Dissociative Disorders

Department of Psychology, University of California, Berkeley, California 94720-1650, USA.
Annual Review of Clinical Psychology (Impact Factor: 12.67). 02/2005; 1(1):227-53. DOI: 10.1146/annurev.clinpsy.1.102803.143925
Source: PubMed


The dissociative disorders, including "psychogenic" or "functional" amnesia, fugue, dissociative identity disorder (DID, also known as multiple personality disorder), and depersonalization disorder, were once classified, along with conversion disorder, as forms of hysteria. The 1970s witnessed an "epidemic" of dissociative disorder, particularly DID, which may have reflected enthusiasm for the diagnosis more than its actual prevalence. Traditionally, the dissociative disorders have been attributed to trauma and other psychological stress, but the existing evidence favoring this hypothesis is plagued by poor methodology. Prospective studies of traumatized individuals reveal no convincing cases of amnesia not attributable to brain insult, injury, or disease. Treatment generally involves recovering and working through ostensibly repressed or dissociated memories of trauma; at present, there are few quantitative or controlled outcome studies. Experimental studies are few in number and have focused largely on state-dependent and implicit memory. Depersonalization disorder may be in line for the next "epidemic" of dissociation.

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    • "El hecho de que, dentro de la población general, la mayor o menor frecuencia con que se experimentan estados disociativos sea considerada propia de la idiosincrasia personal (Kihlstrom, 2005), aparte de confirmar la idea de que la disociación no supone la ocurrencia de un proceso patológico en sí misma, sugiere que la tendencia a disociar podría estar relacionada con alguna variable de personalidad. De esta forma, algunos autores se han centrado en estudiar la posible relación entre la tendencia a disociar y factores de personalidad conocidos. "
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    DESCRIPTION: tesis doctoral defendida en octubre de 2010
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    • "In DID, repeated early traumatization may disrupt unification of identity through creation of behavioral and mental states associated with mitigating traumatic experiences and providing reparative experiences for the child (Putnam, 1997). Of note, the fantasy/sociocognitive model alternatively proposes that DID is an artefact mediated by high suggestibility, fantasy proneness and/or cognitive distortions (Lilienfeld et al., 1999; Kihlstrom, 2005; Giesbrecht et al., 2008; Lynn et al., 2012; Paris, 2012; Boysen and VanBergen, 2013). This controversy can be resolved by analyzing the neurobiological basis of the different identity states in DID, especially in comparison with other stress-related disorders such as PTSD. "
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    ABSTRACT: Imaging studies in posttraumatic stress disorder (PTSD) have shown differing neural network patterns between hypo-aroused/dissociative and hyper-aroused subtypes. Since dissociative identity disorder (DID) involves different emotional states, this study tests whether DID fits aspects of the differing brain-activation patterns in PTSD. While brain activation was monitored using positron emission tomography, DID individuals (n=11) and matched DID-simulating healthy controls (n=16) underwent an autobiographic script-driven imagery paradigm in a hypo-aroused and a hyper-aroused identity state. Results were consistent with those previously found in the two PTSD subtypes for the rostral/dorsal anterior cingulate, the prefrontal cortex, and the amygdala and insula, respectively. Furthermore, the dissociative identity state uniquely activated the posterior association areas and the parahippocampal gyri, whereas the hyper-aroused identity state uniquely activated the caudate nucleus. Therefore, we propose an extended PTSD-based neurobiological model for emotion modulation in DID: the hypo-aroused identity state activates the prefrontal cortex, cingulate, posterior association areas and parahippocampal gyri, thereby overmodulating emotion regulation; the hyper-aroused identity state activates the amygdala and insula as well as the dorsal striatum, thereby undermodulating emotion regulation. This confirms the notion that DID is related to PTSD as hypo-aroused and hyper-arousal states in DID and PTSD are similar.
    Psychiatry Research: Neuroimaging 09/2014; 223(3). DOI:10.1016/j.pscychresns.2014.05.005 · 2.42 Impact Factor
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    • "Severely traumatized PTSD patients (complex trauma) develop difficulties in modulating arousal and show signs of severe affect dysregulation (e.g., aggression against self and other, and problems with social attachment and dissociative states). Dissociation, defined as a deficit of the integrative functions of memory, consciousness and identity, is often related to traumatic experiences and traumatic memories (Liotti, 2004; Kihlstrom, 2005). During clinical interviews, dissociation is suggested either by such a degree of unwitting absorption in mental states that ordinary attention to the outside environment is seriously hampered. "
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    ABSTRACT: The following case study is presented to facilitate an understanding of how the attachment information evident from Adult Attachment Projective Picture System (AAP) assessment can be integrated into a psychodynamic perspective in making therapeutic recommendations that integrate an attachment perspective. The Adult Attachment Projective Picture System (AAP) is a valid representational measure of internal representations of attachment based on the analysis of a set of free response picture stimuli designed to systematically activate the attachment system (George and West, 2012). The AAP provides a fruitful diagnostic tool for psychodynamic-oriented clinicians to identify attachment-based deficits and resources for an individual patient in therapy. This paper considers the use of the AAP with a traumatized patient in an inpatient setting and uses a case study to illustrate the components of the AAP that are particularly relevant to a psychodynamic conceptualization. The paper discusses also attachment-based recommendations for intervention.
    Frontiers in Psychology 08/2014; 5:865. DOI:10.3389/fpsyg.2014.00865 · 2.80 Impact Factor
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