Introduction:
Dissociation in a complex neuropsychological process.
It is the disconnection from one’s surroundings
when one loses all sense of time and place. It
can occur for example, when one gets totally immersed
in a movie or gets lost in a book, and fails to
maintain a balance between the real and unreal.
A person may be driving somewhere, and then he
may later remember that he can not recall which
road he came from because his mind was busy paying
attention to the song he was listening to on the
radio. It is simply a mental process which leads
to an incoherence and dissonance in the person’s
mind – in his thoughts, memories, emotions,
actions, and sense of self.
Dissociation can occur within the normal span
of events and does not always threaten to disrupt
the equilibrium of one’s life. However,
it can also be a serious medical condition, known
as dissociative disorder. When a person reverts
to dissociating, information which is in reality
connected to other information becomes disjoint
from it. When a person undergoes a traumatic experience,
he may dissociate the memory of the place and
happenings of that trauma from his present memory.
The consequences of this would be that he would
experience a temporary mental relief from the
fright and pain of the trauma and, in some situations,
in his mind, there would be a distinct memory
lapse surrounding that experience. Hence, the
memory lapses and changes which this process results
in, dissociative disorders occur in various forms
and people who frequently dissociate often find
that their senses of past events and self are
influenced (Turkus, 1992).
It is the belief of scientists and researchers
that dissociation is commonly practiced by children
and serves as a guard against childhood trauma.
In most cases, it is a practice which children
resort to, but as they turn into adults, it may
become a defense mechanism, a pattern which results
in serious disorders. Dissociative disorders are
usually linked with situations causing overwhelming
stress, which may be the result of traumatic life
events, accidents, or disasters that are experienced
or witnessed or by extreme cases of inner conflict
which lead the mind to detach incompatible or
undesirable information and emotions (Turkus,
1992).
How people become victims of dissociative disorders:
In the previous paragraph, it was mentioned that
it is often children who dissociate. When a child
is confronted with a situation that overwhelms
him, that is beyond his control and he can not
find physical relief from it, he may try to mentally
distance himself from it. In atypical case, dissociation
is usually an effective resort because it can
often protect the child from experiencing severe
physical and emotional pain, because he has ‘gone
away’ from the situation at hand. Through
this process, the child continues to function
and behave normally, as if nothing out of the
ordinary has happened – his thoughts, feelings,
emotions and memories of this painful experience
have been mentally discarded and separated from
his memory.
According to clinicians, dissociative disorders
should even be looked upon as creative and effective
survival techniques because they ensure that the
person behaves normally and does not experience
a breakdown during the highly painful course of
events. A child who continues to experience traumatic
events, dissociation becomes a natural process
as it is repeatedly reinforced and learnt. Since
it helps them and provides much-needed relief,
children often get in the habit of dissociation
and begin to automatically resort to it –
even when the situation at hand is not acutely
serious or traumatic. As these children grow up
and the trauma becomes a story of the past, the
pattern of seeking relief from dissociation persists.
They can even find themselves unable to function
normally in everyday activities (Dissociative
Disorders, 2003).
Kinds of Dissociative Disorders and their Diagnosis:
There are different kinds of Dissociative disorders.
Most researchers agree that dissociation occurs
on a continuum, ranging from mild to serious.
Mild dissociative disorders may be as mentioned
above, getting lost in a book or movie, while
the serious ones may actually cause impairment
or disability to interact normally with people.
According to Joan A. Turkus (Turkus, 1992), there
exists a whole spectrum of dissociative disorders
with increasing levels of intensity, starting
from normal dissociation and ending with Poly-fragmented
DID which is the most serious of all.
Today, there are a number of diagnostic tests
available to doctors and clinicians like the Dissociative
Experiences Scale (DES), Dissociative Disorders
Interview Schedule (DDIS), and the Structured
Clinical Interview for Dissociative Disorders
(SCID-D), Diagnostic Drawing Series (DDS) (Turkus,
1992).
Normal dissociation has been mentioned earlier
on in the text and is not generally a cause of
serious worry, often thought of as a natural mental
process.
Dissociative Amnesia and Fugue -Dissociative Amnesia
and Fugue are next in terms of intensity of disorder.
A dissociative amnesia may be the case when an
individual can not recall important personal information
which is linked with a particularly traumatic
event in his or her life. In his mind, there exists
gaps in his personal history and these gaps can
not be attributed to general forgetfulness. Usually,
this forgotten period of time is clearly demarcated.
A rape victim may be suffering from dissociative
disorder because she has no memory of how it happened.
However, some stimuli like color or smell might
bring back disturbing notions. Common symptoms
of dissociative amnesia are short term memory
loss, depression and feelings of confusion. If
dissociative amnesia is a result of another psychiatric
disorder, it is not considered a discrete problem.
