blurry girls

My previous post was an introduction to dissociation, and I received requests to share more about particular disorders related to dissociation.   This is especially important since there’s not even a consensus that it’s all one thing. The Multiscale Dissociation Inventory, a well-respected measure of dissociation tests for five types of dissociation. What was especially interesting is that there was little overlap between types of dissociation—and the association was smaller than between the types and a generic measure of depression! John Briere, PhD, the author of the test, states that this indicates that dissociation is not a single phenomenon but rather different sets of symptoms.

The most prolific way that dissociation types are described is by diagnosis in the DSM V. They are:

  • Dissociative Identity Disorder requires the identification of at least two distinct personality states that have their own autonomy, age and other characteristics.  They are strong and independent enough that the primary person (or host or client) may forget periods of time where the alter has control.  While this sounds like horror movie fodder, it’s key to remember that these other personalities have the task of protecting the individual, not harming him/her/hir.  They exist in response to traumatic circumstances or by stressors that followed.  The goal of treatment is to help the individual integrate traumatic memories and develop control over all of the parts and the first step is to not see those parts as enemy or alien, but just different parts of the self that are trying to cope.
  • Depersonalization
    This is a feeling of being disconnected from one’s self.  It can feel like either one’s body is not his/her/hir own, like one is in an alien body.  This can also present like a feeling that one’s body is “dirty,” “broken,” or “bad” and that harming the body is separate from harming one’s self.
  • Derealization
    This is a feeling of being disconnected from one’s surroundings.  Some people report that this feels like being in movie, or that things around them are fake.  This can also present as feeling like things being perceived are “foggy,” like sounds are underwater or there is a cloud preventing clear vision.  Again, the mind is protecting itself from the outside world by creating distance from reality.
  • Dissociative amnesia
    This can mean the blocking or repression of traumatic events, or the “misplacing” of moments throughout the day.
  • Dissociative fugue
    The International Society for the Study of Trauma and Dissociation considers dissociative fugue to be a type of dissociative amnesia (with the experience of travelling being the forgotten memory) and it’s not one of the five dimensions of dissociation measured in the MDI, so it’s somewhat neglected. Disorganized travel seems to be an extraneous to memory, which is likely why it is a distinct diagnosis in the DSM IV-TR.  However, the updated DSM V also lists dissociative fugue as a type of dissociative amnesia.

Most of the types listed above don’t have an evidence-based treatment due to lack of research. There are certainly other types of dissociation that don’t have a description in the DSM, or a standardized measure to assess for them. Clearly there is a lot of work to be done.

At the end of the day, treatment entails identifying where there is confusion or a disconnect from present reality, finding how that has served the individual in the past, helping him learn new ways to meet those same needs, and then helping her integrate hir thoughts and mind.


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