorder (DID) Hallmark – failure to integrate identity, memory & consciousness 2 or more distinct identities/personality states with relatively enduring pattern of perceiving, relating to, & thinking a/O environment & self Fluctuating clinical course tending toward chronicity & recurrence

Helpful Movies & Books Movies Three Faces of Eve When Rabbits Howls Trudy Chase Story Sybil Books Try to Remember (Kotter) The First Sin of Ross Michael Carlson (Weissberg ) Sybil When Rabbit Howls