Dissociative Disorder, Study notes of Clinical Psychology

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HUSAN SHERGILL

PSYCHOLOG

Y

ANXIETY BASED DISORDER

ANXIETY

I. (^) DISSOCIATION

• (^) ETYMOLOGY - The word dissociation refers that there is “ break or split ” between two things. Dissociation is a disconnection between a person’s thoughts, memories, feelings, actions, or sense of who he or she is. This is a normal process that everyone has experienced.
• MEANING - In psychology, dissociation is any of a wide array of experiences from mild detachment from immediate surroundings to more severe detachment from physical and emotional experience. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a loss of reality as in psychosis.
• CAUSE -^ Dissociation is commonly displayed on a continuum (range, field). In mild cases, dissociation can be regarded as a coping mechanism or defense mechanisms in seeking to master, minimize or tolerate stress – including boredom or conflict. At the non pathological end of the continuum, dissociation describes common events such as daydreaming while driving a vehicle. Further along the continuum are non-pathological altered states of consciousness
• EXAMPLES - of mild, common dissociation include daydreaming, highway hypnosis, or “getting lost” in a book or movie, all of which involve “losing touch” with awareness of one’s immediate surroundings.
• DISSOCIATION IS HELPFUL - During a traumatic experience such as an accident, disaster, or crime victimization, dissociation can help a person tolerate what might otherwise be too difficult to bear. In situations like these, a person may dissociate the memory of the place, circumstances, or feelings about of the overwhelming event, mentally escaping from the fear, pain, and horror. This may make it difficult to later remember the details of the experience, as reported by many disaster and accident survivors.

II. DISSOCIATIVE DISORDERS (DD)

• DEFINITION
  • Dissociative disorders are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception. People with dissociative disorders use dissociation, as a defense mechanism, pathologically and involuntarily.

• (^) DISRUPT COPING MECHANISM- Inability to cope well with emotional or professional stress. Problems with handling intense emotions
• CAUSES

♦ DEFENSE AGAINST ANXIETY

• Dissociative disorder generally represents a defense against anxiety generated by negative feelings and impulses. In the case dissociative identity disorder he allows the expression of negative impulses in an alternate personality.
• As Murphy says “the main dynamics in most cases of multiple personality seems to be an exaggeration of a conflict situation which is present in all of us namely a conflict between a conforming and guilty non conforming trends”.

♦ EARLY TRAUMA

• Ross has found a close connection between dissociative identity and childhood trauma in many cases particularly in case of severe child abuse.
• Even in fugue people don’t just get up and go away frequently their present situation is such that thee are few reason to continue in present situation.
• Amnesia is also an escape from negative life events depersonalization disorder often occurs in response to severe stress.

♦ PERSONALITY

• People with dissociative disorder are very suggestible and easily hypnotizable they have an active and creative imagination and richer fantasy lives.
• Spanos and burgess hold that the core of the personality, however, is marked by intense hatred and anger.

♦ STATE DEPENDENCY

• Bower holds that fugue and dissociative disorder may be maintained by state dependency.
• State dependency is phenomenon in which people are better able to recall an event or experience.
• If they are in same psychic the amount of amnesia this evidence for the different the personality, more the amount of amnesia this is the evidence for influence of state dependency.

