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Dissociative

Dissociative Disorders

QuestionAnswer
Dissociative Disorders Dissociative disorders are characterized by a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. Dissociative symptoms can potentially disrupt every area of psychological functioning. This chapter includes dissociative identity disorder, dissociative amnesia, depersonalization/derealization disorder, other specified dissociative disorder, and unspecified dissociative disorder.
Dissociative Identity Disorder The defining feature of dissociative identity disorder is the presence of two or more dis- tinct personality states or an experience of possession. The overtness or covertness of these personality states, however, varies as a function of psychological motivation, current level of stress, culture, internal conflicts and dynamics, and emotional resilience.
Dissociative Identity Disorder (Criterion A) A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be ob- served by others or reported by the individual.
Dissociative Identity Disorder (Criterion B &C) B. Recurrent gaps in the recall of everyday events, important personal information, and/ or traumatic events that are inconsistent with ordinary forgetting. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Dissociative Identity Disorder (Criterion D & E) D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play. E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
Depersonalization/Derealization Disorder The essential features of depersonalization/derealization disorder are persistent or recur- rent episodes of depersonalization, derealization, or both. Episodes of depersonalization are characterized by a feeling of unreality or detachment from, or unfamiliarity with, one’s whole self or from aspects of the self.
Depersonalization/Derealization Disorder (Criterion A: 1-2) A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both: 1. Depersonalization: Experiences of unreality ,detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions. 2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, life- less, or visually distorted).
Depersonalization/Derealization Disorder (Criterion B & C) B. During the depersonalization or derealization experiences, reality testing remains intact. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Depersonalization/Derealization Disorder (Criterion D & E) D. The disturbance is not attributable to the physiological effects of a substance or another medical condition (e.g., seizures). E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.
Dissociative Amnesia The defining characteristic of dissociative amnesia is an inability to recall important auto- biographical information that 1) should be successfully stored in memory and 2) ordinarily would be readily remembered
Dissociative Amnesia (Criterion A & B) A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Note: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Dissociative Amnesia (Criterion C & D) C. The disturbance is not attributable to the physiological effects of a substance or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head in- jury/traumatic brain injury, other neurological condition). D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder.
Dissociative Amnesia (Specifier) 300.13 (F44.1) With dissociative fugue: Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information.
Localized Amnesia (Definition) a failure to recall events during a circumscribed period of time, is the most common form of dissociative amnesia. Localized amnesia may be broader than amnesia for a single traumatic event (e.g., months or years associated with child abuse or in- tense combat).
Selective Amnesia (Definition) the individual can recall some, but not all, of the events during a circumscribed period of time. Thus, the individual may remember part of a traumatic event but not other parts. Some individuals report both localized and selective amnesias.
Generalized Amnesia (Definition) a complete loss of memory for one’s life history, is rare. Individuals with generalized amnesia may forget personal identity. Some lose previous knowledge about the world (i.e., semantic knowledge) and can no longer access well-learned skills.
Systematized Amnesia (Definition) the individual loses memory for a specific category of in- formation (e.g., all memories relating to one’s family, a particular person, or childhood sexual abuse).
Continuous Amnesia (Definition) an individual forgets each new event as it occurs.
Other Specified Dissociative Disorder Applies to symptoms of a dissociative disorder that cause clinically significant distress or impairment in areas of functioning do not meet the full criteria for any of the disorders in this class. The category is used when the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific dissociative disorder. This is done by recording “other specified dissociative disorder” followed by the specific reason (e.g., “dissociative trance”).
Other Specified Dissociative Disorder 1. Chronic and recurrent syndromes of mixed dissociative symptoms: This category includes identity disturbance associated with less-than-marked discontinuities in sense of self and agency, or alterations of identity or episodes of possession in an individual who reports no dissociative amnesia.
Other Specified Dissociative Disorder 2. Identity disturbance due to prolonged and intense coercive persuasion: Individuals who have been subjected to intense coercive persuasion (e.g., brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, recruitment by sects/cults or by terror organizations) may present with prolonged changes in, or conscious questioning of, their identity.
Other Specified Dissociative Disorder 3. Acute dissociative reactions to stressful events: This category is for acute, transient conditions that typically last less than 1 month, and sometimes only a few hours or days. These conditions are characterized by constriction of consciousness; depersonalization; derealization; perceptual disturbances (e.g., time slowing, macropsia);micro-amnesias; transient stupor; and/or alterations in sensory-motor functioning (e.g., analgesia, paralysis).
Other Specified Dissociative Disorder 4. Dissociative trance: characterized by an acute narrowing or complete loss of awareness of immediate surroundings as profound unresponsiveness or insensitivity to environmental stimuli. The unresponsiveness may be accompanied by minor stereotyped behaviors of which the individual is unaware and/or that he or she cannot control, as well as transient paralysis or loss of consciousness. The dissociative trance is not a normal part of a broadly accepted collective cultural or religious practice.
Unspecified Dissociative Disorder Applies to symptoms characteristic of a dissociative disorder that cause clinically significant distress or impairment in areas of functioning but do not meet the full criteria for dissociative disorders. The category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific dissociative disorder, and includes presentations for which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).
Dissociative Amnesia (Definition) is characterized by an inability to recall autobiographical information. This amnesia may be localized (i.e., an event or period of time), selective (i.e., a specific aspect of an event), or generalized (i.e., identity and life history). Dissociative amnesia is fundamentally an inability to recall autobiographical information that is inconsistent with normal forgetting.
Created by: amdressler