Dissociative Disorders

• Memory difficulties and other dissociative symptoms found in these disorders are particularly intense

• Dissociative reactions are the main or only symptoms

• People with dissociative disorders do not typically have significant arousal, negative emotions, sleep difficulties, and other problems that characterize acute and posttraumatic stress disorders.

Kinds of Dissociative Disorders

Dissociative amnesia: Unable to recall important personal events/information

Dissociative identity disorder: Subpersonalities/ alternative personalities

Depersonalization-derealization disorder: Detached from their own mental processes or bodies

Dissociative Amnesia Symptoms

• A person cannot recall important life-related information, typically traumatic or stressful information. The memory problem is more than simply forgetting

• Lead to significant distress or impairment

• Symptoms are not caused by a substance or medical condition

• Localized: Most common type; is the loss of all memory of events occurring within a limited period

• Almost always beginning with some very disturbing occurrence

• Selective: Loss of memory for some, but not all, events occurring within a period

• Generalized: Loss of memory beginning with an event, but extending back in time; may lose the sense of identity; may have a failure to recognize family and friends

• Continuous: Forgetting continues into the future; quite rare in cases of dissociative amnesia

• Amnesia interferes with personal material

• 2% of all adults experience dissociative amnesia in a given year

Dissociative Identity Disorder Symptoms

• A person experiences a disruption to his or her identity, as reflected by at least two separate personality states or experiences of possession

• A person repeatedly experiences memory gaps regarding daily events, key personal information, or traumatic events, beyond ordinary forgetting

• This leads to significant distress or impairment

• Symptoms are not caused by a substance or medical condition

Dissociative fugue

• An extreme version of dissociative amnesia

• People not only forget their personal identities and details of their past but also flee to an entirely different location

• May be brief or more severe

• The majority of people regain most or all of their memories and never have a recurrence.

Dissociative identity disorder

• Two or more distinct personalities (subpersonalities or alternate personalities) develop

• Each has a unique set of memories, behaviors, thoughts, and emotions

• A sudden movement from one subpersonality to another (switching) is usually triggered by stress

• Women are diagnosed three times more often than men

• Most cases are first diagnosed in late adolescence or early adulthood, but more often than not, the symptoms actually began in early childhood after episodes of trauma or abuse

How do subpersonalities interact?

Three kinds of relationships

• Mutually amnesic relationships

• Mutually cognizant patterns

• One-way amnesic relationships: most common

• The average number of subpersonalities is now thought to be 15 for women and 8 for men; often appear in groups of 2 or 3

How do theorists explain dissociative amnesia and dissociative identity disorder?

Psychodynamic perspective

• Dissociative amnesia and fugue are single episodes of massive repression

• People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness

• Block memory of the upsetting events to avoid the pain of facing it

• DID results from a lifetime of excessive repression, motivated by very traumatic childhood events

• Most of the support for this model is drawn from case histories

• Only a small fraction of abused children develop this disorder and some individuals with this disorder do not seem to have an abusive background

How do cognitive-behavioral theorists explain dissociative amnesia and dissociative identity disorder?

State-dependent learning

• Learning becomes associated with the conditions under which it occurred so that it is best remembered under the same conditions

• People who are prone to develop dissociative disorders have state-to-memory links that are unusually rigid and narrow

The parallel between hypnotic amnesia and dissociative disorders

Hypnosis: sleeplike state in which people become suggestible

• People can behave, perceive, and think in ways that would ordinarily seem impossible

• Can make people forget facts, events, and even their personal identities

• Dissociative amnesia may develop in people who hypnotize themselves into forgetting horrifying experiences

How do therapists help individuals with dissociative amnesia?

• People with dissociative amnesia often recover on their own

• Psychodynamic therapists guide patients to search their unconscious and bring forgotten experiences into consciousness

• In hypnotic therapy, patients are hypnotized and guided to recall forgotten events

• In drug therapy, intravenous injections of barbiturates are sometimes used to help patients regain lost memories

• The effect is to calm people and free their inhibitions, thus helping them to recall anxiety-producing events

How do therapists help individuals with dissociative identity disorder?

• People with dissociative identity disorder usually require treatment to regain their lost memories and develop an integrated personality

• Recognize fully the nature of their disorder

• Therapists typically try to bond with the primary personality and with each of the subpersonalities

• Try to educate patients and help them to recognize fully the nature of their disorder

• Introduce the subpersonalities to one another, by hypnosis or by having patients look at videos of their other personalities

• Recover the gaps in their memory

• Integrate their subpersonalities into one functional personality

Depersonalization-derealization disorder

• The feeling of detachment from own mental processes or body

• Observing self from outside

• Feeling that external word is unreal and strange

• Aware that their perceptions are distorted

• Transient depersonalization and derealization experiences are relatively common, while depersonalization-derealization disorder is not

• 2% of the population, most often adolescents and young adults

• Symptoms of a depersonalization disorder are persistent or recurrent, cause considerable distress, and interfere with social relationships and job performance

• Few theories about depersonalization-derealization disorder and almost no studies of the efficacy of treatments