CLINICAL FEATURES:

MODULE 10| DISSOCIATIVE DISORDERS

o The emergence of 2/ more distinct
I. NATURE OF DISSOCIATIVE DISORDERS
personalities that vie for control of the
person.
 Disruption or dissociation (“splitting off”)
o More common alter personalities:
of the functions of identity, memory or
o Children of various ages
consciousness
o Adolescents of the opposite gender
o Prostitutes
 COMPONENTS:
o Gay males
o Lesbians
o AMNESIA: Memory loss of certain time
periods, events, people, and personal
ALTERS:
information.
o DEREALIZATION: Perception of the
o A microcosm of conflicting urges and
people and things around you as
cultural themes
distorted and unreal.
o Themes of sexual ambivalence and
o DEPERSONALIZATION: Sense of
shifting sexual orientation
detachment from oneself and one’s
o INTERPERSONALITY RIVALRY
emotions
o IDENTITY CONFUSION: A blurred sense of
CONTROVERSIES LINKED WITH DID: N.
identity
SPANOS (1994): DID as a form of ROLE-
o IDENTITY ALTERATION: Having more than
PLAYING
one distinct personality.

II. DISSOCIATIVE IDENTITY DISORDER o The person construes themselves as
having multiple selves and acting in
 Formerly known as MULTIPLE ways that are consistent with their
PERSONALITY DISORDER OR SPLIT conception of the disorder.
PERSONALITY o Role-playing becomes ingrained
 Two or more personalities “occupy” the that it becomes a REALITY for them.
person o Impressionable people may have
 Personality divides into 2 or more learned how to enact the role of
personalities, but each of them usually persons with the disorder by
shows more integrated functioning on watching others on TV and in the
cognitive, affective, and behavioral movies.
levels o The establishment of roles may
be SOCIALLY REINFORCED.

III. DISSOCIATIVE AMNESIA

 Amnesia: derived from the Greek words

“a-” (Not) and “mnasthia” (To
remember).
 Formerly known as PSYCHOGENIC
AMNESIA.
 Inability to recall important personal
information, usually involving traumatic
or stressful experiences, in a way that
 cannot be accounted for by simple memory about one’s family or
forgetfulness. particular people in one’s life
 Forget events or periods of life that are
traumatic – that generated strong ** MALINGERING: Faking symptoms or
negative emotions. making false claims for personal gain**
 Memory loss is NOT ATTRIBUTED TO A
IV. DISSOCIATIVE FUGUE
PARTICULAR ORGANIC CAUSE.
 REVERSIBLE but may last for days, weeks,
 “Amnesia on the run”
or even years.
 Derived from the Latin
 Recall of memories may happen
word, fugere (flight)
gradually but often occurs suddenly
 A person may travel suddenly and
and spontaneously.
unexpectedly from his or her home or
place of work.
➢ DISTINCT TYPES OF MEMORY PROBLEMS:
 Travels may either be purposeful,
LOCALIZED AMNESIA leading to a particular location, or
involve bewildered wandering.
 Events occurring during a specific  The person is unable to recall past
period of time are lost to memory personal information and becomes
 A person could not recall events for a confused about his or her identity or
number of hours or days after a stressful assumes a new identity.
or traumatic incident  Not think about the past or may report
a past filled with false memories without
SELECTIVE AMNESIA recognizing them as false.
 Act more purposefully.
 People only forget only the disturbing  The new identity is INCOMPLETE and
particulars that take place during a FLEETING, the FORMER SENSE OF SELF
certain period of time RETURNS in a matter of hours or days.
 Assume an IDENTITY that is quite
GENERALIZED AMNESIA spontaneous and sociable as
compared to their former self
 People forget their entire lives- who they  NOT CONSIDERED PSYCHOTIC
are, what they do, where they live,
whom they live with, etc. V. DEPERSONALIZATION/ DEREALIZATION
 Very Rare form DISORDER
 Cannot recall personal information but
retain their skills, habits, and tastes  DEPERSONALIZATION
o Temporary loss or change in the
CONTINUOUS AMNESIA usual sense of our own reality
o People feel detached from
 The person forgets everything that themselves and their surroundings
occurred from a particular point in time o Feel as if they were dreaming or
up to and including the present. acting like a robot
o Feelings of depersonalization: COME
SYSTEMATIZED AMNESIA ON SUDDENLY and FADE
GRADUALLY.
 Memory loss is specific to a particular
category of information, such as
 DEREALIZATION: ZAR
o Sense of unreality about the external
world involving odd changes in  North Africa and the Middle East
one’s perception of the surroundings  Spirit possession in people who
or the passage of time experience dissociative states
o People or objects seem to change  Individuals engage in unusual behavior,
in size or shape and sounds may ranging from shouting to banging their
seem different heads against the wall
o Associated with feelings of anxiety,
including dizziness and fears of going VII. THEORETICAL PERSPECTIVE
insane, or with depression
A. BIOLOGICAL PERSPECTIVE

