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{{Infobox disease
{{Infobox disease
| Name = Dissociative disorder
| Name = Dissociative disorders
| Image = Dissociative identity disorder.jpg
| Image = File:PLOSfreeuseMRIscanofDID-OSDD-DA-PTSD-2.jpg
| Caption = fMRI imaging with distinct personality states observed switching in dissociative identity disorder, but suffused within other specified dissociative disorder, and dissociative amnesia.
| Caption =
| DiseasesDB =
| Field = [[Psychiatry]]
| ICD10 = {{ICD10|F|44||f|40}}
| ICD10 = {{ICD10|F44}}
| ICD9 = {{ICD9|300.12}}-{{ICD9|300.14}}
| ICD11 =
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D004213
| MeshID = D004213
}}
}}
'''Dissociative disorders''' ('''DD''') are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception. People with dissociative disorders use [[dissociation (psychology)|dissociation]], a defense mechanism, pathologically and involuntarily. Dissociative disorders are thought to primarily be caused by [[psychological trauma]].


'''Dissociative disorders''' (DD) are a function of psychopathic childhood disease evidenced by [[fMRI]] scans that reflect parts of the brain responding to damaged areas within specified sections of the thinking part of the brain. The [[Diagnostic and Statistical Manual of Mental Disorders]], fifth edition (DSM-5) is the 2013 update to the [[American Psychiatric Association]]'s (APA) classification and diagnostic tool. In the United States the [[DSM-5]] serves as a universal authority for psychiatric diagnosis. The DSM identifies only the minimum criteria required to diagnosis a disorder, but otherwise the DSM is not a text used to define a mental disorders. The following dissociative disorders are identified by the DSM-5: dissociative identity disorder (DID), [[DDNOS|Other specified dissociative disorder]] (OSDD), [[dissociative amnesia]] (DA), [[DDNOS|unspecified dissociative disorder]].
The dissociative disorders listed in the American Psychiatric Association's [[DSM-5]] are as follows:<ref name=dsm>{{cite book |last=American Psychiatric Association |title=DSM-IV-TR |year=2000 |publisher=American Psychiatric Press |isbn=0-89042-025-4 |pages=543 |edition=4th}}</ref>
* [[Dissociative identity disorder]] (formerly multiple personality disorder): the alternation of two or more distinct personality states with impaired recall among personality states. In extreme cases, the host personality is unaware of the other, alternating personalities; however, the alternate personalities are aware of all the existing personalities.<ref name = Schacter/> This category now includes the old derealization disorder category.
* [[Dissociative amnesia]] (formerly psychogenic amnesia): the temporary loss of recall memory, specifically [[episodic memory]], due to a traumatic or stressful event. It is considered the most common dissociative disorder amongst those documented. This disorder can occur abruptly or gradually and may last minutes to years depending on the severity of the trauma and the patient.<ref>Maldonando R.J. and Spiegel D. (2009). Dissociative Disorders. ''In The American Psychiatric Publishing: Board Review Guide for Psychiatry''(Chapter 22). Retrieved from http://books.google.ca/books?hl=en&lr=&id=RFazteXMaj8C&oi=fnd&pg=PA397&dq=Maldonado+JR,+et+al.+Dissociative+disorders.&ots=OOPwzv6IN4&sig=Xo7WlHv6pGUxMBwdpRNN3HnqBCo#v=onepage&q=Maldonado%20JR%2C%20et%20al.%20Dissociative%20disorders.&f=false</ref>
* [[Dissociative fugue]] (formerly psychogenic fugue) is now subsumed under the [[Dissociative amnesia]] category. It is described as reversible amnesia for personal identity, usually involving unplanned travel or wandering, sometimes accompanied by the establishment of a new identity. This state is typically associated with stressful life circumstances and can be short or lengthy.<ref name = Schacter>Schacter, D. L., Gilbert, D. T., & Wegner, D.M. (2011). ''Psychology: Second Edition'', pages 572-573 New York, NY: Worth.</ref>
* [[Depersonalization disorder]]: periods of detachment from self or surrounding which may be experienced as "unreal" (lacking in control of or "outside of" self) while retaining awareness that this is only a feeling and not a reality.
* The old category of [[dissociative disorder not otherwise specified]] is now split into two: Other specified dissociative disorder, and unspecified dissociative disorder. These categories are used for forms of pathological dissociation that do not fully meet the criteria of the other specified dissociative disorders, or if the correct category has not been determined.


The DSM-5 defines dissociative identity disorder as a disease where two or more distinct personality states alternate in such a way that what is referred to as true amnesia exists between them, resulting in a loss of all [[childhood memory]], which is thought to be a reference of terror trapped within the brain that disrupts the individuals life until it can be eliminated. All the dissociative disorders function in such a way that they identify with [[dissociative amnesia]], but is does not result in childhood loss of [[memory]], or as the DSM-5 calls it, a "disruption of identity characterized by two or more distinct personality states."
Both dissociative amnesia and dissociative fugue usually emerge in adulthood and rarely occur after the age of 50.{{citation needed|date=April 2013}} The [[ICD-10]] classifies [[conversion disorder]] as a dissociative disorder<ref>{{cite book|title=International Statistical Classification of Diseases and Related Health Problems, 10th Revision|url=http://apps.who.int/classifications/icd10/browse/2010/en#/F44.9}} F44.9</ref> while the DSM-IV classifies it as a [[somatoform disorder]].


The dissociative disorders are thought to be caused by [[childhood trauma]] of significance to cause, exaggerate and even control a child, and it is the current direction of [[neuroscience]] that such occurrence can only be obtained prior to normal integration of memory, with the various organs of the [[human brain]]. It is not until adulthood that treatment is beneficial because in the formative years the [[Human brain|brain]] is not yet ready to integrate [[Childhood memory|personal information]] that is mixed with horrific terror and events in which the child participated in or had heart-felt feelings about, as in something happening to someone they loved or depended upon. Therefore, depending on the degree of the dissociative disorder, the ability to integrate [[Childhood memory|memory]], [[Mind|thoughts]], ideas (self direction and required needs in order to survive) and history of the [[self]] is self-evident, or in other words, it depends on the [[terror]] a child has experienced that determines if and when they will ever address the first step of therapy, which is recognition of their own mental health disorder. Pharmacology, while addressing symptoms inhibits healing as a whole and is considered to be counterproductive. While [[DDNOS|other specified dissociative disorder]] is fairly common, dissociative identity disorder is not. Historically, the category of dissociation disorders has been misunderstood, popularized, and glorified by the media and as a whole has been made victim of the mainstream populous.
== Cause and treatment ==
'''Dissociative identity disorder (multiple personality disorder)'''


