MABD Notes

Unit 5 Dissociative Disorders

 Dissociative Amnesia
 Dissociative Fugue
 Dissociative Possession

Dissociative Disorders
The term dissociation refers to the human mind’s capacity to engage in complex mental
activity in channels split off from, or independent of, conscious awareness.
Dissociative disorders are characterized by a disruption of and/or discontinuity
in the normal integration of consciousness, memory, identity, emotion, perception, body
representation, motor control, and behavior. Dissociative symptoms can potentially disrupt
every area of psychological functioning.
Dissociative symptoms are experienced as a) unbidden intrusions into awareness and
behavior, with accompanying losses of continuity in subjective experience (i.e., ‘‘positive’’
dissociative symptoms such as fragmentation of identity, depersonalization, and
derealization) and/or b) inability to access information or to control mental functions that
normally are readily amenable to access or control (i.e., “negative’’ dissociative symptoms
such as amnesia).
The dissociative disorders are frequently found in the aftermath of trauma, and many
of the symptoms, including embarrassment and confusion about the symptoms or a desire
to hide them, are influenced by the proximity to trauma.

Dissociative Amnesia
Dissociative amnesia is a dissociative disorder in which the sufferer has significantly
impaired memory for important experiences or personal information that cannot be explained
by ordinary forgetfulness.
Retrograde Amnesia is the partial or total inability to recall or identify previously acquired
information or past experiences; by contrast, anterograde amnesia is the partial or total
inability to retain new information.
Dissociative Amnesia is usually limited to a failure to recall previously stored personal
information (retrograde amnesia) when the failure cannot be accounted for by ordinary
forgetting. The gaps in memory most often occur following intolerably stressful
circumstances- wartime combat conditions, for example, or catastrophic events such as
serious car accidents suicide attempts, or violent outbursts. In this disorder, apparently
forgotten personal information is still there beneath the level of consciousness, as sometimes
becomes apparent in interviews conducted under hypnosis or narcosis (induced by sodium
amytal, or so-called truth serum) and in cases where the amnesia spontaneously clears up.
Amnesia episodes usually last between a few days and a few years. Although many people
experience only one such episode, some people have multiple episodes in their lifetimes. In
typical dissociative amnesia reactions individuals cannot remember certain aspects of their
personal life history or important facts about their identity. Yet their basic habit patterns-
such as their abilities to read, talk, perform skills work and so on- remain intact, and they
seem normal that is affected is episodic (pertaining to personal events experienced). The
other recognized forms of memory- semantic (pertaining to language and concepts),
procedural (how to do things), and short-term storage- seem usually to remain intact.

The memory problems in dissociative amnesia can take any of several forms:
Localized amnesia, a failure to recall events during a circumscribed period of time, is the
most common form of dissociative amnesia. Localized amnesia may be broader than amnesia
for a single traumatic event (e.g., months or years associated with child abuse or intense
combat).
In selective amnesia, the individual can recall some, but not all, of the events during a
circumscribed period of time. Thus, the individual may remember part of a traumatic event
but not other parts. Some individuals report both localized and selective amnesias.
Generalized amnesia, a complete loss of memory for one’s life history, is rare. Individuals
with generalized amnesia may forget personal identity. Some lose previous knowledge about
the world (i.e., semantic knowledge) and can no longer access well-learned (i.e., procedural
knowledge). Generalized amnesia has an acute onset; the perplexity, disorientation, and
purposeless wandering of individuals with generalized amnesia usually bring them to the
attention of the police or psychiatric emergency services. Generalized amnesia may be more
common among combat veterans, sexual assault victims, and individuals experiencing
extreme emotional stress or conflict. Individuals with dissociative amnesia are frequently
unaware (or only partially aware) of their memory problems. Many, especially those with
localized amnesia, minimize the
importance of their memory loss and may become uncomfortable when prompted to address
it.
In systematized amnesia, the individual loses memory for a specific category of information
(e.g., all memories relating to one’s family, a particular person, or childhood
sexual abuse).
In continuous amnesia, an individual forgets each new event as it occurs.

Treatment
Treatment most likely includes some combination of the following methods:
Psychotherapy: Psychotherapy, sometimes called “talk therapy,” is the main treatment for
dissociative disorders. This is a broad term that includes several forms of therapy.
Cognitive-behavioral therapy: This form of psychotherapy focuses on changing harmful
thinking patterns, feelings and behaviors.
Eye movement desensitization and reprocessing: This technique is designed to treat people
who have continuing nightmares, flashbacks and other symptoms of post-traumatic stress
disorder (PTSD).
Dialectic-behavior therapy: This form of psychotherapy is for people with severe personality
disturbances (which can include dissociative symptoms), and often takes place after the
person has suffered abuse or trauma.
Family therapy: This helps teach the family about the disorder and helps family members
recognize if the patient’s symptoms come back.
Creative therapies (for example, art therapy, music therapy): These therapies allow patients to
explore and express their thoughts, feelings, and experiences in a safe and creative
environment.
Meditation and relaxation techniques: These help people better handle their dissociative
symptoms and become more aware of their internal states.
Clinical hypnosis: This is a treatment that uses intense relaxation, concentration, and focused
attention to achieve a different state of consciousness, and allows people to explore thoughts,
feelings and memories they may have hidden from their conscious minds.
Medication: There is no medication to treat dissociative disorders. However, people with
dissociative disorders, especially those with depression and/or anxiety, may benefit from
treatment with antidepressant or anti-anxiety medications.
Dissociative Fugue

