The LDN Book, Volume Two by Linda Elsegood

Author:Linda Elsegood
Language: eng
Format: epub
Publisher: Chelsea Green Publishing

—  NINE  —

Dissociative Disorders

WIEBKE PAPE, MD

Dissociative disorders are among the most common trauma-related disorders after post-traumatic stress disorders. Dissociation, as opposed to association, describes a lack of integration of relevant information, or the separation of normally related mental processes. As defined by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), “Dissociation is a disruption of and/or discontinuity in the normal, subjective integration of one or more aspects of psychological functioning, including—but not limited to—memory, identity, consciousness, perception, and motor control. In essence, aspects of psychological functioning that should be associated, coordinated, and/or linked are not.”1

In an overwhelming traumatic situation, dissociation occurs as a part of the passive defensive response. It can be seen both as a pathological reaction and a protective mechanism, as dissociation makes it possible to keep traumatic memories from the conscious mind. The dissociative patient may experience amnesia around the traumatic event, or a feeling of detachment—the perception that the trauma did not happen to them (like, for example, the out-of-body-experience that often is reported by victims of car accidents). When an individual experiences repetitive and cumulative traumatization, especially during childhood, dissociative tendencies might enable them to disconnect from the traumatic events and form attachments, even to traumatizing or neglectful caregivers—a capacity that is crucial for survival. Another dissociative reaction to severe traumatization in childhood is the development of different personality states, some that are connected with traumatic memories and others that are settled in everyday life and often deny that the traumatization occurred. The development of cognitive and social skills as though the trauma didn’t happen is possible, but in adult life dissociative symptoms usually become a severe impairment.

The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D)—a standardized diagnostic tool—identifies five specific symptoms of dissociation:2

Amnesia or memory problems involving difficulty recalling personal information.

Depersonalization or a sense of detachment or disconnection from oneself. A common feeling associated with depersonalization is feeling like a stranger to oneself.

Derealization or a sense of disconnection from familiar people or one’s surroundings.

Identity confusion or inner struggle about one’s sense of self/identity.

Identity alteration or a sense of acting like a different person.

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