== Dissociative Disorders in the DSM-5 ==
'''Cause:''' People with dissociative identity disorder usually have close relatives who have also had similar experiences.<ref>(Miller, 2010, p.1)
The DSM-5 was updated May 2013. It continues to include the following in the category of Dissociative Disorders: [[DDNOS|Other specified dissociative disorder]] and [[DDNOS|unspecified dissociative disorder]], [[dissociative identity disorder]] and [[dissociative amnesia]]. The updated [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM) was released to the public May 27, 2013 with codes meant to entail decisive diagnosis rather than explain, interpret or otherwise describe any [[mental illness]], while journal articles, multi-authored texts and other peer reviewed information exists for the purpose of discovery, research and identification.<ref name="APA 2013 DSM-5">{{cite book|last1=APA|title=Diagnostic and statistical manual of mental disorders: DSM-5|date=2013|publisher=American Psychiatric Publishing|location=Washington [etc.]|isbn=0-89042-555-8|edition=5th}}</ref> Expert consensus, using said material defines dissociative amnesia as a function of rapid dissociation based on [[Functional magnetic resonance imaging|ƒunctional magnetic resonance imaging]] (ƒMRI) imaging and [[Positronic brain|positron emission tomography]] (PET) scans that identify areas of the brain that respond to stimuli and expert interpretation. The material identifies a reduced ability to attribute facts to lived events within a process of brain apparitions, damage and recoil of the upper membrane covering the [[corpus callosum]] and anterior function of the upper [[Basal ganglia|caudate]] and lower aspects of the tail end of the [[thalamus]].<ref name="UF-Lanius 2012">{{cite book|last1=Lanius|first1=Ulrich F|last2=Paulsen|first2=Sandra L.|last3=Corrigan|first3=Frank M.|title=Neurobiology and treatment of traumatic dissociation: towards an embodied self|date=2012|publisher=Springer|location=New York|isbn=0-8261-0631-5}}</ref><ref name="Alan Schore 2014">{{cite book|last1=Schore|first1=Alan N.|title=Neuroscience and Psychoanalysis|date=2014|isbn=88-97479-06-5}}</ref><ref name=Nijenhuis2011>{{cite journal|last1=Nijenhuis|first1=Ellert R. S.|last2=van der Hart|first2=Onno|title=Dissociation in Trauma: A New Definition and Comparison with Previous Formulations|journal=Journal of Trauma & Dissociation|date=July 2011|volume=12|issue=4|pages=416–445|doi=10.1080/15299732.2011.570592}}</ref> Recoil is expected between both the upper limits of the general covets of the corpus callosum, general areas of the hemispheres and the lower general aspects of the trail end of the amygdala. In general it is considered that dissociative disorders are biological processes of both innate and subaxial brain processes that identify generally the youth in their youngest years of development, but then continue on into later life and often individuals die without resolving their familial disease.<ref name="Empirical Reference 2014">{{cite journal|last1=Empirical Reference|first1=2014|last2=Loewenstein|first2=Richard J.|last3=Spiegel|first3=David|last4=Brand|first4=Bethany L.|title=Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach|journal=Psychiatry: Interpersonal and Biological Processes|date=June 2014|volume=77|issue=2|pages=169–189|doi=10.1521/psyc.2014.77.2.169}}</ref> <ref name="Reinders 2014">{{cite journal|last1=Reinders|first1=Antje A.T.S.|last2=Willemsen|first2=Antoon T.M.|last3=den Boer|first3=Johan A.|last4=Vos|first4=Herry P.J.|last5=Veltman|first5=Dick J.|last6=Loewenstein|first6=Richard J.|title=Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: A PET study and neurobiological model|journal=Psychiatry Research: Neuroimaging|date=September 2014|volume=223|issue=3|pages=236–243|doi=10.1016/j.pscychresns.2014.05.005}}</ref>
Miller, J. (30 Dec 2010). Dissociative Disorders. 1-3.
Retrieved May 5, 2015, from http://www.athealth.com/cinsumer/disorders/dissociative.html</ref>


===Personality===
'''Treatment:''' Long-term psychotherapy that helps the patient merge his/her multiple personalities into one personality. “The trauma of the past has to be explored and resolved with proper emotional expression. Hospitalization may be required if behavior becomes bizarre or destructive”.<ref name="athealth.com">(Miller, 2010, p.2) Miller, J. (30 Dec 2010). Dissociative Disorders. 1-3.
In the DSM-5 the [[personality]] is one entity but with different characteristics that show up on fMRI and are referred to as personality states ranging from slightly distinct to highly distinct.<ref name="APA 2013 DSM-5"/> The various lighting technique used on scans shows marked differences between [[posttraumatic stress disorder]], dissociative amnesia, other specified dissociative disorder and dissociative identity disorder, but there is no visible evidence of what the DSM-5 calls depersonalization/derealization disorder.<ref name="Dissociation 2011"/>
Retrieved May 5, 2015, from http://www.athealth.com/cinsumer/disorders/dissociative.html</ref> Dissociative identity disorder has a tendency to recur over a period of several years, and may become less of a problem after mid-life.<ref name="athealth.com"/>


{{cquote|Personality can be defined as a biopsychosocial system that determines an individual's characteristic mental and behavioral actions. This definition highlights the fact that personality includes perception and emotion; that perception, emotion, and thought involve mental actions, including decision making; and that behavior involves combined mental and motor action. Personality constitutes a whole system that has an ongoing tendency toward integration, that is, binding and differentiation of different components of experiences as well as different experiences across time. In dissociation in trauma, personality as a system includes two or more insufficiently integrated subsystems.<ref name="Dissociation 2011"/>}}
'''Dissociative amnesia'''


===Distinct personality state (DPS)===
'''Cause:''' A way to cope with trauma.
The DSM-5 uses the terminology distinct personality state<ref name="UF-Lanius 2012"/><ref name="Schlumpf 2014">{{cite journal |last1=Schlumpf |first1=Yolanda R. |last2=Reinders |first2=Antje A. T. S. |last3=Nijenhuis |first3=Ellert R. S. |last4=Luechinger |first4=Roger |last5=van Osch |first5=Matthias J. P. |last6=Jäncke |first6=Lutz |last7=Chao |first7=Linda |title=Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study |journal=PLoS ONE |date=12 June 2014 |volume=9 |issue=6 |pages=e98795 |doi=10.1371/journal.pone.0098795}}</ref> to define the different [[mental disorders]] classified within the category referred to as Dissociative Disorders.<ref name="Alan Schore 2014"/><ref name="APA 2013 DSM-5"/><ref name="Siegel 2011">{{cite book |last1=Siegel |first1=Daniel |title=Mindsight: The New Science of Personal Transformation |date=2011 |doi=10.1521/ijgp.2010.60.4.605}}</ref><ref name="fMRI study 2014">{{cite journal |last1=fMRI study |first1=2014 |last2=Yennu |first2=Amarnath |last3=Smith-Osborne |first3=Alexa |last4=Gonzalez-Lima |first4=F. |last5=North |first5=Carol S. |last6=Liu |first6=Hanli |last7=Tian |first7=Fenghua |title=Prefrontal responses to digit span memory phases in patients with post-traumatic stress disorder (PTSD): A functional near infrared spectroscopy study |journal=NeuroImage: Clinical |date=2014 |volume=4 |pages=808–819 |doi=10.1016/j.nicl.2014.05.005}}</ref><ref name="fMRI study 2014"/>


===Less-distinct personality state===
'''Treatment:''' Psychotherapy (e.g. talk therapy) counseling or psychosocial therapy which involves talking about your disorder and related issues with a mental health provider. Psychotherapy often involves hypnosis (help you remember and work through the trauma); creative art therapy (using creative process to help a person who cannot express his or her thoughts); cognitive therapy (talk therapy to identify unhealthy and negative beliefs/behaviors); and medications (antidepressants, anti-anxiety medications or tranquilizers). These medications help control the mental health symptoms associated with the disorders, but there are no medications that specifically treat dissociative disorders.<ref>(Mayo, 2011, p.11) (3 Mar 2011). Mayo Clinic. 1-12.
The DSM-5 avoids using the term distinct personality state<ref name="UF-Lanius 2012"/><ref name="Schlumpf 2014"/> to describe anything other than dissociative identity disorder. When terminology is absolute then this version refers to the most innate of all types of disorders and reflects the very essence of each independent disorder referring to each as a unique part of a make up and class of disorders.<ref name="Reinders 2014"/><ref name="Alan Schore 2014"/><ref name="APA 2013 DSM-5"/><ref name="fMRI study 2014"/>
Retrieved May 5, 2015, from
http://www.mayoclinic.com/health/dissociative-disorders/DS00574
</ref> However, the medication Penthothal can sometimes help to restore the memories.<ref>(Miller, 2010, p.2)Miller, J. (30 dec 2010). Dissociative Disorders. 1-3.
Retrieved May 5, 2015, from http://www.athealth.com/cinsumer/disorders/dissociative.html
</ref> The length of an event of dissociative amnesia may be a few minutes or several years. If an episode is associated with a traumatic event, the amnesia may clear up when the person is removed from the traumatic situation.


