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DISSOCIATIVE DISORDERS

• Are conditions that involve disruptions or


breakdowns of memory, awareness,
identity, or perception.
• Characterized by changes in a person’s
sense of identity, memory or
consciousness.
• Individuals with these kind of disorders
may be unable to recall important
personal events or may temporarily forget
their identity or even assume a new
identity.
DSM IV-TR :
 Dissociative Amnesia
 Dissociative Fugue
 Depersonalization Disorder
 Dissociative Identity Disorder

DSM 5 :
 Dissociative Identity Disorder
 Dissociative Amnesia
 Depersonalization/Derealization
Disorder
 Other Specified Dissociative Disorder
 Unspecified Dissociative Disorder
DISSOCIATIVE AMNESIA
• Person is unable to recall
important personal
information, usually after some
stressful episode.
DISSOCIATIVE FUGUE
FUGUE – from the Latin word
“fuga” meaning “flight”. It
describes a psychiatric disorder
that involves memory loss and
travel.
• The memory loss is more
extensive than in the
dissociative amnesia.
• The person not only
becomes totally amnestic
but suddenly leaves home
and work and assumes a
new identity.
DEPERSONALIZATION DISORDER
• In which the person’s perception or
experience of the self is
disconcertingly and disrupted altered.
• Involves no disturbance of memory
• They have unusual sensory
experiences
• They may have the impression that
they are outside their bodies, viewing
themselves from a distance.
DISSOCIATIVE IDENTITY
DISORDER
• It requires that a person have at least two
separate ego states or alters- different
modes of being and feeling and acting
that exist independently of each other
and that come forth and are in control at
different times.
• Gaps in the memory are also common
and are produced because at least one
alter has no contact with the other.
• The existence of different alters must
also be chronic and severe (causing
considerable disruptions of one’s life);
it cannot be temporary changes
resulting from the ingestion of a drug
for example.
• Each alter may be quite complex,
having their own unique behavior
patterns, memories, and relationships.
• DID usually begins in childhood but it
is rarely diagnosed until adulthood.
DSM IV-TR CRITERIA FOR DID
• Presence of two or more
personalities or identities
• At least two of the alters
recurrently take control of
behavior
• Inability to recall important
personal information
DSM IV-TR
DISORDER DESCRIPTION
Dissociative Amnesia Memory loss following a
stressful experience
Dissociative Fugue Memory loss accompanied
by leaving home and
establishing a new identity
Depersonalization Disorder Experience of the self is
altered
Dissociative Identity At least two distinct ego
Disorder states—alters—that act
independently of each
other
DSM 5
 Dissociative Identity Disorder
 Dissociative Amnesia
 Depersonalization/Derealization
Disorder
 Other Specified Dissociative
Disorder
 Unspecified Dissociative Disorder
Major Changes:
• Derealization is included in the name and symptom
structure of what previously was called
depersonalization disorder. The disorder is now
called depersonalization/derealization disorder.
• Dissociative fugue is now a specifier of dissociative
amnesia — rather than as a separate diagnosis.
• Diagnostic criteria for dissociative identity disorder
have been updated:
– Symptoms of disruption of identity may now be
reported, as well as observed
– Gaps in the recall of events may occur for
everyday events — not just traumatic events
– Experiences of pathological possession in some
cultures are included in the description of identity
disruption
DISSOCIATIVE IDENTITY DISORDER
Diagnostic Criteria:

(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 in identity involves marked
discontinuity in sense of self and sense of
agency accompanied by related
alterations in affect, behavior,
consciousness, memory, perception,
served 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.
(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.
(e.) The symptoms are not attributable
to the physiological effects of a
substance (e.g., blackouts or chaotic
behavior during alcohol intoxication)
or other medical condition (e.g.,
complex partial seizures)
• Individuals with DID typically present with
corbid depression, anxiety, substance
abuse, self-injury, non-epileptic seizures,
or another common symptoms.
• They are not fully aware of disruptions in
consciousness, amnesia or other
dissociative symptoms.
• Experiences flashbacks
• Self multilation and suicidal behavior are
frequent.
• Some individuals experience transient
psychotic phenomena or episodes.
• DID is associated with overwhelming
experiences, traumatic events, and/or
abuse occuring in childhood.
• May first manifest at almost any age.
• Dissociation in children may generate
problems with memory, concentration,
attachment and traumatic play.
Differential Diagnosis:

• Other specified dissociative disorder


• Major depressive disorder
• Bipolar disorder
• Posttraumatic stress disorder
• Psychotic disorder
• Substance/medication-induced
disorders
• Personality disorders
• Conversion disorder
• Seizure disorder
• Factitious disorder and malingering
DISSOCIATIVE AMNESIA
Diagnostic Criteria:
(a.) An inability to recall important
autobiographical information, usually of
a traumatic or stressful nature, that is
inconsistent with ordinary forgetting.
(b.) The symptoms cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
(c.) The disturbance is not attributed to the
physiological effect of a substance or a
neurological or other medical conditions
(d.) 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.

*Coding note:
Without dissociative fugue – 300.12 (F44.0)
With dissociative fugue – 300.13 (f44.1)
Dissociative Amnesia is an inability to recall
important autobiographical information
that should be successfully stored in
memory and ordinarily remembered.

Localized Amnesia – a failure to recall


events during a circumscribed period of
time
Selective Amnesia – can recall some, but
not all of the events during a
circumscribed period of time
Generalized Amnesia – complete loss of
memory for one’s life history. Forgetting
personal identity
DEPERSONALIZATION/DEREALIZATION
DISORDER
Diagnostic Criteria:
(a.) The presence of persistent or recurrent
experiences of depersonalization,
derealization or both:
1. Depersonalization- experiences
unreality, detachment or being an
outside observer with respect to one’s
thoughts, feelings, sensations, body or
actions.
2. Derealization- experiences of unreality
or detachment with respect to the
surroundings.
(b.) During the depersonalization or
derealization experiences, reality testing
remains intact.
(c.) The symptoms cause clinically
significant distress or impairment in social,
occupational, or other areas of
functioning.
(d.) The disturbance is not attributable to
the physiological effects of a substance
or another medical condition.
(e.) The disturbance is not better explained
by another mental disorder such as
schizophrenia, panic disorder, major
depressive disorder, acute stress disorder,
PTSD, or another dissociative disorder.
OTHER SPECIFIED DISSOCIATIVE DISORDER
1. Chronic and recurrent syndromes of
mixed dissociative symptoms.
2. Identity disturbance due to prolonged
and intense coercive persuasion.
3. Acute dissociative reactions to stressful
events
4. Dissociative trance
UNSPECIFIED DISSOCIATIVE DISORDER
This category applies to presentations in which
symptoms characteristic of a dissociative
disorder that cause clinically significant distress
or impairment in social, occupational, or other
important areas of functioning predominate but
do not meet the full criteria for any of the
disorders in the dissociative disorders diagnostic
class. The unspecified dissociative disorder
category is used in situations in which the
clinician chooses not to specify the reason that
the criteria are not met for a specific
dissociative disorder, and includes presentations
for which there is insufficient information to
make a more specific diagnosis (e.g., in
emergency room settings).