Dissociative disorder: description
A dissociative disorder is a complex psychological phenomenon. In response to an unbearable experience, those involved hide memories of their own identity.
Healthy people experience their “I” as a unit of thoughts, actions, and feelings. In a dissociative disorder, this stable picture breaks one’s own identity. Hence the term dissociation (Latin for separation, decay).
Such a division of consciousness is usually associated with a traumatic experience or serious conflicts. Dissociative disorder is often associated with other mental disorders, such as depression, schizophrenia, or personality disorder at the border.
Dissociative Disorder: Forms of the Disorder
Dissociative amnesia:
It is a partial or complete memory loss associated with stressful events or problems. In very rare cases, the memory of the whole life is lost.
Amnesia usually occurs in connection with a traumatic event. The loss of memory usually only affects certain scenes of the stressful experience or the time thereafter. Such a dissociative disorder can occur, for example, after a car accident. The person can no longer or only partially remember the accident. However, she did not suffer any brain damage that could explain the loss of memory. The memory loss is usually as fast as it occurred. Relapses are rare.
It is estimated that the risk of dissociative memory loss during life is seven percent.
Dissociative fugue:
Affected by a stressful event, the person suddenly leaves home or work and assumes a new identity (fugue = escape). He cannot remember his previous life (memory loss). When he later returns to his old life, he usually has no memories of his departure and meanwhile in a different identity.
According to the estimate, the risk for this dissociative disorder is only 0.2 percent.
Dissociative stupidity:
Those who are barely affected no longer move, speak or respond to light, sounds, or touch. In this state, it is not possible to make contact with them. However, the person is not unconscious because the muscles do not relax and the eyes move. The symptoms of dissociative folly are not due to organic problems, but a mental burden.
Dissociative stupidity is rare. Experts believe that this dissociative disorder occurs throughout life in 0.05 to 0.2 percent of the population.
Dissociative disorders of movement and sensation:
Unlike the other dissociative disorders, no memory loss (amnesia) occurs. On the contrary, there are motor or sensory deficiencies that have no organic cause: for example, with a dissociative movement disorder, those affected may no longer be free, have no coordination problems, or may not perform voluntary movements in certain areas. not, such as those required for speech.
Some sufferers experience dissociative seizures similar to epileptic seizures. However, a dissociative attack goes hand in hand without losing consciousness. In the case of dissociative sensory and sensory disorders, the normal sensation of the skin in specific body parts or the whole body is lost. Or the affected persons can only partially see, not even see, smell or hear.
The frequency of dissociative disorders of movement and sensations is estimated at 0.3 percent. Women are more affected than men.
Dissociative identity disorder (multiple personality disorder):
Dissociative identity disorder is the most severe form of dissociative disorder. It is also known as “multiple personality disorder”.
The personality of those affected is divided into different parts. Each stock has its memory, preferences, and behavior patterns. Often the different personality traits are very different from each other. They never appear at the same time, but vary.
In many cases, a dissociative personality disorder is the result of severe abuse experiences.
Read more in the article Multiple Personality Disorder.
Dissociative disorder: symptoms
A dissociative disorder varies from patient to patient. Some do not have the memory of a particular experience and may not even be aware that they have a memory impairment. Others suffer from a complete memory loss that destroys the memory of their lives. In the case of a dissociative identity disorder, the ego divides into different personalities who then lead their own lives.
Other people in turn have strong physical symptoms, such as paralysis. But even in the same person, the symptoms can change from one moment to the next. A change in symptoms is characteristic of a dissociative disorder.
Although the symptoms of various dissociative disorders differ greatly from memory loss to physical discomfort, they have two common characteristics.
According to the International Classification of Mental Disorders (ICD-10), dissociative disorders have no physical illness that can explain the symptoms, and there is a convincing temporary association between the symptoms of the dissociative disorder and disturbing events or problems.
If a dissociation affects movement, the symptoms are very similar to those of neurological disorders. It is therefore not easy to see if it is a dissociative disorder or another disease. Those affected can suffer from whole-body paralysis. Some can no longer stand or walk. The loss of voice may also indicate a dissociative disorder. In many cases, however, the symptoms disappear quickly. Depending on the shape of the day, the symptoms often differ in severity. Stressful situations can exacerbate dissociative disorder.
A dissociative disorder can also be manifested by self-harming behavior. For example, some patients incur cuts or burns to return from the dissociative state to reality.
Dissociative Disorder: Causes and Risk Factors
A dissociative disorder usually occurs in connection with traumatic life experiences. Severe stressful situations, such as accidents, natural disasters, or abuse, overwhelm the psyche. The symptoms of dissociative disorders are a stress response to this excessive question.
But not every person responds to stressful situations with dissociation. Individual personality and environmental influences influence the development of dissociative disorders. The bond between the parent and the child influences, among other things, how resilient children are to stress. Children who do not have the necessary safety and security at home are more susceptible to dissociative disorders.
The consequences of negative experiences are also visible on a biological level. Heavy stress can alter structures in the brain. For example, too much of the stress hormone cortisol damages the hippocampus, which makes a huge contribution to our memories. Researchers assume that the tendency to dissociation is also innate. However, the role of the genes could not be elucidated.
Dissociative disorder: causes of various forms
As the cause of memory loss and the fugue, dissociation is considered. Stressful or traumatic experiences can be stored in this way so that they are no longer accessible to the person concerned. Experts believe that it is a protection mechanism. If the psyche cannot handle a situation because it is too threatening, it is relieved of the division.