== Dissociation ==
'''Dissociative fugue'''
[[Dissociation]] is defined as a state of being that is pathological to the adult human, but innate to a child because fantasy, [[Dream|dream states]] and other forms of magical play are part of a child's world, but adults don't fall into the category of play because while they dream and even day dream they don't habituate in the avenue of making it a daily life habit. Onno van der Hart and Ellert Nijenhuis further define [[dissociation]], and while they have a set goal the populous of the [[ISSTD]] falls behind them lacking the understanding they have of the subject, but none-the-less, these two researchers are the foremost experts on the subject and have a large following consisting of the top researching in the field.''<ref name="Nijenhuis 2011">{{cite journal|last1=Nijenhuis|first1=Ellert R. S.|last2=van der Hart|first2=Onno|title=Defining Dissociation in Trauma|journal=Journal of Trauma & Dissociation|date=July 2011|volume=12|issue=4|pages=469–473|doi=10.1080/15299732.2011.570599}}</ref>


{{cquote|Dissociation in trauma entails a division of an individual’s personality, i.e., of the dynamic, biopsychosocial system as a whole that determines his or her characteristic mental and behavioral actions. This division of personality constitutes a core feature of trauma. It evolves when the individual lacks the capacity to integrate adverse experiences in part or in full, can support adaptation in this context, but commonly also implies adaptive limitations. The division involves two or more insufficiently integrated dynamic, that is changeable, but excessively rigid subsystems. These subsystems exert functions, and can encompass any number of different dynamic configurations of brain, body, and environment. These different configurations manifest as dynamic actions and implied dynamic states. The dissociative subsystems can be latent, or activated in a sequence or in parallel. Each dissociative subsystem, i.e., dissociative part of the personality includes its own, at least rudimentary person perspectives, that is, its own epistemic pluralism and epistemic dependency. As each dissociative part, the individual can interact with other dissociative parts and other individuals, at least in principle. Dissociative parts maintain permeable biopsychosocial boundaries that keep them divided, but that they can in principle dissolve. Phenomenologically, this division of the personality manifest in dissociative symptoms that can be categorized as negative or positive, and cognitive-emotional or sensorimotor.''<ref name="Dissociation 2011">{{cite journal|last1=Dissociation|first1=2011|last2=van der Hart|first2=Onno|last3=Nijenhuis|first3=Ellert R. S.|title=Dissociation in Trauma: A New Definition and Comparison with Previous Formulations|journal=Journal of Trauma & Dissociation|date=July 2011|volume=12|issue=4|pages=416–445|doi=10.1080/15299732.2011.570592}}</ref>}}
'''Cause:''' A stressful event that happens in adulthood.


===Category 300.14 (F44.81)===
'''Treatment:''' Hypnosis is often used to help patient recall true identity and remember events of the past. Psychotherapy is helpful for the person who has traumatic, past events to resolve.<ref name="Miller 2010, p.2">(Miller, 2010, p.2) Miller, J. (30 dec 2010). Dissociative Disorders. 1-3.
Dissociative identity disorder is diagnosed by the following criteria, which like all mental disorders in the DSM-5,<ref name="Alan Schore 2014"/> the minimum criteria needed to diagnose a disorder is all that is needed and so that is all that is used. As shown below it only takes three criteria to diagnosis the most complex of any mental disorder,<ref name="Alan Schore 2014"/> but a diagnostician must be able to identify true amnesia<ref name="UF-Lanius 2012"/> from dissociative amnesia<ref name="UF-Lanius 2012"/> and it's essential they understand how to recognize a distinct personality state from a less-distinct personality state.<ref name="UF-Lanius 2012"/><ref name="APA 2013 DSM-5"/><ref name="Dissociation 2011"/>
Retrieved May 6, 2015, from http://www.athealth.com/cinsumer/disorders/dissociative.html</ref> Once dissociative fugue is discovered and treated, many people recover quickly. The problem may never happen again.<ref name="Miller 2010, p.2"/>


#Two distinct personality states switch with disruption in identity.<ref name="UF-Lanius 2012"/><ref name="Alan Schore 2014"/><ref name="Dissociation 2011"/>
'''Depersonalization disorder'''
#True amnesia, (not to be confused with dissociative amnesia) is present between two or more distinct personality states.<ref name="UF-Lanius 2012"/><ref name="Alan Schore 2014"/><ref name="Dissociation 2011"/>
#Significant impairment due to symptoms.<ref name="Dissociation 2011"/>
#Lacking a "temporary state" created purposefully by cultural practice, which is a common addition to any DSM category like this.
#The defined symptoms are not attributed to other factors, which again is a common addition to any DSM category like this.


===Category 300.12 (F44.0)===
'''Cause:''' Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to chronic physical, sexual or emotional abuse or, less frequently, a home environment that is otherwise frightening or highly unpredictable.
Dissociative amnesia is diagnosed by four criteria in the DSM-5.<ref name="APA 2013 DSM-5"/>


#Dissociative amnesia, which is not to be confused with true amnesia which is only found in dissociative identity disorder.<ref name="UF-Lanius 2012"/><ref name="Alan Schore 2014"/><ref name="Dissociation 2011"/>
'''Treatment:''' Same treatment as dissociative amnesia, and same drugs. An episode of depersonalization disorder can be as brief as a few seconds or continue for several years.<ref name="Miller 2010, p.2"/>
#Significant impairment due to symptoms.<ref name="Dissociation 2011"/>
#Lacking drug affects, direct trauma to the skull or other neurological condition.<ref name="Dissociation 2011"/>
#Lacking a "temporary state" created purposefully by cultural practice, which is a common addition to any DSM category like this.
#The defined symptoms are not attributed to dissociative identity sisorder, posttraumatic stress disorder, [[acute stress disorder]], [[Somatic symptom disorder|somatic symptoms disorder]] or any other [[neurological disorder]].


===Category 300.6 (F48.1)===
== Specific psychopharmacology ==
Since the last update of the DSM-5 in 2013, fMRI scans have shown<ref name="Alan Schore 2014"/> that the category depersonalization/derealization Disorder not only does not belong within the dissociative disorders, but probably does not exist. All other disorders represented within the DSM-5 section of dissociative disorders are confirmed by multiple studies and the hard evidence of fMRI scans.<ref name="UF-Lanius 2012"/><ref name="APA 2013 DSM-5"/><ref name="Dissociation 2011"/>
As mentioned earlier, anti-anxiety, antidepressants and tranquilizers are treatment medications that do not cure, but help control the symptoms of dissociative disorders. The accepted mode of treatment are atypical neuroleptics such as Abilify, Zyprexa, Seroquel and Geodon. Newer-generation anticonvulsants are also highly effective. Quetiapine is initiated at 25–50&nbsp;mg PO bid and increased by 50&nbsp;mg PO bid q3d until symptom resolution is achieved. The higher dose should be administered nightly due to the strong sedation effects of the medicine. Other medications such as SSRIs and SNRIs may reduce the anxiety and apprehension of the dissociation.


===Category 300.15 (F44.89)===
Keppra may be effective in treating dissociation. Doses are usually kept much lower than for the treatment of seizure disorders. Lamotrigine started at 25&nbsp;mg and increased by 25&nbsp;mg every 2 weeks is another option. The effects of these novel anticonvulsants is thought to be secondary to GABA modulation.<ref>{{EMedicine|article|294508|Dissociative Disorders}}</ref>
In the [[DSM-IV]] the term dissociative disorder not otherwise described was used, but the DSM-5 has changed the information used to diagnose this mental disorder enough that this old term is now obsolete, and the new term other specified dissociative disorder, defines this section in ways that make it so the terms are not interchangeable, and so using the term [[DDNOS]] as of May 2013 is improper.<ref name="Alan Schore 2014"/> It's important for diagnosticians to understand that there are not any distinct personality states within this disorder,<ref name="UF-Lanius 2012"/> but instead there are parts that alternate, instead of what is defined as switching.<ref name="UF-Lanius 2012"/> The ultimate criteria that begets the difference between dissociative identity disorder and [[DDNOS|other specified dissociative disorder]] is the lack of true amnesia<ref name="Alan Schore 2014"/> between two or more distinct personality states.<ref name="UF-Lanius 2012"/> This can only be defined by a skilled and practiced trauma expert, and when not, it leads to immense confusion within the health care community as a whole, and even among the afflicted.<ref name="UF-Lanius 2012"/><ref name="Alan Schore 2014"/><ref name="APA 2013 DSM-5"/><ref name="Dissociation 2011"/>


#Symptoms do not fit the criteria for any other dissociative disorder, and are said to be mixed, confused and don't follow a certain pattern as is seen in dissociative identity disorder.<ref name="UF-Lanius 2012"/><ref name="Alan Schore 2014"/><ref name="Dissociation 2011"/>
'''Risk factors'''
#Significant impairment due to symptoms.<ref name="Dissociation 2011"/>
People who experience chronic physical, sexual or emotional childhood abuse are at a greater risk of developing dissociative disorders. Children and adults experiencing other traumatic events (including war, natural disasters, kidnapping, torture and invasive medical procedures) also may develop these conditions.<ref>(Mayo, 2011, p.4) (3 Mar 2011). Mayo Clinic. 1-12.
#Lacking drug affects, direct trauma to the skull or other neurological condition.
Retrieved May 7, 2015, from
#Lacking a "temporary state" created purposefully by cultural practice, which is a common addition to any DSM category like this.
http://www.mayoclinic.com/health/dissociative-disorders/DS00574</ref>
#The defined symptoms are not attributed to dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptoms disorder or any other neurological disorder.


