Dissociative disorders

Dissociative disorders are defined as conditions that involve disruptions or breakdowns of memory, awareness, identity and/or perception with sufficient disruption to everyday functioning to present clinical problems.

The French psychiatrist Pierre Janet (1859-1947) coined the term in his book L'Automatisme psychologique; he emphasized its role as a defensive manoeuver in response to psychological trauma. While he considered dissociation an initially effective defence mechanism that withdraws the individual psychologically from the impact of overwhelming traumatic events, a habitual tendency to dissociate would, however, promote psychopathology.

The four dissociative disorders listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition are as follows:

• Depersonalization disorder (DSM-IV Codes 300.6) - periods of detachment from self or surrounding which may be experienced as "unreal" (lacking in control of or "outside of" self) while retaining awareness that this is only a feeling and not a reality.
• Dissociative Amnesia (DSM-IV Codes 300.12) - noticeable impairment of recall resulting from emotional trauma
• Dissociative fugue (DSM-IV Codes 300.13) - physical desertion of familiar surroundings and experience of impaired recall of the past. This may lead to confusion about actual identity and the assumption of a new identity.
• Dissociative identity disorder'(DSM-IV Codes 300.14) - the alternation of two or more distinct personality states with impaired recall, among personality states, of important information.

In addition, there's the diagnosis of dissociative disorder not otherwise specified (DSM-IV Codes 300.15) which can be used for forms of pathological dissociation not covered by any of the specified dissociative disorders.

In a 2007 study, only 28.7% of the dissociative participants had received psychiatric treatment previously.

Attention to dissociation as a clinical feature is growing in recent years as a concommitant to knowledge of post-traumatic stress disorder, and as neuroimaging research and population studies show its relevance. Dissociation most often makes the news with regards to soldiers' responses to wartime stress, rape victims with amnesia for details, and in occasional criminal trials where the question of whether a person with Dissociative Identity Disorder (DID) can be responsible for his or her actions.

Perhaps the most widely-known form of dissociative disorder is DID, formerly known as Multiple Personality Disorder (MPD). Dissociation has a storied role in murder trials, or at least in movies about murder, where it is occasionally given as a reason for a "not guilty by reason of insanity" verdict.

Dissociative disorders in children

Main article: Dissociative disorders in childhood

Assessment of dissociative disorders

• Structured Clinical Interview for DSM-IV

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See Also

• Amnesia
• Dissociation
• Depersonalization
• Fugue reaction
• Healthy multiplicity
• Multiple personality controversy
• Personality disorders

Key texts

Papers

• Spiegel, D. & Cardena, E (1991) Disintegrated experience : The dissociative disorders revisited. Journal of Abnormal Psychology, 100, 366-378.

Additional material

Papers

• Google Scholar