 Structural differences in areas of the

brain associated with emotions and
memory.

 Dysfunction in BRAIN METABOLIC

ACTIVITY: possible dysfunction in areas
of the brain involved with body
perception.

 Disruption in NORMAL SLEEP-WAKE

CYCLE: Dissociative experiences i.e.,
being detached from the body.
 Maintain contact with reality
 Distinguish reality from unreality B. PSYCHODYNAMIC PERSPECTIVE
 Memories are intact and they know
where they are  The massive use of repression results in
 DIAGNOSIS: the splitting off from consciousness of
o Experiences become persistent or unacceptable impulses and painful
recurrent memories, typically involving parental
o Cause significant distress or abuse.
impairment in daily functioning
o Become chronic or a long-lasting  DISSOCIATIVE IDENTITY
problem DISORDER: Express unacceptable
impulses through the development of
VI. CULTURE-BOUND SYNDROMES alternate personalities.
AMOK
 DISSOCIATIVE AMNESIA: Adaptive
function of disconnecting or
 Southeast Asia and Pacific Islands
dissociating one’s conscious self from
 Trance-like state where a person
awareness of traumatic experiences or
suddenly becomes highly excited and
other sources of psychological pain.
violently attacks other people or
destroys objects
 EGO DEFENSE against anxiety.
 People who run amuck: claim to have
no memory of the episode or recall
feeling as if they were acting like a
robot
 DEPERSONALIZATION: People stand D. EYE-MOVEMENT DESENSITIZATION AND
outside themselves safely distanced REPROCESSING (EMDR)
from the emotional turmoil within
 Alleviate distress associated with
C. SOCIAL-COGNITIVE THEORY traumatic memories.
DISSOCIATION AS A LEARNED RESPONSE  Combines CBT techniques of re-learning
thought patterns with visual stimulation
 Psychologically distancing the self from exercises to access traumatic memories
disturbing memories or emotions. to replace negative beliefs with positive
 NEGATIVELY REINFORCED by relief from ones.
anxiety or removal of feelings of shame
and guilt.

D. DIATHESIS-STRESS MODEL

 People who are prone to fantasize:

 Highly hypnotizable and are open to
altered states of consciousness.
 Increase the risk that people who
experience severe trauma will develop
a dissociative phenomenon as a
survival mechanism.

VIII. TREATMENT
A. REINTEGRATION OF THE PERSONALITY

 Integrating the altered personalities into

a cohesive personality structure
 Seek to help patients uncover and work
through memories of early childhood
trauma

B. COGNITIVE-BEHAVIORAL THERAPY

 Help change the negative thinking and

behavior associated with depression
 GOAL: Recognize negative thoughts
and teach coping strategies

C. DIALECTICAL-BEHAVIOR THERAPY

 Focus on teaching coping skills to

combat destructive urges, regulate
emotions, and improve relationships
while adding validation.
 Encourages MINDFULNESS techniques
such as meditation, regulated
breathing, and self-soothing.