===Category 300.15 (F44.9)===
==Diagnosis and prevalence==
Unspecified dissociative disorder is used in a setting where a clinician is not qualified to diagnose this complicated mental disorder.<ref name="Empirical Reference 2014"/><ref name="Alan Schore 2014"/><ref name="APA 2013 DSM-5"/><ref name="Dissociation 2011"/>
The lifetime prevalence of dissociative disorders varies from 10% in the general population to 46% in psychiatric inpatients.<ref name = Ross>{{cite journal|last=Ross|title=Prevalence, Reliability and Validity of Dissociative Disorders in an Inpatient Setting|journal=Journal of Trauma and Dissociation|year=2002|pages=7–17 |doi=10.1300/J229v03n01_02|display-authors=etal}}</ref> Diagnosis can be made with the help of structured interviews such as the Dissociative Disorders Interview Schedule (DDIS) and the [[Structured Clinical Interview for DSM-IV]] Dissociative Disorders (SCID-D), or with the [[Dissociative Experiences Scale]] (DES) which is a self-assessment questionnaire.<ref name = Ross/> Some diagnostic tests have also been adapted and/or developed for use with children and adolescents such as the Children's Version of the Response Evaluation Measure (REM-Y-71), Child Interview for Subjective Dissociative Experiences, Child Dissociative Checklist (CDC), [[Child Behavior Checklist]] (CBCL) Dissociation Subscale, and the Trauma Symptom Checklist for Children Dissociation Subscale.<ref name=Steiner />


== Cause ==
There are problems with classification, diagnosis and therapeutic strategies of dissociative and conversion disorders which can be understood by the historic context of [[hysteria]]. Even current systems used to diagnose DD such as the DSM-IV and ICD-10 differ in the way the classification is determined.<ref>{{cite journal|last=Splitzer|first=C|author2=Freyberger, H.J.|title=Dissoziative Störungen (Konversionsstörungen)|journal=Psychotherapeut|year=2007}}</ref> In most cases mental health professionals are still heistant to diagnose patients with Dissociative Disorder, because before they are considered to be diagnosed with Dissociative Disorder these patients have more than likely been diagnosed with major depression, anxiety disorder, and most often post-traumatic disorder<ref>[Nolen-Hoeksema, S. (2014). Somatic Symptom and Dissociative Disorders. In (ab)normal Psychology (6th ed., p. 164). Penn, Plaza, New York: McGraw-Hill.]</ref>
Childhood trauma is attributed to dissociative identity disorder,<ref name="Alan Schore 2014"/><ref name="B vanderKolk 2014">{{cite book|last1=vanderKolk|first1=Bessel|title=Body keeps the score: brain, mind, and body in the healing of trauma.|date=2014|publisher=Viking|isbn=0-670-78593-8}}</ref><ref name="Daniel Siegel 2012">{{cite book|last1=Siegel|first1=Daniel J.|title=The developing mind : how relationships and the brain interact to shape who we are|date=2012|publisher=Guilford Press|location=New York|isbn=978-1-4625-0390-2|edition=2nd}}</ref><ref name="Empirical Overview 2014">{{cite journal|last1=Empirical Overview|first1=2014|last2=Brand|first2=B. L.|last3=ar|first3=V.|last4=Kruger|first4=C.|last5=Stavropoulos|first5=P.|last6=Martinez-Taboas|first6=A.|last7=Lewis-Fernandez|first7=R.|last8=Middleton|first8=W.|last9=Dorahy|first9=M.J.|title=Dissociative identity disorder: An empirical overview|journal=Australian & New Zealand Journal of Psychiatry|date=1 May 2014|volume=48|issue=5|pages=402–417|doi=10.1177/0004867414527523}}</ref> [[DDNOS|Other Specified Dissociative Disorder]] and perhaps even [[Dissociative Amnesia]]<ref name="Alan Schore 2014"/> as reported by the [[International Society for the Study of Trauma and Dissociation]],<ref name="ISSTD 2011">{{cite journal|last1=International Society for the Study|title=Guidelines for Treating dissociative identity disorder in Adults, Third Revision|journal=Journal of Trauma & Dissociation|date=28 February 2011|volume=12|issue=2|pages=115–187|doi=10.1080/15299732.2011.537247}}</ref> which is the foremost society for the subject of [[psychological trauma]] and dissociation<ref name="Alan Schore 2014"/><ref name="B vanderKolk 2014"/> and is the host of the Journal of Trauma and Dissociation. The bulk of the organization agrees that while childhood trauma can be caused by various factors,<ref name="Daniel Siegel 2012"/> it is childhood abuse by a significant caregiver that results in a dissociative disorder.<ref name="Empirical Reference 2014"/><ref name="UF-Lanius 2012"/>


== Children ==
An important concern in the diagnosis of dissociative disorders is the possibility that the patient may be feigning symptoms in order to escape negative consequences. Young criminal offenders report much higher levels of dissociative disorders, such as amnesia. In one study it was found that 1% of young offenders reported complete amnesia for a violent crime, while 19% claimed partial amnesia.<ref>{{cite journal|last=Evans, C., Mezey, G., & Ehlers, A.|title=Amnesia for violent crime among young offenders|journal=Journal of Forensic Psychology|year=2009|issue=20|pages=85–106}}</ref> There have also been incidences in which people with dissociative identity disorder provide conflicting testimonies in court, depending on the personality that is present.<ref>{{cite journal|last=Haley, J.|title=Defendent's wife testifies about his multiple personas|journal=Bellingham Herald|year=2003|pages=B4}}</ref>
[[Neurobiology]] has shown that all the dissociative disorders are caused by environmental design in the earliest years of childhood, and rather than being [[Innate|innate disease]] they are caused by various factors that revolve around [[childhood abuse]],<ref name="Alan Schore 2014"/> [[Attachment theory|attachment]] and isolation, and it's also thought that this category of disorders must be fully formed prior to the age natural integration of the organs of the [[brain]] take place,<ref name="Alan Schore 2014"/> because it's impossible for it to occur in any other fashion.<ref name="Empirical Reference 2014"/><ref name="UF-Lanius 2012"/><ref name="Alan Schore 2014"/><ref name="Dissociation 2011"/><ref name="Daniel Siegel 2012"/>


== Adults ==
==Children and adolescents==
While an adult is someone over the age of eighteen years old, a person of this age is still in their formative years and as such they are still unable to heal from any of the dissociative disorders.<ref name="Alan Schore 2014"/> Later in life if an adult feels safe, then they might be able to understand enough about what's wrong with them that they can begin to work on healing, but until this point, they are lost in many ways. Dissociative identity disorder is called a disease of [[amnesia]] for good reason.<ref name="Alan Schore 2014"/> The people who suffer from it not only switch from distinct personality state to distinct personality state, but they do so in a way that they have no idea of their childhood friends, abusers or the life they actually lived. They are usually given some time frame of their life and that's all they know of it. [[DDNOS|Other specified dissociative disorder]] on the other hand, is not a disease of true amnesia<ref name="Alan Schore 2014"/> and so these people not only remember their childhood, their friends and abusers, but they dwell on it. Both disorders are drowned in the actions of [[dissociative amnesia]], and because of this point both those afflicted with dissociative identity disorder and [[DDNOS|other specified dissociative disorder]] are misdiagnosed.<ref name="Empirical Reference 2014"/><ref name="UF-Lanius 2012"/><ref name="Alan Schore 2014"/><ref name="Dissociation 2011"/>
Dissociative disorders (DD) are widely believed to have roots in traumatic childhood experience (abuse or loss), but symptomology often goes unrecognized or is misdiagnosed in children and adolescents.<ref name = Steiner>{{cite journal|last=Steiner|first=H.|author2=Carrion, V. |author3=Plattner, B. |author4=Koopman, C. |title=Dissociative symptoms in posttraumatic stress disorder: diagnosis and treatment|journal=Child and Adolescent Psychiatric Clinics North America|year=2002|volume=12|pages=231–249 |doi=10.1016/s1056-4993(02)00103-7}}</ref><ref name=Diseth>{{cite journal|last=Diseth|first=T.|title=Dissociation in children and adolescents as reaction to trauma - an overview of conceptual issues and neurobiological factors|journal=Nordic Journal of Psychiatry|year=2005|volume=59|pages=79–91|doi=10.1080/08039480510022963}}</ref><ref name = Waters >{{cite journal|last=Waters|first=F.|title=Recognizing dissociation in preschool children|journal=The International Society for the Study of Dissociation News|date=July–August 2005|volume=23|issue=4|pages=1–4}}</ref><ref name = James >{{cite journal|last=James|first=B.|title=The dissociatively disordered child|journal=Unpublished paper|year=1992}}{{vs|date=July 2015}}</ref> There are several reasons why recognizing symptoms of dissociation in children is challenging: it may be difficult for children to describe their internal experiences;<ref name = James /> caregivers may miss signals or attempt to conceal their own abusive or neglectful behaviors;<ref name = James /> symptoms can be subtle or fleeting;<ref name="Steiner"/> disturbances of memory, mood, or concentration associated with dissociation may be misinterpreted as symptoms of other disorders.<ref name=Steiner />