♦ REINFORCEMENT AND LABELING

• Spanos and burgees suggest that dissociative identity disorder patient at least extra attention from therapist who considers them glamorous and exotic.
• Once the patient is labeled as having dissociative disorder his symptoms tend to conform to the expectation of the theorist.
• DEVELOPMENT OF DISSOCIATIVE DISORDER
• When faced with an overwhelming situation from which there is no physical escape, a child may learn to “go away” in his or her head. Children typically use this ability as a defense against physical and emotional pain, or fear of that pain. By dissociating, thoughts, feelings, memories, and perceptions of the trauma can be separated off in the mind.
• This allows the child to function normally. This often happens when no parent or trusted adult is available to stop the hurt, soothe, and care for the child at the time of traumatic crisis. The parent/caregiver may be the source of the trauma, may neglect the child’s needs, may be a co-victim, or may be unaware of the situation.
• PREVALENCE
• The lifetime prevalence of dissociative disorders varies from 10% in the general population to 46% in psychiatric inpatients. Diagnosis can be made with the help of structured interviews such as the Dissociative Disorders Interview Schedule (DDIS) and the Structured Clinical Interview for DSM- IV
  • As many as 99% of people who develop Dissociative Disorders have documented histories of repetitive, overwhelming, and often life- threatening trauma at a sensitive developmental stage of childhood (usually before the age of nine). They may also have inherited a biological predisposition for dissociation. In our culture, the most frequent cause of

• Rare outside of Western cultures Depersonalization (^) • Severe and frightening feelings of detachment dominate

the person’s life

• Affected person feels like an outside observer of his or her
• own mental or body processes
• • Causes significant distress or impairment in functioning,
• especially emotional expression and deficits in perception
• • Some symptoms are similar to those of panic disorder
• • Rare; onset usually in adolescence Dissociative Fugue

Dissociative Trance

• (^) Cause: Dissociative identity disorder is caused by ongoing childhood trauma that occurs before the ages of six to nine. People with dissociative identity disorder usually have close relatives who have also had similar experiences.
• Treatment: Long-term psychotherapy that helps the patient merges his/her multiple personalities into one personality. “The trauma of the past has to be explored and resolved with proper emotional expression. Hospitalization may be required if behavior becomes bizarre or destructive”. Dissociative identity disorder has a tendency to recur over a period of several years, and may become less of a problem after mid-life.

♦ DISSOCIATIVE AMNESIA (formerly psychogenic amnesia):

• The temporary loss of recall memory, specifically episodic memory, due to a traumatic or stressful event.
• It is considered the most common dissociative disorder amongst those documented.
• This disorder can occur abruptly or gradually and may last minutes to years depending on the severity of the trauma and the patient.
• Cause: A way to cope with trauma.
• Treatment: Psychotherapy (e.g. talk therapy) counseling or psychosocial therapy which involves talking about your disorder and related issues with a mental health provider. Psychotherapy often involves hypnosis (help you remember and work through the trauma); creative art therapy (using creative process to help a person who cannot express his or her thoughts); cognitive therapy (talk therapy to identify unhealthy and negative beliefs/behaviors); and medications (antidepressants, anti-anxiety medications or tranquilizers). These medications help control the mental health symptoms associated with the disorders, but there are no medications that specifically treat dissociative disorders. However, the medication Pentothal can sometimes help to restore the memories.[^ The length of an event of dissociative amnesia may be a few minutes or several years. If an episode is associated with a traumatic event, the amnesia may clear up when the person is removed from the traumatic situation.

♦ DISSOCIATIVE FUGUE (formerly psychogenic fugue)

• It is now subsumed under the dissociative amnesia category. It is described as reversible amnesia for personal identity, usually involving

unplanned travel or wandering, sometimes accompanied by the establishment of a new identity.

