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Chapter 15. Dissociative Disorders

José R. Maldonado, M.D., F.A.P.M., F.A.C.F.E.; David Spiegel, M.D.
DOI: 10.1176/appi.books.9781585623402.298080

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Excerpt

The dissociative disorders involve a disturbance in the integrated organization of identity, memory, perception, or consciousness. Events normally experienced on a smooth continuum are isolated from the other mental processes with which they would ordinarily be associated. This discontinuity results in a variety of dissociative disorders depending on the primary cognitive process affected. When memories are poorly integrated, the resulting disorder is dissociative amnesia. Fragmentation of identity results in dissociative fugue or dissociative identity disorder (DID; formerly multiple personality disorder). Disordered perception yields depersonalization disorder. Dissociation of aspects of consciousness produces acute stress disorder and various dissociative trance and possession states (Table 15–1).

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FIGURE 15–1. Hippocampal and amygdalar volumes in patients with dissociative identity disorder (DID) and healthy comparison subjects.aSignificant difference between groups (P < 0.05, t test for nonpaired samples).Source. Reprinted from Vermetten E, Schmahl C, Lindner S, et al: "Hippocampal and Amygdalar Volumes in Dissociative Identity Disorder." American Journal of Psychiatry 163:630–636, 2006. Copyright 2006. Used with permission.
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TABLE 15–1. DSM-IV-TR dissociative disorders
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TABLE 15–2. Differences between dissociation and repression
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TABLE 15–3. DSM-IV-TR diagnostic criteria for acute stress disorder
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TABLE 15–4. DSM-IV-TR diagnostic criteria for dissociative amnesia
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TABLE 15–5. DSM-IV-TR diagnostic criteria for dissociative fugue
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TABLE 15–6. DSM-IV-TR diagnostic criteria for depersonalization disorder
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TABLE 15–7. DSM-IV-TR diagnostic criteria for dissociative identity disorder
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TABLE 15–8. "Rules of engagement" in the treatment of dissociative identity disorder
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TABLE 15–9. Guidelines for the use of hypnosis in memory work
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TABLE 15–10. DSM-IV-TR research criteria for dissociative trance disorder
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TABLE 15–11. Comparison of Western and Eastern types of dissociative syndromes
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Dissociative disorders are underdiagnosed.

Dissociation is a common component of acute response to trauma, and dissociative fugue, amnesia, and identity disorders often have a traumatic etiology.

Dissociation represents a failure of integration of identity, memory, perception, and consciousness.

The primary treatments for dissociative disorders involve various psychotherapies, including hypnosis, trauma-related psychotherapies, and cognitive therapies.

Common comorbid conditions requiring treatment include depression, substance use disorders, and borderline personality disorder.

Dissociative symptoms are ubiquitous around the world, but the content of the dissociative symptoms varies, involving "possession" by external entities more often in the East, and fragmentation of individual identity in the West.

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Repression, as a general model for keeping information out of conscious awareness, differs from dissociation in a number of important ways. Which of the following statements describes repression?
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Which of the following characteristics is indicative of dissociative amnesia?
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Which of the following features is descriptive of depersonalization disorder?
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