== Treatment ==
In addition to developing diagnostic tests for children and adolescents (see above), a number of approaches have been developed to improve recognition and understanding of dissociation in children. Recent research has focused on clarifying the neurological basis of symptoms associated with dissociation by studying neurochemical, functional and structural brain abnormalities that can result from childhood trauma.<ref name = Diseth /> Others in the field have argued that recognizing disorganized attachment (DA) in children can help alert clinicians to the possibility of dissociative disorders.<ref name = Waters />
Treatment for all forms of dissociative disorders is a three step process starting with acknowledgement of the disorder, because until a person knows they are ill they cannot begin to work on it.<ref name="Dell 2008"/> The three steps overlap, with the next step focusing on trauma processing.<ref name="Empirical Overview 2014"/><ref name="ISSTD 2011"/> This is a confusing term, but it simply means that there are harmful events that need to be moved from one part of the brain to another, and during this time the third step takes place which is integration of the harmful events that terrify a person keeping them from moving hurtful thoughts to their final resting place which can then be called memory. Any thoughts before this final step should not be called memory, but it often is by those who don't understand it.<ref name="Empirical Reference 2014"/><ref name="Courtois 2013">{{cite book |last1=Courtois |first1=Christine A. |last2=Ford |first2=Julian D. |title=Treatment of complex trauma: a sequenced, relationship-based approach |date=2013 |publisher=Guilford Press |location=New York |isbn=1-4625-0658-5}}</ref> [[EMDR]] is one of the more popular ways that [[Psychological trauma|trauma]] is integrated with the whole of the brain.<ref name="van der Hart 2010">{{cite journal |last1=van der Hart |first1=Onno |last2=Nijenhuis |first2=Ellert R. S. |last3=Solomon |first3=Roger |title=Dissociation of the Personality in Complex Trauma-Related Disorders and EMDR: Theoretical Considerations |journal=Journal of EMDR Practice and Research |date=1 May 2010 |volume=4 |issue=2 |pages=76–92 |doi=10.1891/1933-3196.4.2.76}}</ref><ref name="Empirical study 2014">{{cite journal |last1=Empirical study |first1=2014 |last2=Brand |first2=B. L. |last3=Şar |first3=V. |last4=Krüger |first4=C. |last5=Stavropoulos |first5=P. |last6=Martínez-Taboas |first6=A. |last7=Lewis-Fernández |first7=R. |last8=Middleton |first8=W. |last9=Dorahy |first9=M. J. |title=Dissociative identity disorder: An empirical overview |journal=Australian & New Zealand Journal of Psychiatry |date=1 May 2014 |volume=48 |issue=5 |pages=402–417 |doi=10.1177/0004867414527523}}</ref><ref name="Review study 2009">{{cite journal |last1=Review study |first1=2009 |last2=Classen |first2=Catherine C. |last3=McNary |first3=Scot W. |last4=Zaveri |first4=Parin |last5=Brand |first5=Bethany L. |title=A Review of Dissociative Disorders Treatment Studies |journal=The Journal of Nervous and Mental Disease |date=September 2009 |volume=197 |issue=9 |pages=646–654 |doi=10.1097/NMD.0b013e3181b3afaa}}</ref>


== Psycho-pharmacology ==
Clinicians and researchers also stress the importance of using a developmental model to understand both symptoms and the future course of DDs.<ref name = Steiner /><ref name = Diseth /> In other words, symptoms of [[dissociation (psychology)|dissociation]] may manifest differently at different stages of child and adolescent development and individuals may be more or less susceptible to developing dissociative symptoms at different ages. Further research into the manifestation of dissociative symptoms and vulnerability throughout development is needed.<ref name = Steiner /><ref name = Diseth /> Related to this developmental approach, more research is required to establish whether a young patient’s recovery will remain stable over time.<ref name = Thomas>{{cite journal |last1=Jans |first1=Thomas |last2=Schneck-Seif |first2=Stefanie |last3=Weigand |first3=Tobias |last4=Schneider |first4=Wolfgang |last5=Ellgring |first5=Heiner |last6=Wewetzer |first6=Christoph |last7=Warnke |first7=Andreas |title=Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence |journal=Child and Adolescent Psychiatry and Mental Health |volume=2 |issue=1 |pages=19 |year=2008 |pmid=18651951 |pmc=2517058 |doi=10.1186/1753-2000-2-19 }}</ref>
[[Medication]] is counter production when used for the treatment with any dissociative disorder because while it does aid in reducing symptoms of [[depression]] and [[anxiety]] the drugs mask the feelings needed to heal the disease.<ref name="Daniel Siegel 2012"/><ref name="ISSTD 2011"/><ref name="Gentile 2013">{{cite journal |last1=Gentile |first1=Julie |title=Psychotherapy and Pharmacotherapy for Patients with dissociative identity disorder |journal=Innov Clin Neurosci |date=Feb 2012 |volume=2 |issue=10 |pmc=3615506 |pmid=23556139 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615506/}}</ref>
<ref name="Dell 2008">{{cite book|last1=Dell|first1=Paul|title=Dissociation and the dissociative disorders: DSM-V and beyond|date=2008|publisher=Routledge|location=London|isbn=978-0-415-95785-4}}</ref>


== Prevalence ==
==Current debates and the DSM-5==
According to the [[ISSTD]] dissociation identity disorder exists in 1% of the population, while [[DDNOS|other specified dissociative disorder]], being more prevalent is thought to exist in over 3%.<ref name="ISSTD 2011"/>
A number of controversies surround DD in adults as well as children. First, there is ongoing debate surrounding the etiology of [[dissociative identity disorder]] (DID). The crux of this debate is if DID is the result of childhood trauma and disorganized attachment.<ref name = Diseth /><ref>{{cite journal |last1=Boysen |first1=Guy A. |title=The Scientific Status of Childhood Dissociative Identity Disorder: A Review of Published Research |journal=Psychotherapy and Psychosomatics |volume=80 |issue=6 |pages=329–34 |year=2011 |pmid=21829044 |doi=10.1159/000323403 }}</ref> A second area of controversy surrounds the question of whether or not dissociation as a defense versus pathological dissociation are qualitatively or quantitatively different. Experiences and symptoms of [[dissociation (psychology)|dissociation]] can range from the more mundane to those associated with [[posttraumatic stress disorder]] (PTSD) or [[acute stress disorder]] (ASD) to dissociative disorders.<ref name=Steiner /> Mirroring this complexity, it is still being decided whether the DSM-5 will group dissociative disorders with other trauma/stress disorders.<ref>{{cite journal |last1=Brand |first1=Bethany L. |last2=Lanius |first2=Ruth |last3=Vermetten |first3=Eric |last4=Loewenstein |first4=Richard J. |last5=Spiegel |first5=David |title=Where Are We Going? An Update on Assessment, Treatment, and Neurobiological Research in Dissociative Disorders as We Move Toward the DSM-5 |journal=Journal of Trauma & Dissociation |volume=13 |issue=1 |pages=9–31 |year=2012 |pmid=22211439 |doi=10.1080/15299732.2011.620687 }}</ref>


