Dissociative Disorders

DISSOCIATIVE
DISORDERS
By : Rahaf Nasser and Tharaa allawama
 Dissociation can be understood as a disruption in the integrated
sense of self.
 This may involve:
1. lapses in autobiographical memory (amnesia)
2. feelings of detachment from one’s self (depersonalization)
3. Or from one’s surroundings (derealization).
These symptoms often develop in the context or aftermath of

significant trauma, particularly during childhood.
 Individuals with dissociative amnesia are unable to remember
important personal information or history. Procedural memory is
preserved.
 The unrecalled autobiographical information has been stored in
memory and is thus potentially retrievable.
Dissociative  More commonly, a single period of time (localized amnesia) or
certain events (selective amne sia) are forgotten.
amnesia
 Affected individuals often do not have insight regarding their
deficits.
 There is a significant incidence of comorbid major depressive
disorder or persistent depressive disorder (dysthymia) and an
increased risk for suicide
1. An inability to recall important autobiographical information,
usually involving a traumatic or stressful event, that is
inconsistent with ordinary forgetfulness.
2. May present with dissociative fugue: sudden, unexpected travel
away from home, accompanied by amnesia for identity or other
Diagnosis autobiographical information.
3. Not due to the physiological effects of a substance or another
medical/ psychiatric/neurological disorder (including traumatic
brain injury).
4. Symptoms cause significant distress or impairment in daily
functioning.
 Lifetime prevalence is 6–7%.
 More common in women than men.
Epidemiology
 Single or repeated traumas often occur prior to the development
ofamnesia.
 Important to establish the patient’s safety.
Treatment  Psychotherapy
 No medications
 Diagnosis :
1. Persistent or recurrent experiences of one or both:
Depersonalization—experiences of unreality or detachment
fromone’s body, thoughts, feelings, or actions
2. Derealization—experiences of unreality or detachment from
one’ssurroundings.
Depersonalizat 3. Reality testing remains intact during an episode.
ion/Derealizati 4. The symptoms cause significant distress or social/occupational
impairment.
on Disorder 5. Not accounted for by a substance (e.g., drug of abuse,
medication),another medical condition, or another mental
disorder.
Course :persistent but may wax and wane

 Lifetime prevalence is 2%.
 Gender ratio 1:1.
 Mean age of onset about 16 years.
Epidemiology
 Increased incidence of comorbid anxiety disorders and major
depression.
 Severe stress or traumas are predisposing factors.
 Psychotherapy
Treatment  No medications
Dissociative
 Dissociative identity disorder (DID) is characterized by the
Identity presence of more than one distinct personality state as a result of
a fragmented sense of self.
Disorder
 DID encompasses features of the other dissociative disorders,
(Multiple such as amnesia, depersonalization, and derealization. DID
predominantly develops in victims of significant and chronic
personality childhood trauma.
Disorder)
1. Disruption of identity manifested as two or more distinct
personality states dominating at different times. These
symptoms may be observed by others or self-reported.
2. Extensive memory lapses in autobiographical information,
daily occur rences, and/or traumatic events.
3. Not due to effects of a substance (drug or medication) or
Diagnosis another medical condition.
4. The condition causes significant distress or impairment in
social/occupa tional functioning.
Symptoms of DID may be similar to those seen in borderline

personality disorder or psychotic disorders.
 Rare. No epidemiologic studies of the national prevalence,
although a few community-based studies claim a prevalence of
1%.
 Increased prevalence in women versus men.
 A history of childhood physical/sexual abuse or neglect is present
in 90%of patients with DID.
Epidemiology  May manifest at any age, but some symptoms are usually present
inchildhood.
 High incidence of comorbid PTSD, major depression, eating
disorders,borderline personality disorder, and substance use
disorders.
 More than 70% of patients attempt suicide, often with frequent
attempts and self-mutilation.
Course and  Course is fluctuating but chronic.
prognosis  Worst prognosis of all dissociative disorders.

 Psychotherapy is the standard treatment.
 Pharmacotherapy: SSRIs to target comorbid depressive and/or
Treatment PTSD symptoms (especially hyperarousal). Prazosin may
ameliorate nightmares and naltrexone may reduce self-
mutilation.
Other
Specified  Characterized by symptoms of dissociation that cause significant
distress or impairment of functioning, but do not meet the full
Dissociative criteria for a specific dissociative disorder.
Disorder
 Identity disturbance due to prolonged and intense coercive
persuasion (e.g., brainwashing, torture, cults).
 Chronic and recurrent syndromes of mixed dissociative symptoms
(with- out dissociative amnesia).
Examples  Dissociative trance: An acute narrowing or loss of awareness of

surroundings manifesting as unresponsiveness, potentially with
minor stereotyped behaviors (not part of a cultural or religious
practice).
 Acute dissociative reactions to stressful events (lasting hours/days
→months)
Thank you all :))

Dissociative Disorders

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DISSOCIATIVE

These symptoms often develop in the context or aftermath of

Course :persistent but may wax and wane

Symptoms of DID may be similar to those seen in borderline

prognosis  Worst prognosis of all dissociative disorders.

Examples  Dissociative trance: An acute narrowing or loss of awareness of

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