Dissociation: Concept, Specific Disorders, and Risk Factors

Dissociation Concept

DISSOCIATION Universidad Europea 2023 -2024ue DISSOCIATION CONCEPT . Since there is no consistent agreement about precisely what dissociation this is the overview of the various uses of the term.

1. As a lack of integration of mental modules or systems,
2. As an altered state of consciousness,
3. As a defense mechanism.

. While the third category largely reflects the function of the other two, the first and second categories qualitatively differ from each other. The majority of recent conceptualizations converge on this dichotomy, and it has been suggested to label these two types of dissociation as "compartmentalization" and "detachment".ue DISSOCIATION CONCEPT · Dissociation is a common symptom of a spectrum of severe psychopathologies, from reactive attachment disorder in infants (Hinshaw -Fuselier et al., 1999), to dissociative identity disorders. • Early Relational Trauma on Right Brain Development (Putnam, 1989 ), psychotic experiences (Allen & Coyne, 1995), borderline personality disorders (Golynkina & Ryle, 1999), and posttraumatic stress disorders of adults (van der kolk, McFarlane, & Weisaeth, 1996).

Dissociation Dichotomy

DISSOCIATION DYCHOTOMY ue Detachment Dissociation Compartmentalization Dissociation . The medial prefrontal cortex interferes with the normal working of the limbic system in its processing of emotion. Reducing the output of the sympathetic nervous system is therefore associated with fixed, frozen, absent facial expression, absence of speaking, and avoidance of eye contact. (The thousand-yard stare) . An emotional numbing, in the sense of self, the body, or the world around them. . Mild and transitory experiences of detachment dissociation are reported associated with fatigue, intoxication, and stress. . It is commonly experienced at the time of a traumatic event, in which case psychiatry labels it 'peri-traumatic dissociation' associated with Acute Stress Disorder. (If untreated, ASD will usually develop into PTSD.)DISSOCIATION DYCHOTOMY ue Detachment Dissociation Compartmentalization Dissociation • Compartmentalization is a form of structural dissociation that takes place in the frontal lobes of the neocortex, that mediate consciousness, identity, memory, sensory awareness and emotion working together. · From non-pathological experience produced by hypnotic suggestion, through temporary amnesia and conversion symptoms, to the chronic disorders of DID and somatization. . When the integration is disrupted, elements of experience can't be integrated into a unitary whole but are stored in memory as isolated fragments consisting of sensory perceptions or affective states. (Nemiah, 1995; van der Kolk & van der Hart,1991.)

Compartmentalization Dissociation Continuum

COMPARTMENTALIZATION DISSOCIATION CONTINUUM Ue NORMAL DISSOCIA- TIVE EPISODE ACUTE STRESS DISORDER (up to 4 wks.) POST TRAUMATIC STRESS DISORDER (4 weeks +) DISSOCIA- TIVE DISORDER DISSOCIA- TIVE DISORDER NOT OTHERWISE SPECIFIED DISSOCIA- TIVE IDENTITY DISORDER · hypnosis · fear/terror . flashbacks · Dissociative amnesia · DDNOS with features of DID · DID · ego states · repression · numbness, detachment, absence of emotional response · Dissociative fugue · Polyfrag- mented DID · childhood imaginary play · sleepwalking reduced awareness of surroundings (dazed) · Depersonali -zation disorder · Polyfrag- mented DDNOS · ! mystical/ · derealization · depersonalization . Dissociative trance disorder · religious experiences (e.g., meditation, ecstatic experiences) · amnesia for aspects of the trauma · Possession trance disorder Adapted from Braun, B. G. (1988) · automatisms · highway hypnosisue