Its diagnosis is based on a physical and psychiatric
examination with blood and urine tests so that
other causes for amnesias like illicit drug use
can be excluded. An EEG is also done so that it
can be confirmed that a seizure disorder was not
the cause. Psychological tests and therapy can
help define the nature of the dissociative experiences
(Merck & Co., 2004).
A dissociative fugue is what happens when a person
impulsively wanders or goes away from home and
then he realizes that he can not recall his past.
He is confused and his sense of self is vague.
This is also generally after a stressful or traumatic
occurrence. There are no symptoms and during the
fugue the person is only a little confused. When
the fugue ends, an avalanche of feelings like
grief, shame, discomfort and conflict occurs.
This happens mostly in adulthood and is, in most
situations, diagnosed when relatives or friends
find a lost family member or acquaintance living
in another community with a new identity (Miller,
2000).
Posttraumatic Stress Disorder and Dissociative
Disorders Not Otherwise Specified:
Posttraumatic Stress Disorder (PTSD) is related
to dissociative disorders and people diagnosed
with the latter almost always are also diagnosed
with the former. 8% of the U.S. population is
affected by PTSD. It is referred to as an anxiety
disorder, but can be taken as a part of the dissociative
spectrum. In PTSD, patient usually experience
flashbacks of the painful experience coupled with
a numbing sensation, a detachment with the trauma
and avoidance of it. Examples of unusual PTSD
are known as Dissociative Disorders Not Otherwise
Specified (DDNOS). PTSD and DDNOS are both most
commonly found in victims of childhood abuse.
These survivors go through flashbacks where the
painful memories come flooding back, even after
years of the abuse. These flashbacks often occur
only after some time has passed since the event
happened and lead to the person detaching himself
from the experience and ‘trancing out’,
ignoring the anguish and feeling hazy, as methods
of dissociating (Turkus, 1992).
Dissociative identity disorder:
Dissociative identity disorder was formerly called
‘multiple personality disorder.’ An
individual with such a disorder experiences two
or more identities at regular intervals. While
the patient is experiencing a new identity, a
separate personality dominates him, and the person
can no longer able to recall the basic information
about his life or himself. Every personality has
a distinct identity and past associated with it
and is called by a different name. This is a serious
disorder, patients are often faced with disability
and incapacity due to it. This personality interchange
and the prevalent temporary amnesia lead to chaotic
lives and disrupt the normal routine. This disorder
is also characterized by frequent suicide attempts
and is said to be most likely to end in suicide
as compared to other mental disorders (Merck &
Co., 2004).
Its symptoms include depression, excessive anxiety
(sweating, rapid pulse, and palpitations), various
phobias, panic attacks, physical symptoms, eating
disorders, and posttraumatic stress. The diagnosis
is a lengthy on due to the ambiguous nature of
the disorder – there can be any amount of
personalities involved. It warrants both medical
and psychiatric assessment, and very direct questions
have to be asked for an accurate appraisal. There
are 4 diagnostic criterion for DID. They are:
1: the confirmation that two or more distinct
personalities or personality states exist within
a person and that they undergo a relatively stable
pattern of perceiving, relating to and thinking
about the environment and self, i.e. they have
distinct personalities; 2: at least two of these
personality states periodically dominate the person's
behavior completely; 3: the person can not remember
vital personal information and this state goes
beyond what can be explained by everyday forgetfulness
and 4: this disruption in normalcy is not caused
by the direct physiological consequences of a
substance (for example, memory loss due to alcohol
intoxication) or a general medical condition.
In some conditions, the psychiatrist or therapist
may use detailed interviews, hypnosis, or drug-facilitated
interviews, often asking the patient to record
his life between visits. These are designed to
facilitate a shifting or switching of personality
states as evaluation and assessment occurs. It
is imperative that the clinician ‘meet’
and watch the ‘switch process’ between
at least two personalities. There are specially
designed questionnaires and surveys which can
identify people suffering from dissociative identity
disorder. This disorder is found with people of
different personalities, ages, and of both genders
(Turkus, 1992; Dissociative Disorders, 2003).
Poly-fragmented DID:
Poly-fragmented DID is an extreme form of DID
and involves over 100 personality states. This
is often the consequence of sadistic and brutal
abuse by a lot of different perpetrators over
a long time interval.
Most of the contemporary research shows that dissociative
disorders are identified primarily among females.
But the latest research has indicated that the
male population has equal cases of dissociative
disorders, only they are not as frequently diagnosed.
Men with these disorders are most likely to be
in treatment for other mental illnesses or drug
and alcohol abuse, or they may be jailed (Women
with disabilities: dissociative disorders, 2003).
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