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alt.support.dissociation FAQ 2/4

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Archive-name: dissoc-faq/part2
Last-modified: 1996/03/15
Posting-frequency: biweekly

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Section 2
Dissociation and
Dissociative Disorders:
A Formal Look
------------------------

=== 2.0 Overview

This section contains a somewhat formalized look at dissociation and
dissociative disorders, as well as containing information on some
disorders that the author feels are related, either symptomatically or in
their effects.

=== 2.1 Dissociation

*** 2.1.1 Definition of Dissociation

Dissociation is the state in which, on some level or another, one becomes
somewhat removed from "reality", whether this be daydreaming, performing
actions without being fully connected to their performance ("running on
automatic"), or other, more disconnected actions.  It is the opposite of
"association" and involves the lack of association, usually of one's
identity, with the rest of the world.

A dissociative disorder would be one in which the degree of dissociation
(or the frequency of it) is such that one's functioning is somehow
impaired.  The DSM-III-R defines a dissociative disorder, generally, as
one in which there "is a disturbance or alteration in the normally
integrative functions of idneity, memory, or consciousness.  The
distrubance or alteration may be sudden or gradual, and transient or
chronic."

It is important to note that a certain amount of dissociation is
considered completely normal; most (if not all) people experience
dissociation at least periodically in their life, and some mental health
workers consider dissociation to be a healthy defense mechanism, provided
the dissociation itself does not cause impairment of functioning.

=== 2.2 Dissociative Disorders

Some mental health care workers and psychological researchers disagree
with the definition of dissociative disorders as presented in the
DSM-III-R, as they feel it is an arbitrary definition; they feel that
dissociation is an aspect of many other, similar disorders.  Because of
that, it is difficult to list just what is a dissociative disorder.

The DSM-III-R considers the following to be dissociative disorders:

Multiple Personality Disorder (in DSM-IV, dissociative identity disorder)
Psychogenic Fugue
Psychogenic Amnesia
Depersonalization Disorder

*** 2.2.1 Multiple Personality Disorder

Multiple Personality Disorder is defined as the existence within a person
of two or more distinct personalities or personality states, in which at
least 2 of these personalities "take control" of the functioning of the
body at given points.  Each personality controls the body seperately, and
there is a memory loss for at least some personalities when others are in
control of the body.

Other personalities may have wildly different traits, belief systems,
relationships, names, and so forth.  Some clinical studies have shown
that EEGs differ by personality.  The personalities may themselves have
other psychological disorders, such as depression; these disorders may be
present in only one, some, or all of the personalities.

The degree of interaction and/or cooperation of the personalities varies
extremely; the degree of co-consciousness (the state of being able to
share memories of the various personalties' actions, and being able to
cooperate in the control of the body) also varies extremely.

Age of onset for MPD is usually (nearly always) in childhood.  In nearly
all cases of MPD, there was childhood abuse or other severe childhood
trauma.  MPD is noted in females more often than in males.  The degree of
impairment ranges from minimal to extreme.  No figures are available on
the prevalnce of MPD (and this is a hotly contested area).

Differential Diagnoses:

Psychogenic Fugue and Psychogenic Amnesia, while having some of the
qualities of MPD, do not have the shifts in personality.

Schizophrenia sometimes includes fragmented thought and the perception of
voices in ones head, as well as a feeling of being controlled by another
entity; however, the shift in control does not appear as it does within
MPD, and schizophrenic patients generally report their voices as being
external in origin.

Borderline Personality Disorder is marked by instability in mood, action
and thoughts; however, these different, conflicting ideas, beliefs, and 
goals are resident within a single personality.

*** 2.2.2 Psychogenic Fugue and Psychogenic Amnesia

Psychogenic Fugue is the assumption of a new identity and the inability to
recall one's previous identity; it involves a complete switch in
lifestyle, including home and/or work recall.  This is usually caused by
severe psychosocial stress, such as severe marital problems, being a
part of military conflict, or being in some type of natural disaster.

Psychogenic Amnesia is a sudden inability to recall important personal
information, when not due to any organic cause.  Like Psychogenic Fugue,
this is usually caused by severe psychosocial stress

Both psychogenic fugue and psychogenic amnesia are sudden, and they both
are usually fairly short-lived, with a complete recovery made.  They are
most common during wartime or just after a natural disaster.

Differential Diagnoses include epilepsy and other forms of amnesia; both
are also sometimes feigned (malingering).

*** 2.2.3 Depersonalization Disorder

Depersonalization disorder is either a persistent or recurring alteration
in one's perception of one's self, such as a feeling of detachment from
one's actions or thoughts, or feeling like an observer of one's own
actions.  Alternatively, one may feel as if one is an automaton, without
conscious will of one's actions, or feel as if one is dreaming, rather
than actually performing, one's actions.

