Support for anyone witha mental disorder
Support for anyone withDissociative disorders are characterized by sudden, temporary changes in consciousness, activity, or identity.
People with Dissociative Disorders may experience any of the following: depression, mood swings, suicidal tendencies, sleep disorders (insomnia, night terrors, and sleep walking), panic attacks and phobias (flashbacks, reactions to stimuli or "triggers"), alcohol and drug abuse, compulsions and rituals, psychotic-like symptoms (including auditory and visual hallucinations), and eating disorders. In addition, individuals with Dissociative Disorders can experience headaches, amnesias, time loss, trances, and "out of body experiences." A few people with Dissociative Disorders have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed).
Dissociative Amnesia is almost always related to traumatising events. A self defense mechanism to block out the event. The amnesia can last from a few minutes to hours or days, even years, after the event is over. The patient can become so use to it that even minor hardships might trigger the amnesia. At a later time some word or picture can trigger the memory to come back. It might seem like there is no feelings tired to this triggered memory but that is because only the seconds before the amnesia occured is returned, just enough to know the event happened but with none of the details. The amnesia must be too extensive to be characterized as typical forgetfulness and cannot be due to an organic disorder or DID. It is the most common of all dissociative disorders, frequently seen in hospital emergency rooms (Maldonado et al., 2002; Steinberg et al., 1993).
More often there are micro-amnesias where the discussion engaged in is not remembered, or the content of a conversation is forgotten from one moment to the next. Some people report that these kinds of experiences often leave them scrambling to figure out what was being discussed. Meanwhile, they try not to let the person with whom they are talking realize they haven't a clue as to what was just said (Maldonado et al., 2002; Steinberg et al., 1993; Steinberg, 1995)
Fugue (from the latin word meaning 'to flee') or Psychogenic Fugue is amnesia accompanied by actual physical flight--a person in a state of amnesia may simply wander away for several hours, or even move to another area and set up a new life. Years later the amnesia may suddenly reverse. The person then awakens in a strange place with a full memory of his or her original identity, but with amnesia now about the fugue period.
Individual's suffering from Dissociative Fugue appear 'normal' to others. That is their psychopathology is not obvious. They are generally unaware of their memory loss/amnesia (American Psychiatric Association, 2000; Frey, 2001; Maldonado et al., 2002; Spiegel & Cardena, 1991; Steinberg et al., 1993).
Somnambulism, or sleepwalking, has been traditionally viewed with psychoanalytic theory as a dissociative disorder because the individual's body movements are apparently being controlled without the knowledge or participation of the conscious mind. More recently it has been reclassified as a sleeping disorder. As researchers have learned more about sleep, a different picture of what is now called 'sleepwalking disorder' has emerged. It usually occurs during stage 3 or stage 4 sleep and involves the carrying out of what looks like purposive sequences of behavior--walking, dressing, or going to the bathroom. Its major danger is that sleepwalkers may accidentally injure themselves during their excursions. Although there have been cases where violence by the patient has taken place. When awaken, the patient doesn't remember what has taken place. The patient would never of committed such violence while they were awake but while in a dream state they see reality in a different way. In these extreme cases, where there is a chance of violence, the patient may have to be restrained in a locked room while asleep.
Up to 15 percent of children show isolated instances of sleepwalking; clinicians estimate that between 1 and 6 percent of children do it often enough to be labeled as having the condition. For the great majority of children, the condition disappears in a few years. The conservative course of treatment is no treatment at all aside from protecting the person against injury during the course of the sleepwalking episode.
Depersonalization Disorder is characterized by a persistent or recurrent feeling of being detached from one's own mental processes or body. Individuals suffering from Depersonalization Disorder relate feeling as if they are watching their lives from outside of their bodies, similar to watching a movie (American Psychiatric Association, 2000; Frey, 2001; Guralnik, Schmeidler, & Simeon, 2000; Maldonado et al., 2002; Simeon et al., 2001; Spiegel & Cardena, 1991). Individuals with Depersonalization Disorder often report problems with concentration, memory and perception (Guralnik et al., 2001). The depersonalization must occur independently of DID, substance abuse disorders and Schizophrenia (Steinberg et al., 1993).
