13.9 Dissociative Disorders
LO 11 Identify differences among dissociative disorders.
Dissociative disorders are disturbances in normal psychological functioning, which can include problems with memory, identity, consciousness, perception, and motor control. The main feature of these disorders is dissociation, or a disturbance in the normally unified experience of psychological functions involved in memory, consciousness, perception, or identity (Speigel et al., 2011). Dissociation may lead to difficulty recalling personal information (for example, where I live, who I am), or the feeling of being detached from one’s body.
In North America and Europe, the prevalence of dissociative disorders imposes a high financial burden (Brand, Classen, McNary, & Zaveri, 2009), in part because of lengthy treatment times. Dissociative disorders generally do not resolve with a simple drug prescription or a couple of therapy sessions. Here, we focus our discussion on two of the more well-known dissociative disorders: dissociative amnesia and dissociative identity disorder.
Dissociative Amnesia
People suffering from dissociative amnesia have difficulty remembering important personal information. Often the lost memories center on traumatic or stressful events. In some cases the amnesia is localized, or fixed around a certain event; other times it may span a lifetime. A person suffering from dissociative amnesia typically reports a great deal of distress or impairment in relationships, work, and other important areas of life, and puts a lot of effort into managing the mundane details of daily existence (Staniloiu & Markowitsch, 2012).
A person with dissociative amnesia who wanders in a confused and unexpected manner may also be experiencing dissociative fugue (fyüg; Spiegel et al., 2011). Consider this example from a case study: A 62-year-old woman is found in a city many miles away from home. She has no understanding of her whereabouts or activities since leaving home. After a medical evaluation, physicians determine there is no neurological or physical explanation for her memory loss. Over time, she is able to recall some events from the “preceding weeks,” including an argument with her husband that left her in despair (Rajah, Kumar, Somasundaram, & Kumar, 2009). As often occurs with dissociative amnesia, this woman’s memory loss seemed to be associated with distressing events.
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Dissociative identity Disorder
Perhaps the most commonly known dissociative disorder is dissociative identity disorder (often referred to as multiple personality disorder), which is characterized by the presence of two or more distinct personalities. Dissociative identity disorder is considered the most complicated and persistent of the dissociative disorders (Sar, 2011). One of its key features is a lack of connection among behavior, awareness, memory, cognition, and other functioning. There is often a reported gap in remembering day-to-day events and personal information. One may feel significant distress in relationships, work, and other areas. And this experience cannot be related to cultural or religious practice, substance use, or other medical issues.
Clinicians have to be mindful of cross-cultural differences and religious differences in relation to dissociative states. For example, some characteristics associated with dissociative identity disorder seem to occur in Brazilian mediums, and it is important to distinguish between culturally accepted religious practice and disordered behavior (Moreira-Almeida, Neto, & Cardeña, 2008). Gender differences can be attributed mostly to cultural and environmental factors, specifically childhood abuse and trauma, although there are inconsistent findings in relation to gender differences and prevalence (Sar, 2011).
What Causes Dissociative Disorders?
A great deal of controversy surrounds the apparent increase in diagnoses of dissociative identity disorder in the United States. One possible explanation is that clinicians are reinforcing the development of these disassociations. In other words, by suggesting the possibility of alternate personalities or using hypnosis to “recover” lost memories, the clinician “cues” the individual to believe an alternative personality is responsible for behaviors (Lynn, Lilienfeld, Merckelbach, Giesbrecht, & van der Kloet, 2012). These disorders are difficult to substantiate when they are based on self-reports. We should also note that they are often linked to childhood abuse and neglect, war, and terrorism not only in the United States, but also around the globe (APA, 2013). Thus, education about and the prevention of early-life stress, as it relates to childhood abuse and neglect, is of significant importance (Sar, 2011).
Psychological disorders are serious and potentially debilitating. The good news is that many people live successful and fulfilling lives in spite of their disorders. Just look at Ross and Melissa.
show what you know
Question 13.26
1. ____________ is a disturbance in the normally integrated experiences of memory, consciousness, perception, or identity.
Question 13.27
1. ____________ involves two or more distinct personalities within an individual. This experience is characterized by a lack of connection with behavior, awareness, memory, cognition, and other functioning.
- Dissociative identity disorder
- Borderline personality disorder
- Major depressive disorder
- Schizophrenia
Question 13.28
3. Describe the similarities and differences between dissociative amnesia and dissociative identity disorder.
CHECK YOUR ANSWERS IN APPENDIX C.
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