DISSOCIATIVE

DISORDER
 DISSOCIATIVE
DISORDER

● Dissociation' means a period

when we feel disconnected
from the environment and/or
from ourselves.
● It is a category of mental
disorders involving sudden
change in consciousness or
self-identity.
 DISSOCIATIVE
DISORDERS

● Depersonalization-Derealization
Disorder
● Dissociative Amnesia
● Dissociative Identity Disorder
Depersonalization-
Derealization
Disorder
 Depersonalization-Derealization Disorder

Depersonalization Derealization
A feeling of detachment A feeling that the world
from oneself around you is not fully
REAL
 Depersonalization-Derealization Disorder

● Clinicians may diagnose depersonalization-derealization

disorder when sensations of unreality are so intense and
terrifying that they take over an individual's life and prohibit
regular functioning.

● Feelings of depersonalization and derealization are part of

several disorders. According to surveys, this illness affects
between 0.8 percent and 2.8 percent of the population.
 SYMPTOMS

● Emotionally or physically numb

● Weak sense of self
● Deadpan speech
● Having forming a relationship
 SYMPTOMS

SEVERE CASES:
➔ Trouble recognizing familiar places, people or objects
➔ Brain Fog and lightheaded
➔ Rumination and anxiety
 Diagnostic for Depersonalization-
Derealization Disorder
● Physical exam. In some cases, symptoms of depersonalization or
derealization may be linked to an underlying physical health
problem, medications, recreational drugs or alcohol.
● Lab tests. Some lab tests may help determine whether your
symptoms are related to medical or other issues.
● Psychiatric evaluation. Your mental health professional asks
about your symptoms, thoughts, feelings and behavior patterns,
which can help determine if you have
depersonalization-derealization disorder or other mental health
disorders.
 Diagnostic for Depersonalization-
Derealization Disorder

● DSM-5. Your mental health professional may use the criteria

for depersonalization-derealization disorder listed in the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5), published by the American Psychiatric Association.
 DSM 5 Diagnostic Criteria

● The presence of persistent or recurrent experiences of

depersonalization, derealization, or both:
○ Depersonalization: Experiences of unreality, detachment,
or being an outside observer with respect to one’s
thoughts, feelings, sensations, body or actions (e.g.,
perceptual alterations, distorted sense of time, unreal or
absent self, emotional and/or physical numbing).
○ Derealization: Experiences of unreality or detachment
with respect to surroundings (e.g., individuals or objects
are experienced as unreal, dreamlike, foggy, lifeless, or
visually distorted).
 DSM 5 Diagnostic Criteria

● During the depersonalization or derealization experience,

reality testing remains intact.
● The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas
of functioning.
● The disturbance is not attributable to the physiological
effects of a substance (e.g., a drug of abuse, medication) or
another medical condition (e.g., seizures).
● The disturbance is not better explained by another mental
disorder, such as schizophrenia or panic disorder
 Treatment
Treatment of depersonalization-derealization disorder is primarily
psychotherapy. However, sometimes medications may be added to
your treatment plan.
❖ Psychotherapy can help you:
➢ Understand why depersonalization and derealization occur
➢ Learn techniques that distract from your symptoms and make you
feel more connected to your world and feelings
➢ Learn coping strategies to deal with stressful situations and
times of extreme stress
➢ Address the emotions related to past trauma you've experienced
➢ Address other mental health conditions such as anxiety or
depression
 Treatment

Medications

There are no medications specifically approved to treat

depersonalization-derealization disorder. However,
medications may be used to treat specific symptoms or to
treat depression and anxiety that are often associated
with the disorder.
Dissociative
Amnesia
 Dissociative Amnesia

