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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.