Psychotherapy Services in South West London

Understanding Dissociative Disorders

Dissociative disorder occur when people have persistent and repeated episodes of dissociation. These usually cause distressing internal chaos and may interfere with work, school, social or home life. Five different forms of these disorders are defined in DSM-IV, the American diagnostic manual commonly used. They can be arranged, in order of complexity, along the dissociation continuum, which also includes everyday dissociation and post traumatic stress disorders. A person position on the continuum will depend to the severity and mix of the types of dissociation they experienced. The dissociation continuum includes everyday dissociation, depersonalization disorder, dissociative amnesia, dissociative fugue, post- traumatic stress disorder (PTSD), dissociative disorder not other wise specified (DDNOS) and dissociative identity disorder (DID). Depersonalisation disorder occurs when you experience strong feelings that you are detached from your body or that your body is unreal. A person may experience mild to moderate derealisation and identity confusion. Dissociative amnesia is an inability to remember significant personal information of particular periods of time, which can’t be explained by ordinary forgetfulness. People may also experience mild to moderate depersonalisation, derealisation and identity confusion. Dissociative fugue occurs when a person travels to a new location during a temporary loss of identity. He or she may assume a different identity and a new life. There is severe amnesia, with moderate to severe identity confusion and often identity alteration. Post traumatic stress disorder (PTSD) is not currently classed as a dissociative disorder but people who experience dissociative distress frequently also meet diagnostic criteria for PTSD. They may experience flashbacks, reliving the trauma repeatedly, which cause extreme distress, This in turn triggers a dissociative numbing reaction. Moderate to severe amnesia is common to both PTSD and dissociative disorders, and is derealisation and depersonalisation. Dissociative disorder not otherwise specified (DDNOS) can include each of the five types of dissociation but the pattern of mix and severity does not fit any of the other disorders. Dissociative identity disorder (DID) is the most complex dissociative disorder. It also known as multiple personality disorder. This has given rise to the idea that this is a personality disorder, although it is not. It defining nature is severe identity alteration. Someone with DID experiences these shifts of identity as separate personalities. Each identity may assume control of behaviour and thoughts at different times. Each has a distinctive pattern of thinking and relating to the world. Severe amnesia implies that one identity may have no awareness of what happens when another identity is in control. The amnesia can be one-way or two-way. Identity confusion is usually moderate to severe. It also includes severe depersonalisation and derealisation.

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