== History ==
A 2012 review article supports the hypothesis that current or recent trauma may affect an individual's assessment of the more distant past, changing the experience of the past and resulting in dissociative states.<ref name="pmid22423434">{{cite journal
The dissociative disorders have a dark and broken history of confusion due to intervention by the popular media, because the media takes what they think they know and they make movies, books and other forms of entertainment that confuse the populous. In reality [[Pierre Janet]] identified dissociative identity disorder and [[DDNOS|other specified dissociative disorder]], while [[Charles Myers]] was the first to separate [[posttraumatic stress disorder]] into a distinct personality state and a less-distinct personality state. While there has been a lot of research <ref name="Schlumpf 2014"/> on the subject it was not until Ellert R.S. Nijenhuis and Onno van Der Hart <ref name="Dissociation 2011"/> began to promote their idea of Structural Dissociation of the Personality that [[psychology]], [[neurology]] and [[psychoneurology]] began to meld and agree with one another because of the advent of the hard science of [[fMRI]]. Kathy Steele, former president of the [[ISSTD]], joined the former in authoring a book called ''Structural Dissociation of the Personality''.<ref name="HauntedSelf 2006">{{cite book|last1=van der Hart|last2=Nijenhuis|first2=Ellert|last3=Steele|first3=Kathy|title=The Haunted self: structural dissociation and the treatment of chronic traumatization|date=2006|publisher=W.W. Norton|location=New York|isbn=978-0-393-70401-3|edition=1st}}</ref> The theory is still being updated by the original authors and now other top researchers like Frank M. Corrigan, Ulrich F. Lanius, Sandra L. Paulsen,<ref name="UF-Lanius 2012"/> Alan Schore,<ref name="Alan Schore 2014"/> Bessel vanderKolk<ref name="B vanderKolk 2014"/> and even Daniel Siegal are all on the same page.<ref name="Daniel Siegel 2012"/><ref name="ISSTD 2011"/>
|author=Stern DB
|title=Witnessing across time: accessing the present from the past and the past from the present
|journal=[[The Psychoanalytic Quarterly]]
|volume=81
|issue=1
|pages=53–81
|date=January 2012
|pmid=22423434
|doi=10.1002/j.2167-4086.2012.tb00485.x
|url=
|issn=
}}</ref> However, experimental research in cognitive science continues to challenge claims concerning the validity of the dissociation construct, which is still based on Freudian notions of repression. Even the claimed etiological link between trauma/abuse and dissociation has been questioned. An alternative model proposes a perspective on dissociation based on a recently established link between a labile sleep–wake cycle and memory errors, cognitive failures, problems in attentional control, and difficulties in distinguishing fantasy from reality."<ref>{{cite journal|last=Lynn|first=SJ|title=Dissociation and dissociative disorders: challenging conventional wisdom|journal=Current Directions in Psychological Science|year=2012|volume=21|pages=48–53 |issue=1|doi=10.1177/0963721411429457|display-authors=etal}}</ref>


==See also==
===ISSTD===
The [http://www.isst-d.org/default.asp?contentID=1 International Society for the Study of Trauma and Dissociation] is considered to be the foremost expert on the subject of dissociative disorders, [[psychological trauma]] and they are by default the organization that should be referenced in bulk.<ref name="ISSTD 2011"/>
* [[Complex post-traumatic stress disorder]]

* [[Dissociative identity disorder in fiction]]
== See also ==
* [[Satanic ritual abuse]]
*[[Psychological dissociation]]
*[[Dissociative amnesia]]
*[[DDNOS|Other specified dissociative disorder]]
*[[Dissociative identity disorder]]


==References==
==References==
{{reflist|30em}}
{{reflist}}

==External links==
* Mayo Clinic - http://www.mayoclinic.org/diseases-conditions/dissociative-disorders/basics/tests-diagnosis/con-20031012
* Cleveland Clinic - http://my.clevelandclinic.org/disorders/dissociative_disorders/hic_depersonalization_disorder.aspx
* International Society for the Study of Trauma and Dissociation - http://www.isst-d.org/
* Sidran Institute - http://www.sidran.org/sub.cfm?sectionID=4


{{Authority control}}
{{Authority control}}

[[Category:Dissociative disorders| ]]
[[Category:Dissociative disorders| ]]
[[Category:Psychiatric diagnosis]]
[[Category:Psychiatric diagnosis]]

Revision as of 00:49, 12 November 2015

Dissociative disorders
SpecialtyPsychiatry, clinical psychology Edit this on Wikidata

Dissociative disorders (DD) are a function of psychopathic childhood disease evidenced by fMRI scans that reflect parts of the brain responding to damaged areas within specified sections of the thinking part of the brain. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) is the 2013 update to the American Psychiatric Association's (APA) classification and diagnostic tool. In the United States the DSM-5 serves as a universal authority for psychiatric diagnosis. The DSM identifies only the minimum criteria required to diagnosis a disorder, but otherwise the DSM is not a text used to define a mental disorders. The following dissociative disorders are identified by the DSM-5: dissociative identity disorder (DID), Other specified dissociative disorder (OSDD), dissociative amnesia (DA), unspecified dissociative disorder.

The DSM-5 defines dissociative identity disorder as a disease where two or more distinct personality states alternate in such a way that what is referred to as true amnesia exists between them, resulting in a loss of all childhood memory, which is thought to be a reference of terror trapped within the brain that disrupts the individuals life until it can be eliminated. All the dissociative disorders function in such a way that they identify with dissociative amnesia, but is does not result in childhood loss of memory, or as the DSM-5 calls it, a "disruption of identity characterized by two or more distinct personality states."

The dissociative disorders are thought to be caused by childhood trauma of significance to cause, exaggerate and even control a child, and it is the current direction of neuroscience that such occurrence can only be obtained prior to normal integration of memory, with the various organs of the human brain. It is not until adulthood that treatment is beneficial because in the formative years the brain is not yet ready to integrate personal information that is mixed with horrific terror and events in which the child participated in or had heart-felt feelings about, as in something happening to someone they loved or depended upon. Therefore, depending on the degree of the dissociative disorder, the ability to integrate memory, thoughts, ideas (self direction and required needs in order to survive) and history of the self is self-evident, or in other words, it depends on the terror a child has experienced that determines if and when they will ever address the first step of therapy, which is recognition of their own mental health disorder. Pharmacology, while addressing symptoms inhibits healing as a whole and is considered to be counterproductive. While other specified dissociative disorder is fairly common, dissociative identity disorder is not. Historically, the category of dissociation disorders has been misunderstood, popularized, and glorified by the media and as a whole has been made victim of the mainstream populous.

Dissociative Disorders in the DSM-5

The DSM-5 was updated May 2013. It continues to include the following in the category of Dissociative Disorders: Other specified dissociative disorder and unspecified dissociative disorder, dissociative identity disorder and dissociative amnesia. The updated Diagnostic and Statistical Manual of Mental Disorders (DSM) was released to the public May 27, 2013 with codes meant to entail decisive diagnosis rather than explain, interpret or otherwise describe any mental illness, while journal articles, multi-authored texts and other peer reviewed information exists for the purpose of discovery, research and identification.[1] Expert consensus, using said material defines dissociative amnesia as a function of rapid dissociation based on ƒunctional magnetic resonance imaging (ƒMRI) imaging and positron emission tomography (PET) scans that identify areas of the brain that respond to stimuli and expert interpretation. The material identifies a reduced ability to attribute facts to lived events within a process of brain apparitions, damage and recoil of the upper membrane covering the corpus callosum and anterior function of the upper caudate and lower aspects of the tail end of the thalamus.[2][3][4] Recoil is expected between both the upper limits of the general covets of the corpus callosum, general areas of the hemispheres and the lower general aspects of the trail end of the amygdala. In general it is considered that dissociative disorders are biological processes of both innate and subaxial brain processes that identify generally the youth in their youngest years of development, but then continue on into later life and often individuals die without resolving their familial disease.[5] [6]

Personality

In the DSM-5 the personality is one entity but with different characteristics that show up on fMRI and are referred to as personality states ranging from slightly distinct to highly distinct.[1] The various lighting technique used on scans shows marked differences between posttraumatic stress disorder, dissociative amnesia, other specified dissociative disorder and dissociative identity disorder, but there is no visible evidence of what the DSM-5 calls depersonalization/derealization disorder.[7]

