DISSOCIATIVE DISORDERS- Chapter 7MEMORY AND DISSOCIATIVE DISORDERS- Memory is key to one’s identity – the sense of who we are and where we fit in our environmento Our past guides our reactions in the present / decisions for the futureo People sometimes experience a major disruption of their memory, identity, or consciousnesso When these lack a clear physical cause, they are called “dissociative” disordersWHAT IS DISSOCIATION?- A process in which different parts of an individual’s identity, memories, or consciousness become split off from one another.- Daydreaming is a common, mild form of dissociation.DISSOCIATIVE DISORDERS- Four types:o Dissociative Amnesiao Dissociative Fugueo Dissociative Identity Disordero Depersonalization DisorderDISSOCIATIVE AMNESIA- 1+ episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness. - Episodic, not semantic memory, is affected.- Types of amnesia that can be experienced: o Localized, Selective, Generalized, Continuouso No organic cause for the memory lossDISSOCIATIVE FUGUE- Localized (most common): loss of memory about events that took place within a limited period of time surrounding a traumatic event- Selective: loss of some, but not all, memories about a given period of time- Generalized: loss of memory extends beyond the period surrounding the traumatic event- Continuous: forgetting continues into the presentON FUGUES- People with dissociative fugue not only forget their personal identities and details of their past, but also flee to an entirely different location The fugue state can last from hours to months, and typically ends suddenly There may be confusion about one’s identity or, in more severe cases, people may take a new name and start a new life Once the fugue is over, people generally regain most or all of their memories and do notexperience a recurrence.- Most cases are reported in adults.- Onset usually related to traumatic, stressful or overwhelming life events.- Duration may be determined by the extent of other problems, such as loss of employment or severe disruption of personal or family relationships.- More common in the highly hypnotizable or those with a history of amnesia due to head injury.- Only on resumption of their former identities do they recall past memories, at which time they become amnestic for experiences during the fugue episode.DISSOCIATIVE IDENTITY DISORDER (diagnostic criteria)A: The presence of two or more distinct identities or personality states.o Alternate identities (subpersonalities or ALTERS) may have different names, genders, ages, personal characteristics, abilities, and physiological responses.COMMON ALTER TYPES- Child type: alters that are young children, who do not age as the individual ages, appear to be the most common type of alter.- Persecutor type: alters that inflict pain or punishment on the other alters by engaging in self-mutilating acts.- Helper type: alters that protect the weaker alters or control the switching between the alters. B: At least two of these identities or personality states recurrently take control of the person’s behavior.- Generally there are three kinds of - relationships between - subpersonalities:- Mutually amnesic - Mutually cognizant - One-way amnesic relationshipsC: Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.o The more passive identities tend to have more constricted memories, whereas the morehostile or controlling identities have more complete memories. - DATA ON DID AND CONTROVERSY- Limited data on prevalence- Higher in US than elsewhere- 3:1 ratio W:M- Some noteworthy cases (e.g., ‘Sybil’) have been discredited years later DEPERSONALIZATION DISORDER- Frequent episodes in which people feel detached from their own mental processes or bodies, as if they are outside observers of themselves.- Derealization also can occur – the feeling that the external world, too, is unreal and strange- The symptoms of depersonalization disorder are persistent or recurrent, significantly distressing,and interfere with social relationships and job performance- DEPERSONALIZATION- Transient experiences like this are normal, perhaps especially when very anxious (e.g., PA) or when very sleepy- May show individual and cultural variability- More common in adolescents and young adultsEXPLANATIONS OF DISSOCIATION- Psychodynamic Viewo Dissociative disorders are caused by excessive repression- Behavioral Viewo Dissociation has been reinforcedo State-dependent Learning – may struggle to remember things when not in same emotional state- Self-hypnosisETIOLOGY OF DID: 2 COMPETING MODELS - Post-traumatic Model o DID arises from a history of severe physical or sexual abuse in childhood (often dissociative coping is involved)o Sociocognitive Model o DID is socially constructed; it results from inadvertent therapist cueing, media influences, and broader sociocultural expectations. o IATROGENIC – disorder inadvertently caused by therapistEVIDENCE CONSISTENT WITH EACH MODEL OF DID- Post-Traumatic Model o Most individuals with DID have a history of childhood physical and sexual abuse.o Children who were physically or sexually abused demonstrate more symptoms of dissociation.- Sociocognitive Model o Most patients don’t show clear signs prior to treatmento Practitioners who use hypnosis tend to have more DID caseso Most DID cases come from few practitionersTREATMENTS FOR DISSOCIATIVE DISORDERS- Psychodynamic therapy- Hypnotic therapy- Drug therapy (Sodium Amobarbital)- For DID in particular:o 1. Recognizing the disorder, 2. Recovering memories, 3. Integrating the subpersonalities * most data is from case studies, not well controlled trialsCONCLUSIONS- Dissociative disorders differ in their symptom presentation, but the general consensus is that these disorders stem from reactions to extremely stressful or traumatic experiences.- Due to the rarity of these disorders (2-3% estimated lifetime prevalence), not much is known about specific etiology or effective