Dissociative Disorders
- Conditions marked by disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior
- Hallmarks – shifts in consciousness, the sense of self, and perceptions of the environment
nicer words –> disturbance or dysfunction in the self… and in the perception/consciousness of being WHOLE
Dissociative identity Disorder (DID)
- Disruption of identity by two or more distinct personality states and recurrent gaps in the recall of everyday events, personal information, and/or traumatic events inconsistent with ordinary forgetting
- Distinct personality states instead of distinct personalities
Demographics / possible presentations of DID
- 5% of the population
- trait occupy one person and they may (personalities) may not be aware of one another
-various personalities may have different eye prescriptions - some personalities speak different languages
- some personalities have different EEG ratings
- sometimes there is a “main” dominant personality
- alternate personalities can include:
children ; adolescence; opposite gender; animals
Ross et al. study on abuse children & DID
Ross et al. did a study looking at abused children (sexual) and found that there is a mean # of “alters” (16)
- in this population, about 86% had DID
- 10% had a psychotic personality
Skepticism in DID
- DID can be influenced in vulnerable people
this was demonstrated with a psychologist who reported that she could influence her patients to take on multiple roles on cue. “ Show me Michael now!” - DID Is a rare disorder…it is kind of impossible for her to just happen to have many patients who had it.
Dissociative Amnesia (formerly psychogenic amnesia)
- Inability to recall important information of trauma or a stressful experience that is beyond simply forgetting.
- DA–> amnesia as a result of psychological reasons.
- Dissociative Amnesia is milder form of DID
- DA is reversible b.c it is not neurologically based
- the recall of dissociative memories can occur gradually and/or spontaneously
Types of Dissociative Amnesia
Types:
• Localized – specific time period is lost to memory.
i.e. inability to recall car accident events
• Selective – some, but not all events for a specific period of time
i.e. forget the year of the affair, but not the guilt after
• Generalized – can’t recall anything about their entire lives
i.e. forget who they are, what they did, who they live with.
• Continuous – forget each new event as they occur. Everything from a specific time is lost.
• Systematized – loss of memory of actual systems…categories
i.e. forgetting “college years” or “family”
o Last 3 much more rate, and may be manifestations of DID
Dissociative Fugue
- considered as a condition that may accompany DA (used to be its own dx)
- reversible amnesia for personal identity.
- short lived (hours to days)
- involves unplanned travel or wandering, and is sometimes accompanied by establishing a new identity (they create a new life) .
Depersonalization/Derealization Disorder (formerly depersonalization disorder)
- Depersonalization: experiences of unreality, feelings of detachment or being an outside observer of one’s thoughts, feelings, sensations, or actions, unreal or absent sense of self, phys/emo numbing, time distortion
- Derealization: unreality or detachment with respect to one’s surrounding that include the experience of individuals or objects as unreal, dreamlike, foggy, visually distorted, or lifeless
- Most common , least controversial
- Reality testing remains intact
- Aware the sensations are not real and are not experiencing a break from reality
- Persistent depersonalization, derealization, or both
Dissociative Experiences Scale -II (DES-II)
- a lot of other disorders can score on this as well
- Dissociativeness is based on a spectrum if they score high on this –> warrants a clinical assessment of DID
- People with PTSD score high on this
Scales on the DES-II
- Amnesia Factor- memory loss
- Depersonalization-derealization Factor - detachment of the self and of the immediate environment
- Absorption Factor - being so preoccupied or absorbed by something going on around you
systems involved in dissociative disorders
automatic information processing
controlled information processing
incidental information processing
automatic information processing
something is automatized - it requires no effort
controlled information processing
tasks you do that require constant effort. the theory says that as you get good at doing tasks you can use more automatic processing. (i.e. driving a car, or reading)
incidental information processing
is not learned, but it does not require much effort to do.
Learning cognitive perspective on DID
- plays on information processing
- people learn to use cognitive avoidance in order for it to be negatively reinforcing to not think /process situations associated with guilt and shame.
- reinforced by reducing anxiety/shame
- providing an escape
- many times they become so absorbed in their role play that they forget they are acting and the role becomes reinforced to avoid processing negative emotions.
** in DID you become SOOO absorbed in the role that you forget about the trauma
Cognitive point of view:
- use of avoidance, negative reinforcement, and roleplaying
The consciousness in DID
DID suggests that individuals can splinter their consciousness into different roles. You become different roles as opposed to integrated roles organized as a whole
**is it such a far leap to suggest that consciousness can be splintered?
Role of Childhood Trauma in DID
Trauma Dissociation Model - states that DID develops to deal with sexual/physical abuse.
DID–> way to distance from trauma
DID stats
about 83% report a history of sexual/physical abuse
2/3s of patients in the study report incest
DID occurs due to childhood trauma usually from a caretaker or guardian
another study found that 95% of 102 people suffered form childhood physical and sexual abuse
Trauma Dissociation model
The model indicates that children learn how to distance the self. This is referred to as. Psychological Escape.
Psychological Escape ( as a part of the Trauma Dissociation Model)
- going somewhere else in the mind (imagining themselves to be somewhere else)
- imagining themselves as stronger or smarter
- allows the creation of associations… and keeping them outside of conscious awareness and detached from the trauma. Provides an ________ effect where they do not feel the pain.
DID based on age
if trauma occurs during childhood–> developing of DID increases
if trauma occurs during adolescence you are more likely to repress –> develop DA
As an adult with DID, if you are in an emotional situation you are likely to trip those personalities and activate them. You use the same escape and these personalities are triggered to deal with situations/responsibilities.
Controversy behind suppressed memories
- can we say childhood memories that recall abuse are real?
- some people become aware of some memories after intensive therapy (hypnosis)
- memories can be planted by therapists…
MRI and DID
individuals with DID have reduced hippocampus activation (responsibility for STM and LTM, processing neg. emotions/traumatic memories)
hippocampus can be a biological consequence to abuse
TRAUMA –> Reduced hippocampus –> cortisol increases –> likely to develop DID
