Dissociation and dissociative disorders



Dissociation And Dissociative Disorders 983
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Definition

The dissociative disorders are a group of mental disorders that affect consciousness and are defined as causing significant interference with the patient's general functioning, including social relationships and employment.

Description

Dissociation is a mechanism that allows the mind to separate or compartmentalize certain memories or thoughts from normal consciousness. These split-off mental contents are not erased. They may resurface spontaneously or be triggered by objects or events in the person's environment.

Dissociation is a process that occurs along a spectrum of severity. If someone experiences dissociation, it does not necessarily mean that that person has a dissociative disorder or other mental illness. A mild degree of dissociation occurs with some physical stressors; people who have gone without sleep for a long period of time, have had "laughing gas" for dental surgery, or have been in a minor accident often have brief dissociative experiences. Another commonplace example of dissociation is a person becoming involved in a book or movie so completely that the surroundings or the passage of time are not noticed. Another example might be driving on the highway and taking several exits without noticing or remembering. Dissociation is related to hypnosis in that hypnotic trance also involves a temporarily altered state of consciousness. Most patients with dissociative disorders are highly hypnotizable.

People in other cultures sometimes have dissociative experiences in the course of religious (in certain trance states) or other group activities. These occurrences should not be judged in terms of what is considered "normal" in the United States.

Moderate or severe forms of dissociation are caused by such traumatic experiences as childhood abuse , combat, criminal attacks, brainwashing in hostage situations, or involvement in a natural or transportation disaster. Patients with acute stress disorder , post-traumatic stress disorder (PTSD), conversion disorder, or somatization disorder may develop dissociative symptoms. Recent studies of trauma indicate that the human brain stores traumatic memories in a different way than normal memories. Traumatic memories are not processed or integrated into a person's ongoing life in the same fashion as normal memories. Instead they are dissociated, or "split off," and may erupt into consciousness from time to time without warning. The affected person cannot control or "edit" these memories. Over a period of time, these two sets of memories, the normal and the traumatic, may coexist as parallel sets without being combined or blended. In extreme cases, different sets of dissociated memories may cause people to develop separate personalities for these memories— a disorder known as dissociative identity disorder (formerly called multiple personality disorder).

Types of dissociative disorders

Dissociative amnesia

Dissociative amnesia is a disorder in which the distinctive feature is the patient's inability to remember important personal information to a degree that cannot be explained by normal forgetfulness. In many cases, it is a reaction to a traumatic accident or witnessing a violent crime. Patients with dissociative amnesia may develop depersonalization or trance states as part of the disorder, but they do not experience a change in identity.

Dissociative fugue

Dissociative fugue is a disorder in which a person temporarily loses his or her sense of personal identity and travels to another location where he or she may assume a new identity. Again, this condition usually follows a major stressor or trauma. Apart from inability to recall their past or personal information, patients with dissociative fugue do not behave strangely or appear disturbed to others. Cases of dissociative fugue are more common in wartime or in communities disrupted by a natural disaster.

Depersonalization disorder

Depersonalization disorder is a disturbance in which the patient's primary symptom is a sense of detachment from the self. Depersonalization as a symptom (not as a disorder) is quite common in college-age populations. It is often associated with sleep deprivation or "recreational" drug use. It may be accompanied by "derealization" (where objects in an environment appear altered). Patients sometimes describe depersonalization as feeling like a robot or watching themselves from the outside. Depersonalization disorder may also involve feelings of numbness or loss of emotional "aliveness."

Dissociative identity disorder (DID)

Dissociative identity disorder (DID) is considered the most severe dissociative disorder and involves all of the major dissociative symptoms. People with this disorder have more than one personality state, and the personality state controlling the person's behavior changes from time to time. Often, a stressor will cause the change in personality state. The various personality states have separate names, temperaments, gestures, and vocabularies. This disorder is often associated with severe physical or sexual abuse, especially abuse suffered during childhood.

Dissociative disorder not otherwise specified (DDNOS)

DDNOS is a diagnostic category ascribed to patients with dissociative symptoms that do not meet the full criteria for a specific dissociative disorder.

Rebecca J. Frey, Ph.D.



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Feb 6, 2011 @ 9:09 am
i had a horrific childhood which i assume contributed to my disassociation. but i had chosen to bury my childhood nightmares. unfortunately i had an accident in 1990 when i was age 30, in which i fractured my skull and spine and although i recovered physically at the time i was left with mental health issues which were very confusing, for 10 months after the accident i was totally confused and every day was a near suicidal nightmare worst of all my GP was seemingly annoyed at me. I was eventually sent to a psychiatrist who diagnosed petit-mal epilepsy i am now 51 and i haven't worked since that accident due to anxiety and depression and obesity. i have seen various psychologists and psychiatrists during the past 20 years as i am still very much confused. i am now recently being assessed yet again by a psychologist to see what further help(if any) they can offer. i self harm myself from scalding my arms to constantly scraping my torso with anything pointed like a dart. its embarrassing but i must do it to help combat the feeling of disassociation. i feel like my arms dont belong to me, i can feel they are mine but visually they are not. i try to avoid looking at my arms which isn't easy and looking at myself in a mirror is eerie, i cant quite connect with what i'm seeing and its totally bizarre. One psychiatrist i had briefly seen a few years ago said she didn't know what she was supposed to do with me, she said considering the length of time i had the problem could i not just accept it and get on with life!! She reduced me to tears. i cannot get used to it as its far too confusing, i take mirtazepine 45mg at bedtime as i could not sleep. i asked the doctor could they give me something to help me get through the day but they are not interested. maybe if they could experience the disassociation briefly then they would understand my torment, i appreciate tablets to help me sleep but i need help whilst I'm awake.i have had this problem for 20 years so the doctors assume i am dealing with it wrong!! they don't have to live with me they see me for between 15 minutes to an hour depending which doctor, families are the real people who see the true effects of this problem. maybe doctors should spend some time speaking to a partner or family member of the sufferer.

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