DISSOCIATIVE DISORDERS

What is the Difference Between Clinical and Normal Levels of Dissociative Disorder?

In dissociative disorder considered normal, the individual continues to feel connected with others and the environment. These individuals do not worry about forgetfulness and can recall their occasional forgetfulness by following contextual clues. However, the situation is different at the clinical level. Individuals at this level feel completely disconnected from people around them and their environment, and they experience alienation from their current situation. Clinically, they experience deficiencies in insight regarding their identity and changing life conditions, or they face severe and recurrent episodes of amnesia, fugue, and identity confusion, indicating a cognitive disconnection (Selvi, 2022; 258).

Dissociative disorders include dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder. This article will describe all three types.

1.      DISSOCIATIVE IDENTITY DISORDER

Dissociative identity disorder was formerly known as multiple personality disorder. In this disorder, the individual exhibits at least two distinct identity states. These new identity types, known as "alter identities," emerge suddenly and can temporarily take control of the individual's primary identity. This leads the individual to exhibit behaviors and attitudes different from their usual self. The number of these alter identities can be numerous, and they may have different characteristics, preferences, thought patterns, and accents. Additionally, alter identities can vary in age and gender. Most individuals with dissociative identity disorder cannot recall the period when the alter identities were dominant, although some have awareness of these identity transitions (Selvi, 2022; 259).

There are ongoing debates and uncertainties in the literature regarding some aspects of this disorder. The current diagnostic criteria used today are provided below.

DSM-5 DIAGNOSTIC CRITERIA

A.    Disruptions in identity characterized by the presence of two or more distinct personality states. The disruption in identity involves marked discontinuity in the sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning, which may be observed by the individual or others.

B.     Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

C.    The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D.    The disturbance is not a normal part of a broadly accepted cultural or religious practice, and the symptoms are not attributable to the physiological effects of a substance or another medical condition (Selvi, 2022; 260).

2.      DISSOCIATIVE AMNESIA

Dissociative amnesia is a severe form of forgetting important personal information, which is different from everyday forgetfulness. Individuals with this condition may forget family members, their place of residence, or even their own names. This memory loss typically follows a traumatic or stressful event. These individuals often appear confused, bewildered, and aimless. Dissociative amnesia usually emerges suddenly and also ends suddenly. The duration can range from a few minutes to several hours, and memory typically returns within a week.

Dissociative amnesia is detailed in four types: localized amnesia (failure to recall events that occurred within a specific period), selective amnesia (inability to remember certain details of an event), generalized amnesia (loss of memory for one's entire life), and continuous amnesia (failure to recall events following a specific time up to and including the present).

In addition to dissociative amnesia, individuals may experience dissociative fugue. These individuals forget personal information and abruptly leave their homes or workplaces. They may assume a new identity and start a new life. It is crucial to note that dissociative fugue does not involve conscious motivation. It should not be assumed that the individual consciously escapes and avoids recognition. In the latest DSM edition, this topic is addressed under dissociative amnesia rather than as a separate category

DSM-5 DIAGNOSTIC CRITERIA

A.    An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.

B.     The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C.     The disturbance is not attributable to the physiological effects of a substance or a neurological or other medical condition.

D.    The disturbance is not better explained by dissociative identity disorder, post-traumatic stress disorder, acute stress disorder, somatic symptom disorder, or major/mild neurocognitive disorder (Selvi, 2022; 262).

Note: If wandering or seemingly purposeful travel occurs, it is specified as dissociative fugue; otherwise, it is classified as non-fugue amnesia (Selvi, 2022; 262).

3.      DEPERSONALIZATION/DEREALIZATION DISORDER

People are known to perceive and feel their bodies as a whole. In depersonalization, individuals feel that their identity and body are separated, and they observe their body and behaviors as if from outside. They become alienated from their own emotions, thoughts, and bodily sensations, feeling that these are not their own.

In derealization, individuals feel detached from their surroundings and the external world, experiencing it as unreal. They may feel as if they are in a dream, with altered perceptions of objects and sounds. Individuals with this disorder may experience both conditions or just one. Despite the subtle difference between these two states, a significant distinction from other dissociative disorders is the absence of memory loss. According to APA, individuals with this disorder are aware that their experiences are not real.

DSM-5 DIAGNOSTIC CRITERIA

A.    The presence of persistent or recurrent experiences of depersonalization, derealization, or both.

B.     During the depersonalization or derealization experiences, reality testing remains intact.

C.    The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D.    The disturbance is not attributable to the physiological effects of a substance or another medical condition.

E.     The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, post-traumatic stress disorder, or another dissociative disorder (Selvi; 2022; 263).

TREATMENT OF DISSOCIATIVE DISORDERS

Psychotherapy Applications: Although treating dissociative disorders with psychotherapy is challenging, studies show that this therapeutic approach can effectively improve symptoms. It isn't easy to make a conclusive statement about the efficacy and content of these applications. There are more psychotherapy applications related to dissociative identity disorder.

Psychopharmacological Treatments: Medications are not the first choice for treating dissociative experiences, as they do not eliminate dissociative experiences. These medications are generally used to treat mood disorders, post-traumatic stress disorder, and other conditions that co-occur with dissociative disorders, helping to regulate the emotional fluctuations common among patients with dissociative disorders (Selvi; 2022; 265).

REFERENCES:

Selvi, K. (2022). Disosiyatif bozukluklar ve bedensel belirti bozuklukları. Tuna E. ve Ö. Öncül Demir (ed.) DSM-5’ E Göre Anormal psikoloji. (2;258-260). Nobel Yayıncılık.