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  Dissociative symptoms might be present in a number of other diagnoses (PTSD).

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  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 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  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 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 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 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 Disorder  Depersonalization is the major symptom necessary in order to meet the diagnostic criteria.  Causes distress and/or psychosocial impairment.

Assessment  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  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 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 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 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.