Chapter 4

Dissociative Disorders

Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.

Dissociation in the news

Im not really running, Im 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. Id 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

Magrittes The Lovers

Chapter 8

Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.

Dissociative Experiences in the General Population

90 80 70 60 50 40 30 20 10 0 Missing part of Talking outloud to Feeling as Fantasy seems conversation oneself thought one were real two different people

83

56 47 29 18 12 11 45 26 7

Percent acknowledging Percent in pathological range

23 14 4 1

Hearing voices Feeling as though Not recognizing one's body is not one's reflection in one's own a mirror

Chapter 8

Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.

Dissociation

Normal vs. abnormal dissociation (different parts of an individuals 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 individuals ability to function

Chapter 8

Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.

Dissociative Disorders (Summary)

Dissociative Identity Disorder Dissociative Fugue

Separate, multiple personalities in the same individual. The person moves away and assumes a new identity, with amnesia for the previous identity.

Dissociative Amnesia
Depersonalization Disorder

The person loses memory of important personal facts, including personal identity, for no apparent organic cause
Frequent episodes where individual feels detached from his or her mental state or body
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.

Chapter 8