Personality can be defined as a biopsychosocial system that determines an individual's characteristic mental and behavioral actions. This definition highlights the fact that personality includes perception and emotion; that perception, emotion, and thought involve mental actions, including decision making; and that behavior involves combined mental and motor action. Personality constitutes a whole system that has an ongoing tendency toward integration, that is, binding and differentiation of different components of experiences as well as different experiences across time. In dissociation in trauma, personality as a system includes two or more insufficiently integrated subsystems.[7]

Distinct personality state (DPS)

The DSM-5 uses the terminology distinct personality state[2][8] to define the different mental disorders classified within the category referred to as Dissociative Disorders.[3][1][9][10][10]

Less-distinct personality state

The DSM-5 avoids using the term distinct personality state[2][8] to describe anything other than dissociative identity disorder. When terminology is absolute then this version refers to the most innate of all types of disorders and reflects the very essence of each independent disorder referring to each as a unique part of a make up and class of disorders.[6][3][1][10]

Dissociation

Dissociation is defined as a state of being that is pathological to the adult human, but innate to a child because fantasy, dream states and other forms of magical play are part of a child's world, but adults don't fall into the category of play because while they dream and even day dream they don't habituate in the avenue of making it a daily life habit. Onno van der Hart and Ellert Nijenhuis further define dissociation, and while they have a set goal the populous of the ISSTD falls behind them lacking the understanding they have of the subject, but none-the-less, these two researchers are the foremost experts on the subject and have a large following consisting of the top researching in the field.[11]

Dissociation in trauma entails a division of an individual’s personality, i.e., of the dynamic, biopsychosocial system as a whole that determines his or her characteristic mental and behavioral actions. This division of personality constitutes a core feature of trauma. It evolves when the individual lacks the capacity to integrate adverse experiences in part or in full, can support adaptation in this context, but commonly also implies adaptive limitations. The division involves two or more insufficiently integrated dynamic, that is changeable, but excessively rigid subsystems. These subsystems exert functions, and can encompass any number of different dynamic configurations of brain, body, and environment. These different configurations manifest as dynamic actions and implied dynamic states. The dissociative subsystems can be latent, or activated in a sequence or in parallel. Each dissociative subsystem, i.e., dissociative part of the personality includes its own, at least rudimentary person perspectives, that is, its own epistemic pluralism and epistemic dependency. As each dissociative part, the individual can interact with other dissociative parts and other individuals, at least in principle. Dissociative parts maintain permeable biopsychosocial boundaries that keep them divided, but that they can in principle dissolve. Phenomenologically, this division of the personality manifest in dissociative symptoms that can be categorized as negative or positive, and cognitive-emotional or sensorimotor.[7]

Category 300.14 (F44.81)

Dissociative identity disorder is diagnosed by the following criteria, which like all mental disorders in the DSM-5,[3] the minimum criteria needed to diagnose a disorder is all that is needed and so that is all that is used. As shown below it only takes three criteria to diagnosis the most complex of any mental disorder,[3] but a diagnostician must be able to identify true amnesia[2] from dissociative amnesia[2] and it's essential they understand how to recognize a distinct personality state from a less-distinct personality state.[2][1][7]

  1. Two distinct personality states switch with disruption in identity.[2][3][7]
  2. True amnesia, (not to be confused with dissociative amnesia) is present between two or more distinct personality states.[2][3][7]
  3. Significant impairment due to symptoms.[7]
  4. Lacking a "temporary state" created purposefully by cultural practice, which is a common addition to any DSM category like this.
  5. The defined symptoms are not attributed to other factors, which again is a common addition to any DSM category like this.

Category 300.12 (F44.0)

Dissociative amnesia is diagnosed by four criteria in the DSM-5.[1]

  1. Dissociative amnesia, which is not to be confused with true amnesia which is only found in dissociative identity disorder.[2][3][7]
  2. Significant impairment due to symptoms.[7]
  3. Lacking drug affects, direct trauma to the skull or other neurological condition.[7]
  4. Lacking a "temporary state" created purposefully by cultural practice, which is a common addition to any DSM category like this.
  5. The defined symptoms are not attributed to dissociative identity sisorder, posttraumatic stress disorder, acute stress disorder, somatic symptoms disorder or any other neurological disorder.

Category 300.6 (F48.1)

Since the last update of the DSM-5 in 2013, fMRI scans have shown[3] that the category depersonalization/derealization Disorder not only does not belong within the dissociative disorders, but probably does not exist. All other disorders represented within the DSM-5 section of dissociative disorders are confirmed by multiple studies and the hard evidence of fMRI scans.[2][1][7]

Category 300.15 (F44.89)

In the DSM-IV the term dissociative disorder not otherwise described was used, but the DSM-5 has changed the information used to diagnose this mental disorder enough that this old term is now obsolete, and the new term other specified dissociative disorder, defines this section in ways that make it so the terms are not interchangeable, and so using the term DDNOS as of May 2013 is improper.[3] It's important for diagnosticians to understand that there are not any distinct personality states within this disorder,[2] but instead there are parts that alternate, instead of what is defined as switching.[2] The ultimate criteria that begets the difference between dissociative identity disorder and other specified dissociative disorder is the lack of true amnesia[3] between two or more distinct personality states.[2] This can only be defined by a skilled and practiced trauma expert, and when not, it leads to immense confusion within the health care community as a whole, and even among the afflicted.[2][3][1][7]

  1. Symptoms do not fit the criteria for any other dissociative disorder, and are said to be mixed, confused and don't follow a certain pattern as is seen in dissociative identity disorder.[2][3][7]
  2. Significant impairment due to symptoms.[7]
  3. Lacking drug affects, direct trauma to the skull or other neurological condition.
  4. Lacking a "temporary state" created purposefully by cultural practice, which is a common addition to any DSM category like this.
  5. The defined symptoms are not attributed to dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptoms disorder or any other neurological disorder.

Category 300.15 (F44.9)

Unspecified dissociative disorder is used in a setting where a clinician is not qualified to diagnose this complicated mental disorder.[5][3][1][7]

Cause

Childhood trauma is attributed to dissociative identity disorder,[3][12][13][14] Other Specified Dissociative Disorder and perhaps even Dissociative Amnesia[3] as reported by the International Society for the Study of Trauma and Dissociation,[15] which is the foremost society for the subject of psychological trauma and dissociation[3][12] and is the host of the Journal of Trauma and Dissociation. The bulk of the organization agrees that while childhood trauma can be caused by various factors,[13] it is childhood abuse by a significant caregiver that results in a dissociative disorder.[5][2]

Children

Neurobiology has shown that all the dissociative disorders are caused by environmental design in the earliest years of childhood, and rather than being innate disease they are caused by various factors that revolve around childhood abuse,[3] attachment and isolation, and it's also thought that this category of disorders must be fully formed prior to the age natural integration of the organs of the brain take place,[3] because it's impossible for it to occur in any other fashion.[5][2][3][7][13]

Adults

While an adult is someone over the age of eighteen years old, a person of this age is still in their formative years and as such they are still unable to heal from any of the dissociative disorders.[3] Later in life if an adult feels safe, then they might be able to understand enough about what's wrong with them that they can begin to work on healing, but until this point, they are lost in many ways. Dissociative identity disorder is called a disease of amnesia for good reason.[3] The people who suffer from it not only switch from distinct personality state to distinct personality state, but they do so in a way that they have no idea of their childhood friends, abusers or the life they actually lived. They are usually given some time frame of their life and that's all they know of it. Other specified dissociative disorder on the other hand, is not a disease of true amnesia[3] and so these people not only remember their childhood, their friends and abusers, but they dwell on it. Both disorders are drowned in the actions of dissociative amnesia, and because of this point both those afflicted with dissociative identity disorder and other specified dissociative disorder are misdiagnosed.[5][2][3][7]

Treatment

Treatment for all forms of dissociative disorders is a three step process starting with acknowledgement of the disorder, because until a person knows they are ill they cannot begin to work on it.[16] The three steps overlap, with the next step focusing on trauma processing.[14][15] This is a confusing term, but it simply means that there are harmful events that need to be moved from one part of the brain to another, and during this time the third step takes place which is integration of the harmful events that terrify a person keeping them from moving hurtful thoughts to their final resting place which can then be called memory. Any thoughts before this final step should not be called memory, but it often is by those who don't understand it.[5][17] EMDR is one of the more popular ways that trauma is integrated with the whole of the brain.[18][19][20]

