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
forgetfulness.
 Forget events or periods of life that are
traumatic – that generated strong
negative emotions.
 Memory loss is NOT ATTRIBUTED TO A
PARTICULAR ORGANIC CAUSE.
 REVERSIBLE but may last for days, weeks,
or even years.
 Recall of memories may happen
gradually but often occurs suddenly
and spontaneously.
➢ DISTINCT TYPES OF MEMORY PROBLEMS:
LOCALIZED AMNESIA
 Events occurring during a specific
period of time are lost to memory
 A person could not recall events for a
number of hours or days after a stressful
or traumatic incident
SELECTIVE AMNESIA
 People only forget only the disturbing
particulars that take place during a
certain period of time
GENERALIZED AMNESIA
 People forget their entire lives- who they
are, what they do, where they live,
whom they live with, etc.
 Very Rare form
 Cannot recall personal information but
retain their skills, habits, and tastes
CONTINUOUS AMNESIA
 The person forgets everything that
occurred from a particular point in time
up to and including the present.
SYSTEMATIZED AMNESIA
 Memory loss is specific to a particular
category of information, such as
memory about one’s family or
particular people in one’s life
** MALINGERING: Faking symptoms or
making false claims for personal gain**
IV. DISSOCIATIVE FUGUE
 “Amnesia on the run”
 Derived from the Latin
word, fugere (flight)
 A person may travel suddenly and
unexpectedly from his or her home or
place of work.
 Travels may either be purposeful,
leading to a particular location, or
involve bewildered wandering.
 The person is unable to recall past
personal information and becomes
confused about his or her identity or
assumes a new identity.
 Not think about the past or may report
a past filled with false memories without
recognizing them as false.
 Act more purposefully.
 The new identity is INCOMPLETE and
FLEETING, the FORMER SENSE OF SELF
RETURNS in a matter of hours or days.
 Assume an IDENTITY that is quite
spontaneous and sociable as
compared to their former self
 NOT CONSIDERED PSYCHOTIC
V. DEPERSONALIZATION/ DEREALIZATION
DISORDER
 DEPERSONALIZATION
o Temporary loss or change in the
usual sense of our own reality
o People feel detached from
themselves and their surroundings
o Feel as if they were dreaming or
acting like a robot
o Feelings of depersonalization: COME
ON SUDDENLY and FADE
GRADUALLY.
 DEREALIZATION:
o Sense of unreality about the external
world involving odd changes in
one’s perception of the surroundings
or the passage of time
o People or objects seem to change
in size or shape and sounds may
seem different
o Associated with feelings of anxiety,
including dizziness and fears of going
insane, or with depression
 Maintain contact with reality
 Distinguish reality from unreality
 Memories are intact and they know
where they are
 DIAGNOSIS:
o Experiences become persistent or
recurrent
o Cause significant distress or
impairment in daily functioning
o Become chronic or a long-lasting
problem
VI. CULTURE-BOUND SYNDROMES
AMOK
 Southeast Asia and Pacific Islands
 Trance-like state where a person
suddenly becomes highly excited and
violently attacks other people or
destroys objects
 People who run amuck: claim to have
no memory of the episode or recall
feeling as if they were acting like a
robot
ZAR
 North Africa and the Middle East
 Spirit possession in people who
experience dissociative states
 Individuals engage in unusual behavior,
ranging from shouting to banging their
heads against the wall
VII. THEORETICAL PERSPECTIVE
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.
B. PSYCHODYNAMIC PERSPECTIVE
 The massive use of repression results in
the splitting off from consciousness of
unacceptable impulses and painful
memories, typically involving parental
abuse.
 DISSOCIATIVE IDENTITY
DISORDER: Express unacceptable
impulses through the development of
alternate personalities.
 DISSOCIATIVE AMNESIA: Adaptive
function of disconnecting or
dissociating one’s conscious self from
awareness of traumatic experiences or
other sources of psychological pain.
 EGO DEFENSE against anxiety.
 DEPERSONALIZATION: People stand
outside themselves safely distanced
from the emotional turmoil within
C. SOCIAL-COGNITIVE THEORY
DISSOCIATION AS A LEARNED RESPONSE
 Psychologically distancing the self from
disturbing memories or emotions.
 NEGATIVELY REINFORCED by relief from
anxiety or removal of feelings of shame
and guilt.
D. EYE-MOVEMENT DESENSITIZATION AND
REPROCESSING (EMDR)
 Alleviate distress associated with
traumatic memories.
 Combines CBT techniques of re-learning
thought patterns with visual stimulation
exercises to access traumatic memories
to replace negative beliefs with positive
ones.

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.