Chapter 4
Dissociative Disorders
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociation in the news
I’m not really running, I’m not really running…
(NYTimes, Dec 6, 2007)
“Without realizing what I was doing, I dissociated a few months ago, in the
middle of a long, fast bike ride. I’d become so tired that I could not hold the
pace going up hills. Then I hit upon a method — I focused only on the seat
of the rider in front of me and did not look at the hill or what was to come.
And I concentrated on my cadence, counting pedal strokes, thinking of
nothing else. It worked. Now I know why. “
Dr. Bill Morgan, who has worked
with hundreds of sub-elite
marathon runners, said every one
had a dissociation strategy. One
wrote letters in his mind to
everyone
he knew. Another stared
Chapter
8
at his shadow.
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociation in life and art
Examples of voluntary
engagement in a positive
dissociative experience?
Matt Dillon in Drugstore Cowboy
Magritte’s “The Lovers”
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociative Experiences in the
General Population
90
80
Percent
acknowledging
Percent in pathological
range
83
70
60
56
47
50
45
40
29
30
26
18
20
10
12
11
0
Missing part of Talking outloud to
Feeling as
Fantasy seems
conversation
oneself
thought one were
real
two different
people
Chapter 8
23
14
7
4
1
Hearing voices Feeling as though Not recognizing
one's body is not one's reflection in
one's own
a mirror
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociation


Normal vs. abnormal dissociation (different parts of
an individual’s identity, memories, or consciousness
become split off from one another)
When dissociation becomes chronic and a defining
feature, the person may be diagnosed with a
dissociative disorder.
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociation Exercise



Imagine what aspects of yourself could become
isolated as unique personalities. Detail the traits and
emotions associated with each alternative
personality.
Construct the type of situation that might produce the
emerging personality.
Debrief: Feelings in completing this task? Possible
reasons for doing it?
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociative Identity Disorder
Symptoms
Presence of two or more separate identities in the same
individual. These personalities may have different ways of
speaking and relating to others and can have different ages and
genders.
Etiology
Alters may be created by people under conditions of extreme
stress, often child abuse. Self-hypnosis may be involved.
OR
Created inadvertently by therapists
Treatment
Long-term psychotherapy to discover functions of the
personalities and to assist in “integration.”
Chapter 8
Sybil
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociative Fugue
Symptoms
Person suddenly moves away from home and assumes an
entirely new identity, with no memory of previous identity
Etiology
Fugue states usually occur in response to some stressor, but
because they are extremely rare, little is known about etiology
Treatment
Psychotherapy to help the person identify the stressors leading
to the fugue state and learn better coping skills
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociative Amnesia
Symptoms
Loss of memory due to psychological rather than
physiological causes. The memory loss is usually
confined to personal information only
Etiology
Typically occurs following traumatic events. May involve
motivated forgetting of events, poor storage of
information during events due to overarousal, or
avoidance of emotions experience during an event
Treatment
Help the individual remember traumatic events and
accept them
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Depersonalization Disorder



People with this disorder have frequent episodes in
which they feel detached from their own mental
processes or bodies, as if they are outside observers
of themselves.
Occasional experiences of depersonalization are
common, especially when people are sleep deprived.
Depersonalization Disorder is only diagnosed when
they are so frequent and distressing that they interfere
with an individual’s ability to function
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociative Disorders (Summary)

Dissociative
Identity Disorder

Separate, multiple personalities in the
same individual.

Dissociative
Fugue

The person moves away and assumes a
new identity, with amnesia for the previous
identity.

Dissociative
Amnesia

The person loses memory of important
personal facts, including personal identity,
for no apparent organic cause

Depersonalization
Disorder

Frequent episodes where individual feels
detached from his or her mental state or
body
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.