Dissociative Disorder

What is Dissociative Disorder?

Dissociative disorders (Latin dissociare “separated from the community”) – a group of mental disorders characterized by changes or disorders of a number of mental functions – consciousness, memory, feelings of personal identity, awareness of the continuity of their own identity. Usually these functions are integrated in the psyche, but when dissociation occurs, some of them are separated from the stream of consciousness and become, to a certain extent, independent. Thus, personal identity may be lost and a new one may arise, as it happens in states of a fugue or multiple personality, or individual memories may become inaccessible to consciousness, as in cases of psychogenic amnesia.

The term “dissociation” was proposed at the end of the 19th century by a French psychologist and physician P. Jean, who noted that a complex of ideas can be split off from the main personality and exist independently and outside of consciousness (but can be restored to consciousness through hypnosis). In modern psychiatry, the term “dissociative disorders” is used to refer to three phenomena:
– the emergence of multiple personality,
– psychogenic fugue
– and psychogenic amnesia.

Causes of Dissociative Disorder

Dissociation (splitting) is a mechanism that allows the mind to divide or divide particular memories or thoughts of ordinary consciousness into parts. These forked subconscious thoughts are not erased. They can re-spontaneously emerge in consciousness. They are enlivened by triggers (triggers), triggers can serve as objects and events surrounding a person during a traumatic event.

Dissociative identity disorder is thought to be caused by a combination of several factors: intolerable stress, ability to dissociate (including the ability to separate one’s memories, perceptions or identity from consciousness), manifestation of protective mechanisms in ontogenesis and – during childhood – lack of care and participation towards a child with a traumatic experience or lack of protection from subsequent unwanted experience. Children are not born with a sense of unified identity, the latter develops based on a variety of sources and experiences. In critical situations, child development is hindered, and many parts of what should have been integrated into a relatively unified identity remain segregated.
The process of dissociation (bifurcation) is a serious and long process with a large spectrum of action. If a patient (client) has a dissociative disorder, it does not mean that this is a manifestation of a mental illness.

A moderate degree of dissociation may occur due to stress; for people who have spent a long time without sleep, received a dose of “laughing gas”, during a dental surgery or suffered a minor accident, they often get a short dissociative experience. Another simple example of dissociative disorder is a person, who is sometimes so completely interested in a book or a film, that the world around him and the period of time pass by him imperceptibly. Known dissociation associated with hypnosis, which in turn includes a temporary change in the state of consciousness.

People often experience dissociative experience in the process of practicing religion (being in special trance states), or other group or individual classes (meditative practices, the highest level of autogenic training). These cases should not be taken as “frequent / ordinary”, considering Ukraine.

Moderate or complex forms of dissociation are observed in persons with traumatic experiences of childhood abuse, participants in hostilities, robbery, torture, or when suffering a natural disaster, a car accident. Dissociative symptoms may develop in patients with pronounced manifestations of post-traumatic stress disorder, or with disorders that have developed during somatization (diseases of internal organs, as a result of psychological conflicts).

North American studies show that 97-98% of adults with dissociative identity disorder describe situations of violence in childhood and that the fact of violence can be documented in 85% of adults and in 95% of children and adolescents with multiple personality disorder and other similar forms of dissociative disorder. These data indicate that childhood violence acts as the main cause of the disorder among North American patients, while in other cultures the consequences of war or natural disaster may play a big role. Some patients may not have experienced violence, but have experienced an early loss (for example, the death of a parent), a serious illness, or another extremely stressful event.

Human development requires the child’s ability to successfully integrate various types of comprehensive information. In ontogenesis, a person goes through a series of stages of development, in each of which different personalities can be created. The ability to generate multiple personalities is not observed or manifested in every child who has suffered violence, loss or injury. Patients with dissociative disorder identity have the ability to easily enter into trance states. Such ability in relation to the ability to dissociate is considered to act as a factor for the development of the disorder. However, most children with these abilities also have normal adaptive mechanisms and are not in an environment that can cause dissociation.