Self Development & Dissociation

SELF DEVELOPMENT & DISSOCIATION · Part of the self that processes cognitive integration (ongoing processes of awareness, responses to input from external sources, emotional regulation, etc) can be conceptualized as a 'working self'. Conway (2000) • The working self consists of hierarchically organized goals in working memory. • The goals are constructed to reduce mismatches and discrepancies between the current state of the system and the desired state of the system. · One important goal of the working self is to limit the retrieval of memory that might destabilize the system (examples: memory that triggers strong negative emotion, memory that highlights discrepancies between one's knowledge and one's goals). · The working self does this by creating a retrieval program that specifies inhibition of the relevant memory content. The unwanted content remains compartmentalized in the system.SELF DEVELOPMENT & DISSOCIATION ue Attachment System The growing child has a fundamental need (goal) to be close to her / his attachment figures. Defense System But also has a fundamental need (goal) to avoid physical and emotional pain and to feel safe in her / his environment. . If the discrepancies between these basic behavioural goals are impossible to deal with. The cognitive processing prevents the simultaneous activation of conflicting goals by compartmentalizing them in dissociated neural systems. • If this strategy is repeated in similar circumstances over and over again, separate working selves might develop over time, each comprising the goals and sub- goals associated with the conflictual goal.

Disintegration of the Self

DESINTEGRATION OF THE SELF ue Four main integrative circuits Following are some theoretical combinations of disconnection. It is interesting to stop and think about how one's experience of reality would be affected, depending on which of these systems were involved in one's compartmentalization of experience. Disconnection - Disintegration of the Self (Information Processing System) MEMORY IDENTITY SENSORY PERCEPTION CONSCIOUSNESS Disconnection - Disintegration of the Self (Information Processing System) MEMORY IDENTITY SENSORY PERCEPTION CONSCIOUSNESS Disconnection - Disintegration of the Self (Information Processing System) MEMORY IDENTITY SENSORY PERCEPTION CONSCIOUSNESS Disconnection - Disintegration of the Self (Information Processing System) MEMORY IDENTITY SENSORY PERCEPTION CONSCIOUSNESSue

Dissociative Phenomena Assessment

1. Sensory and memory fragmentation of experience. - Trauma Memory Quality Questionnaire: [T.M.Q.Q.]
2. Depersonalization and derealization at the moment of trauma. - Peritraumatic Dissociation Experiences Questionnaire [P.D.E.Q.]
3. Ongoing depersonalization in everyday life. - Dissociative Experiences Questionnaire [D.E.S II] - Screening Brief Dissociative Experiences Scale [DES-B]
4. DSM 5 interview for traumatic memories within distinct ego-states(D.I.D). - Dissociative Disorders Interview [DDIS]
5. DSM-5 definition of the dissociative subtype of PTSD. - Dissociative Subtype of PTSD Scale [DSPS]
6. Body awareness and bodily dissociation - Scale of Body Connection [ SBC]

Dissociative Disorders

DISSOCIATIVE DISORDERS • Dissociative identity disorder (DID) - DSM5 code 300.14 (ICD-10 F44.81) • Dissociative amnesia (With Dissociative Fugue 300.13) -DSM5 code 300.12 (ICD-10 F44.0) • Depersonalization /Derealization disorder -DSM5 code 300.6 (ICD-10 F48.1) • Other Specified Dissociative Disorder - DSM5 code 300.16 (ICD-10 F44.89) · Unspecified Dissociative Disorder - DSM5 code 300.15 DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS FIFTH EDITION DSM-5 AMERICAN PSYCHIATRIC ASSOCIATION ue IUe

Dissociative Identity Disorder DSM-5 [300.14]

Dissociative identity disorder DSM-5 [300.14] A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual. 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. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play. E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures)."ue

Dissociative Amnesia DSM-5 [300.12]

Dissociative amnesia DSM-5 [300.12] A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Note: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history. 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 (e.g., alcohol or other drug of abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury / traumatic brain injury, other neurological condition). D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute partial seizures)." o With dissociative fugue [ 300.13] : Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or other important autobiographical information ._ue

Depersonalization / Derealization [300.6]

Depersonalization / Derealization [300.6] A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both: 1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/ or physical numbing). 2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted). 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 (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures). E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.