The exact causes of Stupors, in which patients do not respond to the outside world, are still under-investigated. Some experts compare the symptoms of dissociative intoxication with the dead reflex in animals. A threatening situation causes the person to freeze everywhere. The lethal reflex is a survival strategy that some animals use when they have no way out.
As the Cause of Multiple Personality Disorder Above all, serious experiences of childhood abuse apply. The division into different personalities is protection against unbearable experiences.
the dissociative Movement and Sensation Disorders are also called Conversion Disorders. Psychologists speak of repentance when mental states become visible through physical complaints. The psychoanalyst Sigmund Freud has already said that people expel unbearable mental tension from the consciousness and that this conflict is then a physical symptom. Conversion disorders are difficult to distinguish from physical disorders. Therefore, many sufferers move from doctor to doctor in the hope of finding a physical explanation for the symptoms.
However, there is also the assumption that conversion symptoms are more or less consciously used by those affected to avoid problems. The physical symptoms relieve the person in a situation that would otherwise seem insoluble to the person concerned. Experts speak in this case of an increase in primary diseases. Due to the physical limitation, those affected also need care and they often get more affection than before. This positive aspect of disability can sustain the dissociative disorder as it benefits sufferers.
Dissociative disorder: risk factors
The susceptibility to a dissociative disorder increases when the body is not adequately supplied. A dissociative disorder can be caused by a lack of sleep, a lack of alcohol, or a lack of exercise.
Dissociative disorder: examinations and diagnosis
The symptoms and symptoms reported by the person concerned are important for the diagnosis of a dissociative disorder. For example, some patients suffer from frequent memory loss or often find themselves in places without knowing how they got there.
Personal background questions also help the doctor/therapist to diagnose the dissociative disorder (for example, questions about the current life situation, family background, and potential problems in the family’s mental health). Information from third parties (for example, previous medical findings for minors: reports from parents and teachers) is also useful here.
In addition, a therapist or physician in conversation with the patient pays attention to possible signs of a dissociative disorder. For example, frequent memory gaps that a patient shows during visits to the therapist may indicate a dissociative disorder.
A dissociative disorder can only be diagnosed if organic causes are excluded. Because the symptoms can also be caused by epilepsy, migraines, tumors in the brain, or other diseases. For example, the doctor examines the visual, olfactory, and taste nerves, as well as the movements and reflexes. In some cases, an image of the brain is also made using computed tomography (CT). For minors, the doctor also looks for possible signs of abuse or mistreatment.
The therapist bases his or her diagnosis on special questionnaires or given interview guidelines (‘diagnostic interviews’). To determine the dissociative disorder, the therapist may ask the following questions:
- Do you miss memories of certain parts of your life?
- Do you sometimes find yourself in places without knowing how you got there?
- Do you sometimes get the impression that you have done something that you do not remember? For example, do you find things in your home that you do not know how you got there?
- Do you sometimes feel like you are a completely different person?
Dissociative disorder: treatment
Dissociative disorders are treated as psychotherapy. The therapy usually consists of stabilizing in the initial phase, reducing the symptom, and treating traumatic experiences. Patients are sometimes hypnotized to bring hidden memories (such as dissociative amnesia) to the surface. Once access is created, the person concerned can begin to process the trauma with the help of the therapist. Depending on the severity, duration, and severity of the symptoms, patients with dissociative disorders are treated on an outpatient, day patient, or inpatient basis.
Dissociative disorder: stabilization and reduction of symptoms
At the beginning of the therapy, the therapist explains to the patient in detail the clinical picture of the dissociative disorder. Even if the patient does not respond, the therapist informs him of the disorder. Psychotherapists call this education psychoeducation.
In the further course, the patient learns to consciously observe his feelings and to reduce stress promptly. To reduce dissociative symptoms, the therapist works with the patient to develop strategies to help him cope with the stress. In addition, the patient learns early on indications of an emerging dissociative disorder and to act against it. If the patient is nevertheless in a dissociative state, the therapist uses the help of breathing and thinking exercises to bring him back. It also uses strong smells or loud music to make the patient realize it again.
Dissociative Disorder: Investigating the Trauma
If there have been traumatic experiences in the past, they will be treated in therapy. If the patient is heavily burdened, the therapist pays attention to a step-by-step dispute that does not burden the patient too much. So that patients do not relapse into dissociation during a trauma treatment, the therapist uses different techniques. For this purpose, for example, the person should be touched on a shaky surface while talking about the memories.
Therapy for dissociative movement or sensation disorders
People with one dissociative disorder of movement or sensation They usually seek help from a doctor and not from a therapist because they think their ailments are physical. Many people do not even want to be confronted with the fact that their problems may be psychological, which makes treatment difficult. The therapist teaches the patient that the symptoms are real, but that no physical cause is responsible. Only when the patient is convinced can the cause of the symptoms be addressed as part of psychotherapy.
Dissociative disorder: disease course and prognosis
Often, a dissociative disorder begins suddenly due to a stressful event. After a few weeks or months, the symptoms usually disappear again. In severe cases, those affected suffer the symptoms for the rest of their lives or experience repeated relapses. A higher risk exists on an unfavorable course if the dissociative disorder has been left untreated for a long time and there are still other mental disorders.
