Dissociative Disorders

Dissociation Psychogenic disruption in conscious awareness Complex mental activity that is independent from or not integrated within conscious awareness

Automatisms Accomplishing a task with little or no conscious awareness Much of our life involves non- conscious mental activity (both perception and memory)  Automatic, non-deliberate, not self- monitored

When is Dissociation a problem? Loss of overall, integrative control Unable to access information Loss of a coherent sense of self

Dissociative Disorders Splitting apart of components (identity, memory, perception) of a persons personality that are usually integrated

Types of Dissociative Disorders Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder Depersonalization Disorder

Dissociative Amnesia Partial or total forgetting of past experience without a biological cause Almost always anterograde – blocking out a period of time after psychogenic cause (e.g. stress / trauma) Memory loss is often selective Relative indifference to loss of memory Remain well oriented to time and place

Dissociative Amnesia: Patterns of Memory Loss Localized amnesia  All events in a circumscribed period Selective amnesia  Forget only certain events that occur during a circumscribed period Generalized amnesia Continuous amnesia Systematized amnesia

Dissociative Fugue Amnesia + sudden, unexpected trip away from home Often involves the creation of a new identity Fugue state usually ends abruptly – then amnesic for events during the fugue

Dissociative Identity Disorder Sense of self, or personality breaks up into two or more distinct identities which take turns “controlling” behaviour At least one “personality” is amnesic for the experiences of the others “Alter” often coconscious with the host

Dissociative Identity Disorder Identities are often polarized Often each identity specializes in different areas of functioning, encapsulates different memories Very high proportion report significant trauma in childhood – possible strategy that children use to distance themselves from trauma

Controversy re. cause of DID Faking - malingering Induced by therapy - iatrogenic Social Role Hypnotizability “False Memory Syndrome”

Depersonalization Disorder Disruption in identity without amnesia Sense of strangeness or unreality in oneself Derealization Reduced emotional responsiveness

Explaining Dissociative Disorders Most theories assume that dissociation is a way of escape from situations that are beyond coping powers

Psychodynamic Perspective Janet (1929) Anxiety relief Dissociative amnesia = repression Fugue and DID also involve acting out of repressed wish Treatment: safety, awareness*, integration

Behavioural and Sociocultural Perspective Behavioural: Learned coping response – symptoms are rewarded and / or relieve stress Sociocultural: Adopting a “social role”, often see iatrogenic forces as part of cause Treatment = non-reinforcement

Cognitive Perspectives Disorders of memory State dependent memory

Neuroscience Perspective Undiagnosed epilepsy Stress induced damage to Hippocampus – which brings different sensory modalities back together during recall Disruptions in serotonin