➔ Dissociative amnesia was formerly called

psychogenic amnesia. It occurs when a
person blocks out certain information, often
associated with a stressful or traumatic
event, leaving the person unable to remember
important personal information.
➔ Amnesia is derived from the greek roots a -
which means “not” and mnasthai, meaning to
remember.
 4 Types of Dissociative Amnesia
➔ Localized Amnesia. The most common type of amnesia
which occurs and that events that took place during a
specific time period are lost to memory. For instance, an
individual cannot remember anything that happened for
hours after a traumatic incident as in warfare.
➔ Generalized Amnesia. In this type of amnesia, people
forget their entire lives - who they are, what they do, and
where they live. This type of amnesia is quite rare.
Person’s with this amnesia usually have difficulty
recalling personal information.
 4 Types of Dissociative Amnesia
➔ Selective or Systematized Amnesia. In this type of
amnesia an individual forget only the disturbing details
that happened during the duration period of the incident,
as the soldier may recall the fierce fighting during the
battle, but not the fatal death of his comrade.
➔ Continuous Amnesia. In this form of amnesia, individuals
usually forget all events that happened after the problem
begins. This continuous amnesia is very rare form of
dissociative amnesia.
 Dissociative Amnesia
➔ Dissociative Fugue
◆ with fugue literally meaning “flight” (fugitive is
from the same root)
◆ Memory loss in these unusual situations is linked
to a specific event—an unexpected travel (or
trips). Typically, people simply take off and end
up in a new location, unable to recall why or how
they arrived there. Typically, they have left an
uncomfortable environment behind. During these
excursions, a person may adopt a new identity or
get confused about their current one.
 How common is dissociative amnesia?

➔ it affects about 1% of men and 2.6% of women in

the general population

➔ rates of dissociative amnesia tend to increase after

natural disasters and during the war.
 What causes dissociative amnesia?

➔ overwhelming stress

➔ traumatic events such as war, abuse, accidents, or

disasters

➔ suffered from the trauma or just witnessed it

➔ genetic (inherited) connection in dissociative amnesia

 How is dissociative amnesia diagnosed?
➔ If a patient has symptoms of dissociative amnesia, the doctor
will perform a complete medical history and physical examination.
Although there are no laboratory tests to diagnose dissociative
disorders, the doctor might use blood tests or imaging (X-rays,
CT scans, or MRIs) to make sure the patient doesn’t have a
physical illness or side effects from a medication. If the person
does not have a physical illness, he or she might be referred to
a mental health professional such as a psychiatrist, psychologist,
or psychiatric social worker who is specially trained to diagnose
and treat mental illnesses. This caregiver will perform a clinical
interview to get a full picture of the person’s experiences and
current functioning. Some psychiatrists and psychologists may
use specialized tests or a standard interview such as the
Structured Clinical Interview for Dissociation (SCID-D).
 Diagnostic Criteria for Dissociative
Amnesia

➔ An inability to recall important autobiographical information,

usually of a traumatic or stressful nature, that is inconsistent
with ordinary forgetting.
◆ Note: Dissociative amnesia most often consists of
localized or selective amnesia for a specific event or
events; or generalized amnesia for identity and life
history.
➔ The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas
of functioning.
 Diagnostic Criteria for Dissociative
Amnesia

➔ The disturbance is not attributable to the physiological

effects of a substance (e.g., alcohol or other drug of abuse, a
medication) or a neurological or other medical condition
(e.g., partial complex seizures, transient global amnesia,
sequelae of a closed head injury/traumatic brain injury, or
other neurological condition).
➔ The disturbance is not better explained by dissociative
identity disorder, posttraumatic stress disorder, acute stress
disorder, somatic symptom disorder, or major or mild
neurocognitive disorder.
 How is dissociative amnesia treated?

Treatment also aims to help the person:

