Dissociative Disorders

(multiple personality disorder or split personality disorder)

What is Disassociation?
 According to Keri Wiginton, a freelance health writer, it is a sense of disconnection from the
world around you and often a lot more complicated than that. It is how your mind handles
information. You often feel disconnected from your thoughts, feelings, surroundings, and
memories that affects your sense of identity and perception of time.

Dissociative Disorders
 Dissociative identity disorder used to be called multiple personality disorder or split personality
disorder.

 Mental disorders that involve experiencing a disconnection and lack continuity between
thoughts, memories, surroundings, actions, and identity.

 People with Dissociative Disorders escape reality in ways that are involuntary (done without will
or conscious control) and unhealthy and would cause problems in their functioning in everyday
life.

 Dissociative disorders usually develop as a reaction to trauma and help keep difficult memories
at bay.

The first documented case of multiple personality disorder (MPD) was that of Mary Reynolds in 1815 (I).
Strange " fits" ca me over Ms. Reynold s beginning at the age of 18, which, according to the author, were
"evidently hysterical. " During the attacks Ms. Reynolds might sleep eighteen hours a day and then awaken
with large discrepancies in her memory, penman ship and disposition. The patient ca me to ac knowledge
two different states of being which alternated in herself, and accounts of her story became a focus of
much curiosity and interest after Dr. S.L. Mitchell published it in the Medical Repository in 1817 (2).

Causes of Dissociative Disorders

 People who experience long-term physical, sexual or emotional abuse during childhood are at
greatest risk of developing dissociative disorders.

 Children and adults who experience other traumatic events, such as war, natural disasters,
kidnapping, torture, or extended, traumatic, early-life medical procedures, also may develop
these conditions.

 Dissociative disorders usually develop as a way to cope with trauma.

Symptoms of Dissociative Disorders
Signs and symptoms depend on the type of dissociative disorders you have, but may include:

 Memory loss (amnesia) of certain time periods, events, people and personal information.

 A sense of being detached from yourself and your emotions.

 A perception of the people and things around you as distorted and unreal.

 A blurred sense of identity.

 Significant stress or problems in your relationships, work or other important areas of your life.

 Inability to cope well with emotional or professional stress.

 Mental health problems, such as depression, anxiety, and suicidal thoughts and behaviors.

Types of Dissociative Disorders

1. Dissociative amnesia

 The main symptom is memory loss that's more severe than normal forgetfulness and that can't
be explained by a medical condition. You can't recall information about yourself or events and
people in your life, especially from a traumatic time. Dissociative amnesia can be specific to events
in a certain time, such as intense combat, or more rarely, can involve complete loss of memory
about yourself. It may sometimes involve travel or confused wandering away from your life
(dissociative fugue). An episode of amnesia usually occurs suddenly and may last minutes, hours,
or rarely, months or years. This amnesia is usually related to a traumatic or stressful event and
may be:

localized – unable to remember an event or period of time (most common type)

selective – unable to remember a specific aspect of an event or some events within a period of time

generalized – complete loss of identity and life history (rare)

2. Dissociative identity disorder

 Formerly known as multiple personality disorder, this disorder is characterized by "switching" to

alternate identities. You may feel the presence of two or more people talking or living inside your
head, and you may feel as though you're possessed by other identities. Each identity may have a
unique name, personal history and characteristics, including obvious differences in voice, gender,
mannerisms and even such physical qualities as the need for eyeglasses. There also are
differences in how familiar each identity is with the others. People with dissociative identity
disorder typically also have dissociative amnesia and often have dissociative fugue.
3. Depersonalization/De-realization disorder

 This involves an ongoing or episodic sense of detachment or being outside yourself — observing
your actions, feelings, thoughts and self from a distance as though watching a movie
(depersonalization). Other people and things around you may feel detached and foggy or
dreamlike, time may be slowed down or sped up, and the world may seem unreal (de-realization).
You may experience depersonalization, de-realization or both. Symptoms, which can be
profoundly distressing, may last only a few moments or come and go over many years.

Treatment
Psychotherapy is the primary treatment for dissociative disorders. This form of therapy, also known as
talk therapy, counseling or psychosocial therapy, involves talking about your disorder and related issues
with a mental health professional. Look for a therapist with advanced training or experience in working
with people who have experienced trauma.

 Cognitive Behavioral Therapy (CBT) - a talking therapy that can help you manage your problems
by changing the way you think and behave. It's most commonly used to treat anxiety and
depression, but can be useful for other mental and physical health problems.
 Dialectical Behavioral Therapy (DBT) - a type of cognitive behavioral therapy. Cognitive behavioral
therapy tries to identify and change negative thinking patterns and pushes for positive behavioral
changes. DBT may be used to treat suicidal and other self-destructive behaviors.

Medication
Although there are no medications that specifically treat dissociative disorders, your doctor may prescribe
antidepressants, anti-anxiety medications or antipsychotic drugs to help control the mental health
symptoms associated with dissociative disorders.

 Antidepressants - Selective Serotonin Reuptake Inhibitors(SSRIs), Serotonin-Norepinephrine

Reuptake Inhibitors(SNRIs), and Tricyclic Antidepressants(TCAs).
 Anti-anxiety medications – Benzodiazepines, and Buspirone.
 Antipsychotic drugs – Olanzapine, and Risperidone.

Roles of Social Workers to People with Dissociative Disorders

 Adaptation and integration, emotional adjustment, secrecy and selective disclosure of illness,
change in identity and sense of self, labeling, self-labeling, and challenging and rejecting labeling.

 Implications of findings for social work practice and directions for future research are discussed.

 To help investigate the shortcomings of the health care for the Mentally ill.
Case Example of Dissociative Disorder
Edith, (“Baby”) Mary was a quiet 30-year-old woman who was meek and reticent and had many avoidant
traits. She was talking about some of the events of her past, which included severe sexual abuse starting
at the age of 20 months. She began to tell the psychiatrist about a crying voice she heard constantly:

Mary: Baby cries all the time—Baby—I hear her. She is sad all the time. She can’t talk, but she cries all
the time. (Mary stops speaking. Her demeanor and posture were now so different the psychiatrist was
startled. It really felt as though a different person was in the room.)

Mary (now Edith): She is a wimp. I would never put up with any of that sh--. I’ll kill him. I’ll kill him. I’ll kill
you too and she deserves to die.

Psychiatrist: Who? Baby?

Mary (now Edith): Mary. She’s a wimp.

Psychiatrist: What about Baby?

Mary (now Edith): What are you talking about?

Psychiatrist: May I speak to Mary?

Mary (now Edith): She doesn’t have the guts to come here.

References:

https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/symptoms-causes/syc-
20355215#:~:text=Dissociative%20disorders%20are%20mental%20disorders,with%20functioning%20i
n%20everyday%20life

https://psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders

https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/diagnosis-treatment/drc-
20355221#:~:text=have%20these%20conversations.-
,Medication,symptoms%20associated%20with%20dissociative%20disorders.

https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1266&context=jeffjpsychiatry