Anaesthetic areas of skin often have boundaries that make it clear that they are associated with the patient's ideas about bodily functions, rather than medical knowledge. There may be differential loss between the sensory modalities which cannot be due to a neurological lesion. Sensory loss may be accompanied by complaints of paraesthesia. Loss of vision and hearing are rarely total in dissociative disorders.
Psychogenic deafness
Disorders in which there is a temporary loss of the sense of personal identity and full awareness of the surroundings. Include here only trance states that are involuntary or unwanted, occurring outside religious or culturally accepted situations.
Excludes: states associated with:
In the commonest varieties there is loss of ability to move the whole or a part of a limb or limbs. There may be close resemblance to almost any variety of ataxia, apraxia, akinesia, aphonia, dysarthria, dyskinesia, seizures, or paralysis.
Psychogenic:
Dissociative convulsions may mimic epileptic seizures very closely in terms of movements, but tongue-biting, bruising due to falling, and incontinence of urine are rare, and consciousness is maintained or replaced by a state of stupor or trance.
Anaesthetic areas of skin often have boundaries that make it clear that they are associated with the patient's ideas about bodily functions, rather than medical knowledge. There may be differential loss between the sensory modalities which cannot be due to a neurological lesion. Sensory loss may be accompanied by complaints of paraesthesia.
Loss of vision and hearing are rarely total in dissociative disorders.
Psychogenic deafness
People with Dissociative Identity Disorder(DID), also known as Multiple Personality Disorder(MPD), have several personalities living in the one body. Everyone has what is termed sometimes, as mini minds in their brain that controls different functions. With DID these mini minds become independent or personalities of their own. This disorder almost always develops from some kind of abuse when they are young, usually before age 12 but mostly between 4 and 6. DID can occur at younger ages occasionally and sometimes the cause is a very signicant trauma such as an accident rather than abuse. The different personalities show up as a defense mechanism to protect themselves from painful memories or anxiety or post tramantic stress. The personalities compete for access to the consciousness, but not all of them, some prefer to remain hidden in the sub-conscious, hiding because of a fear of the outside. Usually one of the personalities knows of and retains the memories of all the other personalities, this personalitiy is often capable of sending anyone of the other personalities out when it thinks its in the best interest of the system. There have been quite a few cases where the birth personality has dissapeared in the system, sometimes the others say it is dead. On rare occasions the birth person is in the system but is unable to come out, either because of fear or because they have never aged since the first trauma that caused the initial split from the system. At present there is no medication to treat DID only some of the side disorders like anxiety and depression. The only real treatment is a lot of counseling, preferably at least twice a week. There is no real need to intregrate the personalities if they are getting along well, it is only necessary to work with the mental problems of the individual personalities and to bring about a co-operative system.
Diagnostic Criteria for Dissociative Identity Disorder (DID)
The Diagnostic and Statistical Manual, 4th Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000a) defines the following diagnostic criteria for Dissociative Identity Disorder (300.14):
In recent years, there has been debate about the diagnostic criteria for
DID. Some have suggested that a set of polythetic criteria would more
accurately portray the typical polysymptomatic presentations of DID
patients (Dell, 2001). Others have argued that the current criteria are
sufficient (Spiegel, 2001). Still others have suggested that dissociative
disorders should be reconceptualized as among “Trauma Spectrum Disorders”,
emphasizing their intimate association with overwhelming and
traumatic circumstances.
(Davidson & Foa, 1993)
DDNOS includes dissociative presentations that do not meet the full criteria for any other dissociative disorder (American Psychiatric Association, 2000; Steinberg et al., 1993). In clinical practice, this appears to be the most commonly presented dissociative disorder, and may often be better characterized by Major Dissociative Disorder with partially dissociated self states (Dell, 2001).