● Safely deal with and manage painful events;
● Develop new coping skills and life skills;
● Get back to functioning as well as possible; and
● Improve relationships.
 How is dissociative amnesia treated?
Treatment will most likely include some combination of the
following methods:
➔ Psychotherapy
➔ Cognitive-behavioral therapy
➔ Eye movement desensitization and reprocessing
➔ Dialectic-behavior therapy
➔ Family therapy
➔ Creative therapies (for example, art therapy, music
therapy)
➔ Meditation and relaxation techniques
➔ Clinical hypnosis
➔ Medication
DISSOCIATIVE
IDENTITY
DISORDER
 Dissociative
Identity Disorder
People with dissociative identity disorder
(DID) may adopt as many as 100 new
identities, all simultaneously coexisting,
although the average number is closer to
15. In some cases, the identities are
complete, each with its own behavior,
tone of voice, and physical gestures. But
in many cases, only a few characteristics
are distinct, because the identities are
only partially independent, so it is not
true that there are “multiple” complete
personalities.
 2 TYPES OF DID
➔ Covert Dissociative Identity disorder
◆ Sudden and dramatic shifts in a way they
● PERCEIVE
● THINK
● FEEL
◆ Usually aware that it is unusual
◆ Feel powerless to understand their mood and
behavior
 2 TYPES OF DID
➔ Overt Dissociative Identity disorder
◆ Outright assume 2 or more distinct identities or alters
● Talk/act differently
● Taste
● Political views
● Age
● Gender
● Nationality
◆ Completely take over the body and mind
◆ Not always aware
◆ Forget portions of their day
◆ Fugue
 2 TYPES OF DID
➔ Overt Dissociative Identity disorder
◆ Can endanger the person
● Self-mutilation
● Risky behavior
◆ Prevalence of SUICIDE high
● Almost ¾ attempt at least once
 Characteristics
The person who becomes the patient and asks for
treatment is usually a “host” identity. Host
personalities usually attempt to hold various
fragments of identity together but end up being
overwhelmed. The first personality to seek
treatment is seldom the original personality of the
person. Usually, the host personality develops
later (Putnam, 1992). Many patients have at least
one impulsive alter who handles sexuality and
generates income, sometimes by acting as a
prostitute. In other cases, all alters may abstain
from sex. Cross-gendered alters are not
uncommon. For example, a small agile woman
might have a strong powerful male alter who
serves as a protector.
 Characteristics
The transition from one personality to
another is called a switch. Usually, the
switch is instantaneous (although in movies
and on television it is often drawn out for
dramatic effect). Physical transformations
may occur during switches. Posture, facial
expressions, patterns of facial wrinkling, and
even physical disabilities may emerge. In
one study, changes in handedness occurred
in 37% of the cases (Putnam, Guroff,
Silberman, Barban, & Post, 1986).
 SYMPTOMS
Some of the most common signs of a
dissociative identity disorder include:

● Lapses in memory

● Inability to recall personal information

● Distorted perception of time

● Headache

● Amnesia
 SYMPTOMS
Many people with dissociative identity disorder
also struggle with other mental health problems,
including:
● Anxiety
● Mood swings
● Panic disorder
● Suicidal ideation
● Sleep disorders
● Depression
● Eating disorders

● Substance use

disorders
 Diagnostic
DIFFERENTIALS:
➔ Substance Intoxication
◆ Hallucinogens ( e.g. LSD)
◆ Dissociative drugs (PCP and Ketemine)
➔ Seizures
➔ Brian Trauma
➔ Dementia
➔ Anxiety Disorder - impaired sense of
◆ Identity Mins. - Hours
◆ Time Vs
◆ Sensation Months - Years
 Diagnostic
DIFFERENTIALS:
➔ Bipolar disorder Dramatic mood swings
➔ Schizophrenia

At least a week
Vs
Mins. - hours
 Diagnostic Criteria for
Dissociative Identity Disorder
A. Disruption of identity characterized by two or more distinct personality
states, which may be described in some cultures as an experience of
possession. The disruption of marked discontinuity in sense of self and
sense of agency, accompanied by related alterations in affect, behavior,
consciousness, memory, perception, cognition, and/or sensory-motor
functioning. These signs and symptoms may be observed by others or
reported by the individual.

B. Recurrent gaps in the recall of everyday events, important personal

information, and/or traumatic events that are inconsistent with ordinary
forgetting.
 Diagnostic Criteria for
Dissociative Identity Disorder
C. The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.

D. The disturbance is not a normal part of a broadly accepted cultural or

religious practice.
Note: In children, the symptoms are not attributable to imaginary
playmates or other fantasy play.

E. The symptoms are not attributable to the physiological effects of a

substance (e.g., blackouts or chaotic behavior during alcohol intoxication)
or another medical condition (e.g., complex partial seizures).
 Causes
➔ Most experts, however, agree that the condition is
often developed as a response to extreme stress or
trauma. What causes dissociative identity disorder is
far beyond the normal human experience of stress.
Generally, the condition stems from traumatic events
that occur at a young age. Other dissociative
identity disorder causes include extreme childhood
neglect and emotional abuse.
 Treatment
Dissociative Identity Disorder (DID)
➢ Psychotherapy
○ Nevertheless, the prognosis for most people remains
guarded. Coons (1986) found that only 5 of 20 patients
achieved a full integration of their identities. Ellason
and Ross (1997) reported that 12 of 54 (22.2%) patients
had achieved integration 2 years after presenting for
treatment, which in most cases had been continuous.
These results could be attributed to other factors than
therapy because no experimental comparison was
present (Powell & Howell, 1998).
Can DID be
faked?
THANK
YOU!
VANESSA MOMAY
ADRIAN TANDOC