Dissociative Disorders (Pseudoseizure)

What Are Dissociative Disorders?

Dissociative disorders involve problems with memory, identity, emotion, perception, behaviour, and sense of self. Dissociative symptoms can potentially disrupt every area of mental functioning.

Examples of dissociative symptoms include the experience of detachment or feeling as if one is outside one’s body and loss of memory or amnesia. Dissociative disorders are frequently associated with previous experiences of trauma.

There are three types of dissociative disorders:

  • Dissociative identity disorder
  • Dissociative amnesia
  • Depersonalization/derealization disorder

The Sidran Institute, which works to help people understand and cope with traumatic stress and dissociative disorders, describes the phenomenon of dissociation and the purpose it may serve as follows:

Dissociation is a disconnection between a person’s thoughts, memories, feelings, actions, or sense of who they are. This is a normal process that everyone has experienced. Examples of mild, common dissociation include daydreaming, highway hypnosis, or “getting lost” in a book or movie, all of which involve “losing touch” with awareness of one’s immediate surroundings.

During a traumatic experience such as an accident, disaster,circumstances or crime victimization, dissociation can help a person tolerate what might otherwise be too difficult to bear. In situations like these, a person may dissociate the memory of the place, circumstances, or feelings about the overwhelming event, mentally escaping from the fear, pain, and horror. This may make it difficult to remember the details of the experience later, as reported by many disaster and accident survivors.

Dissociative Identity Disorder

Dissociative identity disorder is associated with overwhelming experiences, traumatic events, and abuse that occurred in childhood. Dissociative identity disorder was previously referred to as multiple personality disorder.

Symptoms of dissociative identity disorder (criteria for diagnosis) include:

  • The existence of two or more distinct identities (or “personality states”). Changes in behaviour, memory, and thinking accompany the distinct identities. The signs and symptoms may be observed by others or reported by the individual.
  • Ongoing gaps in memory about everyday events, personal information, and past traumatic events.
  • The symptoms cause significant distress or problems in social, occupational, or other areas of functioning.

In addition, the disturbance must not be a normal part of a broadly accepted cultural or religious practice. As noted in the DSM-5-TR1, in many cultures around the world, experiences of being possessed are a normal part of spiritual practice and are not dissociative disorders.

The attitude and personal preferences (for example, about food, activities, and clothes) of a person with dissociative identity disorder may suddenly shift and then shift back. The shift in identities happens involuntarily, is unwanted, and causes distress. People with dissociative identity disorder may feel that they have suddenly become observers of their speech and actions, or their bodies may feel different (e.g., like a small child, like the opposite gender, huge and muscular).

The Sidran Institute notes that a person with dissociative identity disorder “feels as if she has within her two or more entities, each with its way of thinking and remembering about herself and her life. It is important to keep in mind that although these alternate states may feel or appear to be very different, they are all manifestations of a single, whole person.” Other names used to describe these alternate states include “alternate personalities,” “alters,” “states of consciousness” and “identities.”

For people with dissociative identity disorder, the extent of problems functioning can vary widely, from minimal to significant problems. People often try to minimize the impact of their symptoms.

Risk Factors and Suicide Risk

People who have experienced physical and sexual abuse in childhood are at increased risk of dissociative identity disorder. The vast majority of people who develop dissociative disorders have experienced repetitive, overwhelming trauma in childhood. Among people with dissociative identity disorder in the United States, Canada, and Europe, about 90% had been the victims of childhood abuse and neglect.

Suicide attempts and other self-injurious behaviour are common among people with dissociative identity disorder. More than 70% of outpatients with dissociative identity disorder have attempted suicide.

Treatment

With appropriate treatment, many people are successful in addressing the major symptoms of dissociative identity disorder and improving their ability to function and live a productive, fulfilling life.

Treatment typically involves psychotherapy. Therapy can help people gain control over the dissociative process and symptoms. The goal of therapy is to help integrate the different elements of identity. Therapy may be intense and difficult as it involves remembering and coping with past traumatic experiences. Cognitive behavioural therapy and dialectical behavioural therapy are two commonly used types of therapy. Hypnosis has also been found to be helpful in the treatment of dissociative identity disorder.

