Dissociative Disorders
➢ Dissociative disorders are most likely to happen after an extremely stressful event,
such as an accident; or it can happen if you’re very tired or under physical or mental
pressure like staying up all night studying for an exam
➢ During an episode of depersonalization, your perception alters so that you
temporarily lose sense of your own reality.
➢ During an episode of derealisation, your sense of the reality of the external world is
lost.
o Things seem to change shape or size; people may seem dead or mechanical
o Symptoms of unreality are characteristic of the dissociative disorders.
o Even our own identity seems to disintegrate
➢ The influence of social and cultural factors is strong in dissociative disorders
Depersonalization-Derealization Disorder
➢ When feelings of unreality are so severe and frightening that they dominate an
individual’s life and prevent normal functioning, clinicians may diagnose the patient
with depersonalization-derealization disorder.
o Repeated experiences of feeling detached from his or her own thoughts or
body.
o The person may feel that he or she is an outside observer of his or her own
body or thoughts.
➢ Unlike psychosis though, the person having this experience remains in touch with
reality – they are aware that they aren’t really outside observers of their own body.
o This disorder is part of several disorders but when the primary problem is
depersonalization-derealization, the individual meets the criteria.
➢ Onset usually starts after a traumatic life event, after sexual abuse, or after giving
birth.
➢ Mean age of onset was 16.1 years and the course tends to be chronic, lasting about
15.7 years. More than 50% of a sample of patients had additional mood and anxiety
disorders.
➢ Compared control group with depersonalization-derealization group on
neuropsychological battery tests and found that although they were of equal
intelligence, the patients often showed a distinctive cognitive profile that indicated
specific cognitive deficits on measures of attention, short-term memory, and spatial
reasoning.
o Patients were easily distracted and had some trouble perceiving 3D objects
because they generally flattened the object to 2D. these seem to correspond
with reports of tunnel vision (perceptual distortions) and “mind emptiness”
(difficulty absorbing new information) that characterize these patients.
➢ Patients with depersonalization-derealization disorder display greatly reduced
emotional responding when compared to a control group and an anxiety group,
indicating their tendency to selectively inhibit emotional expression.
o Brain imaging studies confirm perceptual and emotion regulation deficits.
o Other studies note dysregulation in the hypothalamic-pituitary-
adrenocortical (HPA) axis compared with healthy patients, suggesting deficits
in emotional responding. Dissociative Amnesia
➢ People who are unable to remember anything, including who they are, are said to
have generalized amnesia.
o Could be lifelong or may extend form a period in the more recent past like six
months or a year previously.
➢ More common is localized, or selective, amnesia: a failure to recall specific events,
usually traumatic, that occur during a specific period.
o Very common during war
➢ In most cases of dissociative amnesia, the forgetting is very selective for traumatic
events of memories rather than generalized.
➢ A subtype of dissociative amnesia is called dissociative fugue which literally means
“flight”.
o Memory loss revolves around a specific incident – an unexpected trip (or
trips)
o They leave and end up somewhere, unable to remember how or why they
got there.
➢ Dissociative amnesia usually occurs in adulthood and it rarely occurs for the first
time after the age of 50.
o Prevalence range anywhere between 1.8 to 7.3%, suggesting that it is the
most prevalent of all dissociative disorders.
➢ Fugue states, the disintegrated experience is more than memory loss, involving at
least some disintegration of identity, if not the complete adoption of a new one.
➢ A distinct dissociative state not found in Western culture is amok. Most of people
with this disorder are males; they are in a trance like state often brutally assaulted
and sometimes kill people or animals. There are other “running” syndromes that
mostly occur in women.
➢ Dissociative disorder may be attributed to trance or possession in certain cultures
and only when the state is undesirable and considered pathological would the
individual be diagnosed with dissociative trance disorder (DTD).
Dissociative Identity Disorder (DID)
➢ People with this disorder can adopt as many as 100 identities, all simultaneously co-
ex
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