Symptoms of Dissociative Disorder

Dissociative Identity Disorder (DID) is the new name for the habitual Multiple Personality Disorder (MPD). DID is considered the most severe dissociative disorder and has most of the major dissociative symptoms.

DDNOS (a dissociative disorder not specified elsewhere) is attributed to patients with dissociative symptoms that cannot be placed in any of the categories of particular dissociative disorder.

Both mild / moderate and complex dissociations that occur in patients with dissociative disorders result from a set of reasons:
– Congenital ability to easily resist dissociation.
– Repeated episodes of mental or sexual abuse in childhood.
– The absence of a person who would support, comfort and protect from cruel relatives.
– The influence of other family members suffering from dissociative disorders, symptoms.

The relationship of dissociative disorders to abuse in childhood has generated deep debates and lawsuits in which the accuracy of childhood memories is questioned. The information that is stored in the brain, the functions of recovery and the interpretation of memory are not yet fully understood.

Main dissociative symptoms:
Dissociative (psychogenic) amnesia. Sudden loss of memory to patients due to stress or a traumatic event, while maintaining the ability to absorb new information. Consciousness is not disturbed, and the patient is aware of a loss of memory. Usually observed during war or natural disaster, more often in young women.

Dissociative fugue (psychogenic flight reaction, dissociative flight reaction). The sudden departure of a patient from home or from work, often accompanied by an affectively constricted consciousness, and the subsequent partial or complete loss of memory of his past, in many cases without the awareness of this loss. The patient may consider himself a completely different person and engage in a completely different matter.

Patients with a dissociative flight response, with DDNOS or DID often get confused about their identity or come up with a new personality for themselves. Subsequently, the stressful experience, the patient may behave differently than before, respond to different names, or not be aware of what is happening around.

Dissociative identification disorder (personality disorder in the form of a multiple personality). Identification of a person with several personalities who, as it were, exist in him alone; each of them periodically dominates, defining his views, behavior and attitude to himself as if the other personalities were absent. Individuals may have different gender, different ages and belong to different nationalities, each of them usually has its own name or description. In the period of predominance of one of the personalities, the patient does not remember his original personality and does not realize the existence of other personalities. There is a tendency to a sudden transition from the dominance of one person to the dominance of another.

Depersonalization disorder. Permanent or periodic experience of the alienation of their mental processes or their body, as if the subject experiencing this state was an outside observer (for example, feeling like a person in a dream). Distortions in the sense of time and space, apparent disproportion of limbs and derealization (sense of unreality of the surrounding world) are often observed. Patients can feel like robots. Often, the disorder is accompanied by depressive and anxiety states.

Ganser syndrome. Intentional production of severe mental disorders. Sometimes they describe it as a mimorement (mimorech) – incorrect answers to simple questions. It is noted in individuals with other mental disorders. Sometimes combined with amnesia, disorientation, perception disorders. More often recorded in men, especially among prisoners.

Dissociative disorder in the form of trance. Disorder of consciousness with a significant decrease in the ability to respond to external stimuli. The state of trance is observed in mediums during seance sessions, in pilots during long flights due to the monotony of movement at high speeds and the monotony of visual impressions, which can lead to plane crashes. In children, these conditions can occur after physical abuse or injury. Special states of obsession are observed in a particular region or in a given culture, for example, the Malaysian amok (a sudden attack of rage followed by amnesia, during which the patient runs, destroying everything in his path, until he cripples or kills himself ), Piblocktox in Eskimos (attacks of excitement followed by amnesia, during which patients scream, imitate the sounds of animals, tear off their clothes).

Dissociation states are observed in individuals who have been subjected to prolonged and intense forcing suggestion, such as the forced processing of consciousness when seized by terrorists or when involved in a sect.

Derealization, not accompanied by depersonalization.

Dissociative coma, stupor or loss of consciousness, not associated with somatoneurological disease.