Dissociative Fugue which as the term implies the French word fugue means “flight” is a
defense by actual flight- a person is not only amnesic for some or all aspects of his or her past
but also departs from home surroundings. This is accompanied by confusion about personal
identity or even the assumption of a new identity (although the identities do not alternate as
they do in dissociative identity disorder). During the fugue, such individuals are unaware of
memory loss for prior stages of their life, but their memory for what happens during the
fugue state itself is intact. Their behavior during the fugue state is usually quite normal and
unlikely to arouse suspicion that something is wrong. However, behavior during the fugue
state often reflects a rather different lifestyle from the previous one (the rejection of which is
sometimes fairly obvious). Days, weeks or sometimes even years later, such people may
suddenly emerge from the fugue state and find themselves in a strange place, working in a
new occupation, with no idea how they got there. In other cases, recovery from the fugue
state occurs only after repeated questioning and reminders of who they are.

During the Fugue State

If you're in the midst of a fugue state, you may exhibit
the following symptoms:
• Confusion about your identity
• Appearing to be unsure about your past
• Feeling confronted if challenged about your identity
Symptoms
• Sudden and unplanned travel away from home
• Inability to recall past events or important information from the person's life
• Confusion or loss of memory about their identity, possibly assuming a new identity to
make up for the loss
• Extreme distress and problems with daily functioning (due to the fugue episodes)

Diagnosis in the DSM-5

Since the release of the DSM-5, dissociative fugue is now a subtype of dissociative amnesia
(a disorder) and refers to symptoms of dissociative amnesia accompanied by the state of
purposeful travel or bewildered wandering.

Treatment
The goal of dissociative fugue treatment is to help the person come to terms with the stress or
trauma that triggered the fugue. Treatment also aims to develop new coping methods to
prevent further fugue episodes. The treatment most likely will include some combination of
the following methods:
Psychotherapy: Psychotherapy, a type of counseling, is the main treatment for dissociative
disorders. This treatment uses techniques designed to encourage communication of conflicts
and increase insight into problems.  Cognitive therapy is a specific type of psychotherapy that
focuses on changing dysfunctional thinking patterns and resulting feelings and behaviors.
Medication: There is no established medication to treat the dissociative disorders themselves.
However, if a person with a dissociative disorder also suffers from depression or anxiety,
they might benefit from treatment with a medication such as antidepressant, anti-anxiety, or
antipsychotic drugs.
Family therapy: This helps to teach the family about the disorder and its causes, as well as
to help family members recognize symptoms of a recurrence.
Creative therapies (art therapy, music therapy): These therapies allow the patient to
explore and express their thoughts and feelings in a safe and creative way.
Clinical hypnosis: This is a treatment method that uses intense relaxation, concentration, and
focused attention to achieve an altered state of consciousness (awareness), allowing people to
explore thoughts, feelings, and memories they might have hidden from their conscious minds.
The use of hypnosis for treating dissociative disorders is controversial due to the risk of
creating false memories.

Dissociative Possession

DSM - V
Dissociative trance: This condition is characterized by an acute narrowing or complete loss
of awareness of immediate surroundings that manifests as profound unresponsiveness or
insensitivity to environmental stimuli. The unresponsiveness may be accompanied by minor
stereotyped behaviors (e.g., finger movements) of which the individual is unaware and/or that
he or she cannot control, as well as transient paralysis or loss of consciousness. The
dissociative trance is not a normal part of a broadly accepted collective cultural or religious
practice.

ICD-10
Trance and possession disorders: Disorders in which there is a temporary loss of the sense
of personal identity and full awareness of the surroundings. Include here only trance states
that are involuntary or unwanted, occurring outside religious or culturally accepted situations.
Excl.: states associated with:
• acute and transient psychotic disorders
• organic personality disorder
• post concussional syndrome
• psychoactive-substance intoxication with common fourth character
• schizophrenia

DSM-IV TR
Dissociative Trance disorder: The essential feature is an involuntary state of trance that is
not accepted by the person’s culture as a normal part of a collective cultural or religious
practice and that causes clinically significant distress or functional impairment. This
proposed disorder should not be considered in individuals who enter trance or possession
states voluntarily and without distress in the context of cultural and religious practices that
are broadly accepted by the person’s cultural group.

In trance, the loss of customary identity is not associated with the appearance of alternate
identities, and the actions performed during a trance state are generally not complex (Eg.
Convulsive Movements, Falling, Running)

In Possession Trance, there is the appearance of one (or several) distinct alternate identities
with characteristics behaviors, memories, and attitudes and the activities performed by the
person tend to be more complex (Eg. Coherent Conversation, Characteristic Gestures, Facial
Expression and Specific Verbalizations that are culturally established as belonging to a
particular possessing agent).

Full or partial amnesia is more regularly reported after an episode of possession trance than
after an episode of trance.
Associated Features

The course is typically episodic, with variable duration of acute episodes from minutes to
hours. It has been reported that during a trance state, individuals may have an increased pain
threshold, may consume inedible materials (Eg., Fire, Glass) and may experience increased
muscular strength. The symptoms of a pathological trance may be heightened or reduced in
response to environmental cues and the ministrations of others.

Presumed possessing agents are usually spiritual in nature (Eg., Spirits of the dead,
Supernatural Entities, Gods, Demons) and are often experiences as making demands or
expressing animosity. Individuals with pathological possession trance typically experience a
limited number of agents ( one to five) in a sequential, not simultaneous fashion.
Complications include suicide attempts, self-mutilation, and accidents. Sudden deaths have
been reported as a possible outcome, perhaps due to cardiac arrhythmias.