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Dissociative Disorder

Overview

Dissociation is a normal response to psychological trauma. It is like an emotional anesthesia that aid in survival. Conscious awareness become separated (dissociated) from painful previous memories, thoughts and feelings. Survivor inhabit their head & loss contact with their body.

Dissociative disorders are characterized by


* An involuntary escape from reality

* A disconnection between thoughts, identity, consciousness & memory

Frequent dissociation result in


* Loss of capacity to differentiate reality from imagination

* Leads to uncertainty whether the experience is really happening

Drug addiction and drug dependence are sometimes interchangeable. Many addicts depend on drugs to function. It is possible, however, to be dependent on drugs without being addicted. This often occurs if you rely on medications to control a chronic medical condition. It is also possible to be addicted to drugs without your body becoming dependent on them.

Characteristics of Addiction

use of drugs despite the consequences

inability to stop using drugs

neglect of social and work obligations

Characteristics of Dependence

Features of dependence may include some or all of the features of addiction, plus:


People from all age groups and racial, ethnic & socioeconomic backgrounds can experience a dissociative disorder. 2% of people experience dissociative disorders, with women being more likely than men to be diagnosed. Symptoms of a dissociative disorder usually first develop as a response to a traumatic event, such as abuse or psychological trauma, to keep those memories under control.

Stressful situations can worsen symptoms and cause problems with functioning in everyday activities. Symptoms a person experiences will depend on the type of dissociative disorder. Treatment often involves psychotherapy and medication. Though finding an effective treatment plan can be difficult, many people are able to live healthy and productive lives.


Symptoms

It is as your mind is not in your body & as if you are looking on yourself from a distance, like looking at a stranger

1). Significant memory loss of specific times, people & events

2). Out-of-body experiences, such as feeling as though you are watching a movie of yourself

3). People can have significant depression, anxiety & thoughts of suicide

4). A sense of detachment from your emotions, or emotional numbness

5). A lack of a sense of self-identity

Types of Dissociation

Although only 3 types recognised as disease in DSM, dissociation of mind lies on a continuum. The range of dissociation

Distraction - Depersonalization - Dissociative Amnesia - Dissociative Fugue - Dissociative Identity Disorders

When dissociation become abnormal ?

A degree of dissociation is normal, healthy & adaptive,. For example
1). Getting lost in book
2). Being transiently over involved in a film
3). Children's absorption in play fantasy & imagination
In clinical dissociation, degree of detachment becomes increasingly severe,
1). Person become absorbed in their internal world
2). Losses contact with reality
3). Shows poor control over his/her body & sense of self

Dissociative Amnesia

1). Difficulty remembering important information about one's self
2). Amnesia may surround a particular event, such as emotional trauma or abuse, or more rarely, information about identity and life history
3). Onset is usually sudden & an episode can last minutes, hours, days, or rarely months or years
4). Age of onset - not fixed
5). A person may experience multiple episodes throughout her/her life

Depersonalization disorder

1). Feelings of detachment from actions, feelings, thoughts and sensations as if they are watching a movie (depersonalization)
2). Sometimes people and things in the world around them may feel like unreal (derealization)
3). A person may experience depersonalization, derealization or both
4). Symptoms can last just a matter of moments or return at times over the years
5). Average age of onset - 16

Dissociative identity disorder

1). Also known as multiple personality disorder, characterized by alternative multiple identities controlling the individual for certain period of time
2). Often these identities may have unique names, characteristics, mannerisms & voices
3). Average age of onset - Not fixed, More common in women
4). Cause - Severe, ongoing psychological trauma before the age of 5
5). Women frequently present with acute dissociative symptoms
6). Men commonly exhibit more violent behavior

What causes dissociation

Dissociative disorders usually develop as a way of dealing with psychological trauma. Natural disasters & combat can also cause dissociative disorders. Psychological trauma, the prime inherent cause for dissociation has unique individual experience of an event in which:


Individual's ability is overwhelmed

Individual experiences - A threat to life, bodily integrity or sanity


Psychological effects are likely to be most severe if the trauma is:

1). Human caused

2). Repeated

3). Unpredictable

4). Multifaceted

5). Sadistic

6). Undergone in childhood

7). Perpetrated by a caregiver

Diagnosis

1). Psychiatrists diagnose dissociative disorders based on a review of symptoms and personal history
2). Tests to rule out physical conditions that can cause symptoms such as memory loss and a sense of unreality (for example, head injury, brain lesions or tumors, sleep deprivation or intoxication)
3). If physical causes are ruled out, a mental health specialist is often consulted to make an psychiatric evaluation

Treatment

The goals of treatment for dissociative disorders are to
1). Help the patient safely recall & process painful memories
2). Develop coping skills
3). In the case of dissociative identity disorder, to integrate the different identities into one functional person


Dissociative disorders are managed through various therapies including:


1). Psychotherapies
2). Medications such as antidepressants & benzodiazepines to treat symptoms of related comorbidities like depression & anxieties. It is important to note that there is no drug that deals directly with treating dissociation itself. Rather, medications are used to deal with additional symptoms that commonly occur with dissociative disorders.

Best practice for treatment includes a combination of medication and psychotherapy

Psychotherapy - An effective, popular & versatile treatment


In psychotherapy session, patient speaks with a specialist in a safe and confidential environment to explore and understand feelings and behaviors and gain coping skills. During individual therapy sessions, the conversation can touch on sensitive topics such as past or current problems, experiences, thoughts, feelings or relationships experienced by the person

Types of Psychotherapy

Theses are many. Some patients respond better to one type of therapy than another. Based on nature of the problem & the patient's personality, we have to choose the most effective form of psychotherapy


1). Cognitive Behavioral Therapy (CBT)
2). Dialectical Behavior Therapy (DBT)
3). Eye Movement Desensitization and Reprocessing Therapy (EMDR)
4). Exposure Therapy
5). Interpersonal Therapy
6). Mentalization-based Therapy
7). Psychodynamic Psychotherapy
8). Therapy Pets

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