• This state is typically associated with stressful life circumstances and can be short or lengthy. Dissociative fugue is also known as psychogenic fugue. The person suddenly, and without any warning, can’t remember who they are and has no memory of their past.
• They don’t realize they are experiencing memory loss and may invent a new identity. Typically, the person travels from home – sometimes over thousands of kilometers – while in the fugue, which may last between hours and months.
• When the person comes out of their dissociative fugue, they are usually confused with no recollection of the ‘new life’ they have made for themselves.
• Cause: A stressful event that happens in adulthood.
• Treatment: Hypnosis is often used to help patient recall true identity and remember events of the past. Psychotherapy is helpful for the person who has traumatic, past events to resolve.[9]^ Once dissociative fugue is discovered and treated, many people recover quickly. The problem may never happen again. ♦ DEPERSONALIZATION DISORDER:
• Periods of detachment from self or surrounding which may be experienced as "unreal" (lacking in control of or "outside" self) while retaining awareness that this is only a feeling and not a reality.
• Depersonalization disorder is characterized by feeling detached from one’s life, thoughts and feelings. People with this type of disorder say they feel distant and emotionally unconnected to themselves, as if they are watching a character in a boring movie.
• (^) Other typical symptoms include problems with concentration and memory. The person may report feeling ‘spacey’ or out of control. Time may slow down.
• They may perceive their body to be a different shape or size than usual; in severe cases, they cannot recognize themselves in a mirror.
• Cause: Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to chronic physical, sexual or emotional abuse or, less frequently, a home environment that is otherwise frightening or highly unpredictable; however, this disorder can also acutely form due to severe traumas such as war or the death of a loved one.
• Treatment: Same treatment as dissociative amnesia, and same drugs. An episode of depersonalization disorder can be as brief as a few seconds or continue for several years.

means “uterus,” and the term hysteria reflects the ancient view that frustrated sexual desires, particularly a woman’s desire to have a baby, cause the symptoms.

• Supposedly the uterus detached and moved about the body, causing a

problem wherever it eventually lodged. Variations of this sexist view continued into the late nineteenth century, when many physicians erroneously believed that hysteria occurred only among women (Showalter, 1997).

• Charcot, Freud, and Janet In the latter half of the nineteenth century,

French neurologist Jean-Martin Charcot used hypnosis both to induce and treat hysteria. Charcot greatly influenced Sigmund Freud, who observed Charcot’s hypnotic treatments early in his training.

• Charcot also strongly influenced Freud’s contemporary and rival, Pierre

Janet (1859–1947). Janet was a French philosophy professor who conducted psychological experiments on dissociation and who later trained as a physician in Charcot’s clinic. Both Janet and Freud were eager to explain hysteria, and both developed theories of unconscious mental processes to do so. Their theories differed sharply, however. Janet saw dissociation as an abnormal process. To him, detachment from conscious awareness occurred only as a part of psychopathology.

• In contrast, Freud considered dissociation to be normal, a routine

means through which the ego defended itself against unacceptable unconscious thoughts. Freud saw dissociation and repression as similar processes, and, in fact, he often used the two terms interchangeably (Erdelyi, 1990).

• Thus, Freud viewed dissociative and somatoform disorders as merely

two of many expressions of unconscious conflict. The two theorists criticized each other frequently. Janet thought that Freud greatly overstated the importance of the unconscious; Freud thought that Janet greatly underestimated it.

• (^) Janet’s work became increasingly obscure over time, however, as Freudian theory dominated the mental health professions throughout much of the twentieth century. As Freudian influences have declined in recent years, scholars have rediscovered Janet’s contributions and his more narrow conception of dissociation and unconscious mental processes.

♦ Psychological Science and the Unconscious

• Although contemporary theory differs greatly from Freud’s and Janet’s views, psychological scientists generally agree that unconscious mental processes play a role in both normal and abnormal emotion and cognition.
• We remember a phone number, for example, without knowing how we accessed the memory. However, scientists debate the importance of unconscious processing. Some cognitive scientists call the unconscious mind “dumb,” not “smart” that is, of limited importance.
• Others propose elaborate models of unconscious mental processes— for example, that we have two systems of information processing (Epstein, 1994). The rational system uses abstract, logical knowledge to solve complex problems over time.
• The experiential system uses intuitive knowledge to respond to problems immediately without the delay of thought. The unconscious experiential system is hypothesized to be emotional, powerful, and often illogical (Epstein, 1994). Rationally, we might know that airplanes are safer than automobiles, for example, but emotionally, we are more likely to fear airplanes.
• Contemporary scientists have created new techniques to study unconscious processes. Consider the distinction between explicit and implicit memory. Explicit memory is the conscious recollection of a past event. Implicit memory is indicated by changes in behavior based on a memory of a prior event but with no conscious remembering of the event.