Psycho-pharmacology

Medication is counter production when used for the treatment with any dissociative disorder because while it does aid in reducing symptoms of depression and anxiety the drugs mask the feelings needed to heal the disease.[13][15][21] [16]

Prevalence

According to the ISSTD dissociation identity disorder exists in 1% of the population, while other specified dissociative disorder, being more prevalent is thought to exist in over 3%.[15]

History

The dissociative disorders have a dark and broken history of confusion due to intervention by the popular media, because the media takes what they think they know and they make movies, books and other forms of entertainment that confuse the populous. In reality Pierre Janet identified dissociative identity disorder and other specified dissociative disorder, while Charles Myers was the first to separate posttraumatic stress disorder into a distinct personality state and a less-distinct personality state. While there has been a lot of research [8] on the subject it was not until Ellert R.S. Nijenhuis and Onno van Der Hart [7] began to promote their idea of Structural Dissociation of the Personality that psychology, neurology and psychoneurology began to meld and agree with one another because of the advent of the hard science of fMRI. Kathy Steele, former president of the ISSTD, joined the former in authoring a book called Structural Dissociation of the Personality.[22] The theory is still being updated by the original authors and now other top researchers like Frank M. Corrigan, Ulrich F. Lanius, Sandra L. Paulsen,[2] Alan Schore,[3] Bessel vanderKolk[12] and even Daniel Siegal are all on the same page.[13][15]

ISSTD

The International Society for the Study of Trauma and Dissociation is considered to be the foremost expert on the subject of dissociative disorders, psychological trauma and they are by default the organization that should be referenced in bulk.[15]

See also

References

  1. ^ a b c d e f g h i APA (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington [etc.]: American Psychiatric Publishing. ISBN 0-89042-555-8.
  2. ^ a b c d e f g h i j k l m n o p q r s Lanius, Ulrich F; Paulsen, Sandra L.; Corrigan, Frank M. (2012). Neurobiology and treatment of traumatic dissociation: towards an embodied self. New York: Springer. ISBN 0-8261-0631-5.
  3. ^ a b c d e f g h i j k l m n o p q r s t u v w x y Schore, Alan N. (2014). Neuroscience and Psychoanalysis. ISBN 88-97479-06-5.
  4. ^ Nijenhuis, Ellert R. S.; van der Hart, Onno (July 2011). "Dissociation in Trauma: A New Definition and Comparison with Previous Formulations". Journal of Trauma & Dissociation. 12 (4): 416–445. doi:10.1080/15299732.2011.570592.
  5. ^ a b c d e f Empirical Reference, 2014; Loewenstein, Richard J.; Spiegel, David; Brand, Bethany L. (June 2014). "Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach". Psychiatry: Interpersonal and Biological Processes. 77 (2): 169–189. doi:10.1521/psyc.2014.77.2.169. {{cite journal}}: |first1= has numeric name (help)
  6. ^ a b Reinders, Antje A.T.S.; Willemsen, Antoon T.M.; den Boer, Johan A.; Vos, Herry P.J.; Veltman, Dick J.; Loewenstein, Richard J. (September 2014). "Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: A PET study and neurobiological model". Psychiatry Research: Neuroimaging. 223 (3): 236–243. doi:10.1016/j.pscychresns.2014.05.005.
  7. ^ a b c d e f g h i j k l m n o p q r Dissociation, 2011; van der Hart, Onno; Nijenhuis, Ellert R. S. (July 2011). "Dissociation in Trauma: A New Definition and Comparison with Previous Formulations". Journal of Trauma & Dissociation. 12 (4): 416–445. doi:10.1080/15299732.2011.570592. {{cite journal}}: |first1= has numeric name (help)
  8. ^ a b c Schlumpf, Yolanda R.; Reinders, Antje A. T. S.; Nijenhuis, Ellert R. S.; Luechinger, Roger; van Osch, Matthias J. P.; Jäncke, Lutz; Chao, Linda (12 June 2014). "Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study". PLoS ONE. 9 (6): e98795. doi:10.1371/journal.pone.0098795.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  9. ^ Siegel, Daniel (2011). Mindsight: The New Science of Personal Transformation. doi:10.1521/ijgp.2010.60.4.605.
  10. ^ a b c fMRI study, 2014; Yennu, Amarnath; Smith-Osborne, Alexa; Gonzalez-Lima, F.; North, Carol S.; Liu, Hanli; Tian, Fenghua (2014). "Prefrontal responses to digit span memory phases in patients with post-traumatic stress disorder (PTSD): A functional near infrared spectroscopy study". NeuroImage: Clinical. 4: 808–819. doi:10.1016/j.nicl.2014.05.005. {{cite journal}}: |first1= has numeric name (help)
  11. ^ Nijenhuis, Ellert R. S.; van der Hart, Onno (July 2011). "Defining Dissociation in Trauma". Journal of Trauma & Dissociation. 12 (4): 469–473. doi:10.1080/15299732.2011.570599.
  12. ^ a b c vanderKolk, Bessel (2014). Body keeps the score: brain, mind, and body in the healing of trauma. Viking. ISBN 0-670-78593-8.
  13. ^ a b c d e Siegel, Daniel J. (2012). The developing mind : how relationships and the brain interact to shape who we are (2nd ed.). New York: Guilford Press. ISBN 978-1-4625-0390-2.
  14. ^ a b Empirical Overview, 2014; Brand, B. L.; ar, V.; Kruger, C.; Stavropoulos, P.; Martinez-Taboas, A.; Lewis-Fernandez, R.; Middleton, W.; Dorahy, M.J. (1 May 2014). "Dissociative identity disorder: An empirical overview". Australian & New Zealand Journal of Psychiatry. 48 (5): 402–417. doi:10.1177/0004867414527523. {{cite journal}}: |first1= has numeric name (help)
  15. ^ a b c d e f International Society for the Study (28 February 2011). "Guidelines for Treating dissociative identity disorder in Adults, Third Revision". Journal of Trauma & Dissociation. 12 (2): 115–187. doi:10.1080/15299732.2011.537247.
  16. ^ a b Dell, Paul (2008). Dissociation and the dissociative disorders: DSM-V and beyond. London: Routledge. ISBN 978-0-415-95785-4.
  17. ^ Courtois, Christine A.; Ford, Julian D. (2013). Treatment of complex trauma: a sequenced, relationship-based approach. New York: Guilford Press. ISBN 1-4625-0658-5.
  18. ^ van der Hart, Onno; Nijenhuis, Ellert R. S.; Solomon, Roger (1 May 2010). "Dissociation of the Personality in Complex Trauma-Related Disorders and EMDR: Theoretical Considerations". Journal of EMDR Practice and Research. 4 (2): 76–92. doi:10.1891/1933-3196.4.2.76.
  19. ^ Empirical study, 2014; Brand, B. L.; Şar, V.; Krüger, C.; Stavropoulos, P.; Martínez-Taboas, A.; Lewis-Fernández, R.; Middleton, W.; Dorahy, M. J. (1 May 2014). "Dissociative identity disorder: An empirical overview". Australian & New Zealand Journal of Psychiatry. 48 (5): 402–417. doi:10.1177/0004867414527523. {{cite journal}}: |first1= has numeric name (help)
  20. ^ Review study, 2009; Classen, Catherine C.; McNary, Scot W.; Zaveri, Parin; Brand, Bethany L. (September 2009). "A Review of Dissociative Disorders Treatment Studies". The Journal of Nervous and Mental Disease. 197 (9): 646–654. doi:10.1097/NMD.0b013e3181b3afaa. {{cite journal}}: |first1= has numeric name (help)
  21. ^ Gentile, Julie (Feb 2012). "Psychotherapy and Pharmacotherapy for Patients with dissociative identity disorder". Innov Clin Neurosci. 2 (10). PMC 3615506. PMID 23556139.
  22. ^ van der Hart; Nijenhuis, Ellert; Steele, Kathy (2006). The Haunted self: structural dissociation and the treatment of chronic traumatization (1st ed.). New York: W.W. Norton. ISBN 978-0-393-70401-3.
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