Dissociative Disorders At the most basic level … • Disorders dealing with disruptions or interruptions of typical consciousness • Patients lose track of who, where, and why with respect to identity and self-awareness • Also, profound memory deficits • Assumed to arise from stressful experiences but don’t involve typical anxiety symptoms Dissociation • A process in which some or all of our mental processes are separated from the main stream of consciousness, or • When our actions lose their connection with the rest of our personality Dissociative Disorders - Overview • Three types recognized in DSM 5 • All involve caused by dissociation which leads to some aspects of cognition, memory, or experience to be inaccessible consciously • Consciousness fails to perform its essential task, the seamless integration of our thoughts, emotions, motivations, and other aspects into our experience On the other hand … • Mild forms of dissociation are everyday experiences • Automatization – to perform a task without conscious awareness • You suddenly find yourself in your driveway without any memory of your trip • But for these disorders, the dissociation is much more severe Why? • Both the behavioral and psychodynamic theorists think that these severe levels of disconnectedness arise from an avoidance response • Protects person from experiencing significant fear and/or anxiety • Soldiers involved in intense military survival training report many brief instances A lot we don’t know • Lots of uncertainty • We just don’t know much about these disorders • Worse yet, there are major disputes regarding risk factors and treatment • Another reason arises from their scarcity • One in a thousand? • Even less? Is it just repression? • Psychodynamic theorists have an easy explanation • Some people, when placed under great stress, repress (purposefully forget) experiences, traumatic events, even their identity • But much evidence shows that trauma causes enhanced memory of the essential features of the threat Dissociative Amnesia • The inability to recall important personal information, usually concerning a bad experience • This problem cannot be explained by ordinary forgetfulness • These memories are unavailable during the amnesia episode • But they can be retrieved once it episode passes Fugue • Now a subtype of Dissociative Amnesia • Rare but fascinating • More severe than typical dissociative amnesias • Can involve limited but seemingly purposeful travel • Recovery usually complete except for what happened under fugue state Memory Distinctions • Dissociative Amnesia involves, by definition, problems with memory • But while explicit memory (memories we express in words) is disrupted …. • Implicit memory (memories based on experiences without conscious awareness) is not Depersonalization/Derealization • Depersonalization – a disconnection from your mental processes or body • You feel like a robot, like you have been lifted from your body and are observing yourself • Derealization – a disconnection from your surroundings • Nothing is real, everyone is a robot, the “world” of the Matrix Characteristics • Does not involve memory problems • Usually begins in adolescence and then persists • Comorbidity is common, 2/3s experience depression and anxiety • Childhood trauma is often found Dissociative Identity Disorder (DID) • DSM 5 1) at least two separate personalities (alters) 2) they have unique personalities, including differing and distinct: a) cognition b) behavior c) emotions d) memories, etc. More DID criteria 3) these alters may be seen by others , or reported by the patient 4) gaps in memory that are beyond simple forgetting’ 5) condition must be chronic 6) can’t be explained by cultural influences, drugs or religious beliefs. Alters • • • • • • • Differing personalities Behaviors. Handedness Memories Allergies Eye glasses prescriptions Foods Miscellaneous • More women than men • Begins as kids but generally not diagnosed til early adulthood • More severe than other Dissociative disorders • Tougher and longer for treatment • Often found with PTSD, major depressive disorder and somatic • Often physiological symptoms Why are some skeptical? • • • • Startling increases in diagnosis No cases prior to 1800 Few between 1920 and the 70’s Huge uptick after Sybil and The Three Faces of Eve in the mid-70’s • But very few cases in China and other places • Are some therapists merely finding what they were looking for? Posttraumatic model • Some people are predisposed to dissociation • If they experience severe childhood trauma • Alters develop to cope with the trauma • But the condition is so rare, there are no studies Are some just role-playing? • Maybe some people just jump into the culturally composed role of the “Multiple Personality Patient” • This is prompted by the work of therapists who suggest the existences of the alters then use hypnosis to “confirm” that they are real • Well publicized media reports provide a template Support for “role playing” • Some traumatized have considerable experience with fantasy lives • They may deeply wish they were someone else • They are also eager to please their therapist • Many therapeutic techniques do reward patients for revealing alters • People can readily invent alternate personalities Are the alters really distinct? • Clever studies demonstrate that alters share implicit memories • In another study it was established that alters also share explicit memories • The uniqueness of each alter seems more apparent than real Reliability ? • A disproportionate number of DID diagnoses come from a small number of clinicians • In Switzerland, 66% of diagnoses came from 10% of psychiatrists • In some clinics, DID is never indicated Does DID develop in treatment? • Usually, evidence of DID only develops during therapy – patients had no awareness of alters earlier • Were they suggested by overeager clinicians? • But a study of murders found some DID symptoms (trances, differing handwriting) in childhood Treatment • All therapists take a gentle, empathetic approach • Goal – to function as a completely integrated person • This is done by teaching strategies to effectively deal with stress • Meds don’t influence the presence of the alters Psychodynamics & DID treatment • Most popular therapeutic approach • But still very few • Great efforts to reverse the effects of repression • Since DID are highly hypnotizable, it is used to go back to the childhood abuse through age regression • Controversial and harmful