Updated: 11/30/2019

Dissociative Disorders

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Topic
Introduction
  • Dissociated disorders involve a lost or impaired sense of self
Disorder
Description
Dissociative identity disorder
Presence of 2 or more distinct identities or personality states that recurrently take control of behavior
Depersonalization disorder Persistent feelings of detachment or estrangement from oneself
Dissociative fugue disorder Abrupt change in geographic location with inability to recall past and loss of identity

 

Snapshot
  • A 39-year-old priest is surprised when a woman states that she saw him at a casino several days ago. He denies these accusations and truly has no memory of the event.
Dissociative Identity Disorder
  • Introduction 
    • presence of 2 or more distinct identities or personality states that recurrently take control of behavior
      • formerly known as multiple personality disorder
    • more common in women
      • associated with a history of sexual abuse
    • loss of memory for traumatic or every day activities
  • Treatment
    • psychotherapy
Snapshot
  • A 29-year-old woman presents stating that several times last month she felt as if she was outside of her body. She struggles to describe the experience but says the feeling best approximates "watching a movie of herself."
Depersonalization/derealization Disorder
  • Introduction
    • persistent or recurrent feelings of detachment or estrangement from oneself 
  • Treatment
    • best initial step in management: neurologic testing
      • the possiblity of a brain tumor or epilepsy must be ruled out before considering this a purely psychiatric diagnosis
    • psychotherapy
Snapshot
  • A 21-year-old woman is reported missing by her parents in New York. Years later, it is discovered that she is living in Florida. She has no recollection of her previous life in New York.
Dissociative Amnesia
  • Introduction
    • also called a fugue state or psychogenic fugue
    • abrupt change in geographic location with inability to recall past and loss of identity
      • associated with traumatic circumstances (e.g., disaster and war) and acute life stress
    • leads to significant distress or impairment
    • not the result of substance abuse or general medical condition
     
  • Treatment
    • psychotherapy 
  • Prognosis, Prevention and Complications
    • amnesia of previous life is typically reversible upon return from the fugue but the patient cannot remember the details of the fugue episode 

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