Diagnosis of Dissociative Disorder

According to the Diagnostic and Statistical Handbook of Mental Disorders (DSM-IV), a diagnosis of dissociative identity disorder is made if a person has two or more distinct identities or personal states (each has its own relatively long-lasting pattern of perception and relationship between the environment and oneself), at least two of these identities recurrently seize control over human behavior, the individual is not able to recall important personal information ation that goes beyond ordinary forgetfulness and self disorder is not caused by the direct physiological effects of a substance (eg, insanity or chaotic behavior during alcohol intoxication) or a general medical condition (eg, complex partial seizures). It is noted that in children these symptoms should not be attributed to fictional friends or other types of games using fantasy.

The criteria for diagnosing dissociative identity disorder, published by the DSM-IV, have been criticized. In one study (2001), a number of deficiencies in these diagnostic criteria were highlighted: in this study it is argued that they do not meet the requirements of modern psychiatric classification, are not based on a taxometric analysis of the symptoms of dissociative identity disorder, describe the disorder as a closed concept, have poor content validity, ignore important data, prevent taxonomic research, have a low degree of reliability, and often lead to incorrect formulation of of the diagnosis, they contain a contradiction and the number of cases with dissociative personality disorder in it is artificially underestimated. This study proposes a solution for DSM-V in the form of new, more convenient to use, politetic diagnostic criteria for dissociative disorders.

To exclude organic brain damage: EEG MRI / CT.

Differential diagnosis
– Infectious diseases (herpes simplex), brain tumors affecting the temporal lobe.
– Temporal epilepsy
– Delirium
– Amnesia syndrome
– Postconcussion (posttraumatic) amnesia
– Postoperative amnesia
– Disorders associated with the use of psychoactive substances.
– Schizophrenia
– Mental retardation
– Dementia
– Borderline personality disorder
– Post Traumatic Stress Disorder
– Somatoform disorders
– Bipolar disorder with rapid episode alternation
– Simulation.

Treatment of Dissociative Disorder

Treatment of dissociative disorders may include psychotherapy, drug treatment, or a combination of both approaches.

In the case of psychotherapy, patients often need the help of a doctor who specializes in this problem and is experienced in treating dissociative disorders. Such knowledge is especially necessary if the patient’s symptoms are expressed by the problems of determining personal identity.

Some doctors prescribe tranquilizers or anti-depressants for excessive activity, anxiety, and / or depression, which are often found along with dissociative disorders. However, patients with dissociative disorders are more susceptible to addiction and dependence on medications.
Hypnosis is often recommended as a treatment for dissociative disorders, in part because hypnosis is associated with the process of dissociation. Hypnosis helps get rid of oppressive ideas or memories. Specialists who treat patients with DID use hypnosis from time to time in the process of “closing” alternative individuals.

Prospects for recovery from dissociative disorders are different. Recovery from dissociative escape usually occurs quickly. Dissociative amnesia can be cured fairly quickly, but in some patients it can turn into a chronic disorder. Depersonalization, DDNOS and DID are usually chronic conditions. For the treatment of DID will take from five years of continuous treatment.

Prevention of Dissociative Disorder

Preservation of mental health and the prevention of mental disorders is a much less understandable task than the prevention of infectious diseases, for the prevention of which vaccination is carried out, and antibiotics are used for treatment; in the area of ​​mental illness, such measures do not exist.

Worldwide, drug and alcohol abuse have led to a mental health crisis. As a result of the formation of dependence, the psyche of tens of millions of men, women and children suffers.

Child abuse is also a worldwide phenomenon. As a factor in the emergence of mental illness, it deserves much more attention than it is now being given. In recent years, such violence has been seen as the primary cause of multiple personality syndrome. International organizations such as the World Health Organization are working hard to identify and eradicate child abuse in the third world under the guise of child labor, i.e. the constant and legalized use of children in industry and agriculture is in fact as slaves.

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