Depersonalization Disorder is caused by severe stress; it is not
uncommon to have a single instance of depersonalization (but this is
usually not recurrent or persistent) due to stress.  It is usually found
in younger adults (late adolescence/early adulthood).

Depersonalization may be accompanied by derealization, the alteration of
one's perception of one's surroundings, which leads to the feeling that
the world is not real.  It is sometimes also accompanied by dizziness,
depression, anxiety, or other similar disorders.

Differential Diagnoses include many mood disorders, organic disorders,
anxiety disorders, personality disorders, and schizophrenia.  Although
not listed in the DSM-III-R as a differential diagoisis, MPD may have
similar traits.

*** 2.2.4 Dissociative Disorder Not Otherwise Specified

DDNOS is a convenient diagnostic label used to mean that the disorder,
while not matching any other disorder, involves dissociation.  People
with partial symptoms of the above disorders might be diagnosed as DDNOS.

Because this is a purely diagnostic category, there is no way to actually
define it; you might, however, see or hear people mention that this is
how their therapist has diagnosed them.  A common use of this category
is when a person does not meet the diagnostic criteria of MPD, but
exhibits most of the symptoms and history of someone with MPD.

=== 2.3 Related Disorders

There are a great many disorders which have, at least in part, some
similar symptoms to the dissociative disorders, or result in similar
disfunctions.

Primarily among these are personality disorders, as might not be
surprising to those who look at the name "Multiple Personality Disorder".
In particular, Borderline Personality Disorder would seem to result in
the type of issues that many multiples experience, as would identity
disorder.

Some mood disorders might also result in similar functional problems.
Schizophrenia is considered by some to be similar to MPD.

PTSD (Post Traumatic Stress Disorder) might be considered by some people
to be a related disorder, as its causes are similar to that of MPD and
other dissociative disorders (i.e., severe stress and/or trauma).

Although perhaps not clinically similar, it would seem that autism and
related disorders create similar types of disfunction to dissociative
disorders.

*** 2.3.1 Personality Disorders

Borderline Personality Disorder is defined as instability in mood,
self-image, and relationships, including indecision about serious issues
of identity (one's goals, sexual orientation, values/ethics/morals,
self-image, and the like).  Some of the symptoms include:

* Instability in one's personal relationships
* Impulsiveness to the point of self-damage (substance abuse, impulsive
  sexual activity, etc.)
* Instability of mood, such as short-term depression or anxiety/panic.
* Inappropriate or uncontrolled anger
* Recurrent attempts/threats of suicide or self-mutilation
* Identity disturbance/marked uncertainty about: one's self-image,
  sexual orientation, long-term goals, and the like
* Chronic boredom or feelings of emptiness
* Anxiety about and frantic efforts to avoid real or imagined abandonment

Identity disorder, considered a disorder of childhoood and adolescence,
is severe distress arising from the inability to create an integrated and
cohesive (as well as acceptable) sense of self.  Symptoms include severe
stress regarding uncertainty over one's long-term goals, career choice,
friendship patterns, sexual orientation, religious identification,
morals/values, group loyalties, and other important decisions, accompanied
by impairment in one's functioning due to this stress and uncertainty.


==== 2.4 Treating Dissociative Disorders
Updated 3/15/96

ISSD has published a formal set of guidelines for treating dissociative
disorders; it is now available at their site, which is at
http://www.issd.org/

[The following is the information that was here in lieu of formal
guidelines; these were summarized from a number of books addressing the
treatment of dissociation.]

Treatment has two goals: firstly, to allow the normal functioning of 
a highly dissociative person, and secondly, to treat the underlying cause 
of dissociation.  These goals are generally interconnected and are dealt
with simultaneously.

Since most dissociative disorders result from extreme stress and/or
trauma, and are also exacerbated for that stress, teaching the highly
dissociative person to deal with stress is one method of treatment.
Learning to work around one's stress would seem to be essential in
reaching a plateau of functionality.

For deep-rooted trauma, hypnosis is often used to aid in the recall,
examination of, and transcendence of the past trauma.  Dealing with the
memories of abuse, for instance, is vital in the recovery process.

In multiplicity, learning to communicate with one's personalities and
sharing of control and memory between the personalities is also vital.
Talking with individual personalities and encouraging them to cooperate
seems to be the easiest method of achieving this goal.

There is some debate as to whether complete fusion into one "whole"
personality is necessary to cure the disorders.  For some, the goal is
instead integration into several, co-conscious personalities which
function together in the control of the body and in performing the
day-to-day functions necessary to live.  For others, complete fusion
into one personality may well be necessary to achieve normal functioning.

Regardless of the course of treatment, it is usually long-term, taking
several years to achieve what the therapist considers normality.
However, once the dissociative person enters treatment for their
dissociation (as opposed to any associated disorders they may have),
treatment is almost always successful.

----------
This FAQ is copyright (C) 1995, 1996.  See section 1.1.2 in part 1 
for full copyright notice.


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