There are no medications to treat the symptoms of dissociative identity disorder directly. However, medication may be helpful in treating related conditions or symptoms, such as using antidepressants to treat symptoms of depression.

Depersonalization / Derealization Disorder

Depersonalization/ derealization disorder involves significant ongoing or recurring experience of one or both conditions:

  • Depersonalization – experiences of unreality or detachment from one’s mind, self, or body. People may feel as if they are outside their bodies and watching events happening to them.
  • Derealization – experiences of unreality or detachment from one’s surroundings. People may feel as if things and people in the world around them are not real.

During these altered experiences, the person is aware of reality and that their experience is unusual. The experience is very distressful, even though the person may appear to be unreactive or lacking emotion.

Symptoms may begin in early childhood; the average age at which a person first experiences the disorder is 16. Less than 20% of people with depersonalization/derealization disorder first experience symptoms after age 20.

Dissociative Amnesia

Dissociative amnesia involves not being able to recall information about oneself (not normal forgetting). This amnesia is usually related to a traumatic or stressful event and may be:

  • Localized – unable to remember an event or period (most common type)
  • Selective – unable to remember a specific aspect of an event or some events within a period
  • Generalized – complete loss of identity and life history (rare)

Dissociative amnesia is associated with having experiences of childhood trauma, particularly with experiences of emotional abuse and emotional neglect. People may not be aware of their memory loss or may have only limited awareness. People may also minimize the importance of memory loss regarding a particular event or time.

Related conditions

Both acute stress disorder and posttraumatic stress disorder (PTSD) may involve dissociative symptoms, such as amnesia and depersonalization or derealization.

Related conditions

Both acute stress disorder and PTSD may involve dissociative symptoms, such as amnesia and depersonalization or derealization.

Source From psychiatry.org 

FAQs

Dissociative identity disorder involves a lack of connection among a person’s sense of identity, memory, and consciousness. People with this disorder do not have more than one personality but rather less than one personality. (The name was changed recently from ‘multiple personality disorder’ to ‘dissociative identity disorder.’) This disorder usually arises in response to physical and sexual abuse in childhood as a means of surviving mistreatment by people who should be nurturing and protecting.

Yes. They are sometimes misdiagnosed as having schizophrenia because their belief that they have different identities could be interpreted as a delusion. They sometimes experience dissociated identities as auditory hallucinations (hearing voices). Their symptoms do not improve with antipsychotic medication, but the emotions they display get flatter. This can lead to the mistaken belief that they have schizophrenia and to further ineffective increases in medication. Another common misdiagnosis is borderline personality disorder. People with dissociative identity disorder frequently also have depression.

You may notice sudden changes in mood and behaviour. People with dissociative identity disorder may forget or deny saying or doing things that family members witnessed. Family members can usually tell when a person “switches.” The transitions can be sudden and startling. The person may go from being fearful, dependent, and excessively apologetic to being angry and domineering. They may report not remembering something they said or did just minutes earlier.

Be open and accepting in your responses. Do not ‘take sides’ with one or another component of their identity. Rather, view them as portions of the person as a whole. We are all different in different situations, but we see this as different sides of ourselves. Try to maintain that perspective with the person with dissociative disorder. Also, please help them to protect themselves from any trauma, abuse, or self-harm.

They can, but they usually do not. Typically, those with dissociative identity disorder experience symptoms for six years or more before being correctly diagnosed and treated.

Dissociation is a common coping mechanism, especially in the face of trauma. Many rape victims experience the crime as though they were floating above their bodies, feeling sorry for the person beneath them. Many of us find ways to detach ourselves from painful or unpleasant experiences.

However, people typically restore their usual perspective over time. Those with dissociative disorders experience persistent amnesia, depersonalization, derealization, or fragmentation of identity that actually interferes with the normal process of working through and putting into perspective traumatic or stressful experiences.

Source From psychiatry.org 

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