Dissociative Disorders in Psychopathology, We

Dissociative Disorders

In psychopathology, we deal with the study of various mental illness or mental distress. That illness can be "the manifestation of behaviours and experiences which may be indicative of mental illness of psychological impairment" (Wikipedia: 2008). In this field of study, medical professionals such as psychiatrists, neuroscientists, neuropsychiatrists, and clinical psychologists are commonly involved in the treatment of mental-related illness.

Even in the early times, mental illness is often referred to as being possessed by evil spirits. This is because of the unnatural, somewhat strange and weird behavior shown by the person inflected with the disease. The only way to help the persons suffering from mental illness during those days was to torture them in an attempt to drive out the demon. Other religious authorities performed exorcism as a way of releasing the evil spirits who caused the pathological behavior within the person. This process, however, did not guarantee to reinstate the person to his or her sanity. When the torturous methods failed, the mental patients were deemed to be possessed for life and they were placed to asylums or even put to death.

It was in the eighteenth century when a different view of mental illness was introduced. The old belief of evil possession eventually vanished and was replaced by the understanding that the unlikely behavior of a person was more of a disease that is beyond the control of the person. Those patients who were once "victims" of healing misconception served as prototypes for the different forms of medical treatment.

Oftentimes, we hear about the term psychopathy, and this should not be used interchangeably with psychopathology. The former pertains to a type of personality disorder, while the latter, also known as abnormal psychology, is characterized by maladaptive behaviors. Since psychopathology deals with the manifestation of mental or behavioral behavior, the origin, process, development and treatment of a particular mental disease is given attention. Let us focus on how this study is related to the dissociative disorders.

As defined by Gale Encyclopedia of Medicine (2002), "dissociative disorders are a group of mental disorders that affect the consciousness defined as causing significant interference with the patient's general functioning, including social relationships and employment, the breakdown of one's perception of his/her surroundings, memory, identity, or consciousness." As the term "dissociative" imply, dissociation characterizes a mechanism that allows the mind to separate or group certain memories or thoughts from normal consciousness. Although these mental contents are split-off, they are not removed from the memory. They may come back on an impulse or be set off by bits and pieces of happenings around the person's surroundings.

Before a person is said to have a mental disorder, he needs to be diagnosed to determine the factors that contributed to his or her present condition and to properly administer the necessary treatment. Dissociative disorders vary in their seriousness and the unexpectedness of occurrence. The gravity of illness may vary, depending on the person's exposure to events that may have triggered such disorder. Certain factors such as traumatic experiences can cause moderate or severe forms of dissociation. These traumatic memories such as physical torture, sexual and emotional abuse, frightening event like accident, and other forms of harassment are stored in the human brain differently as compared to the normal memories.

As the person performs his/her daily activities, the normal memories are processed as it is; however, the traumatic memories are disintegrated and disassociated from the normal state of being. From these traumatic experiences, the person involuntarily forms an alternate personality as a way of escape from the distressing experiences. The person occasionally experiences interruption of consciousness in an inconsistent pattern.

As this condition persists, both the traumatic experiences and the normal experiences will co-exist but separately processed. According to the researches of Mayo Clinic (2007), "people with dissociative disorders chronically escape their reality in involuntary, unhealthy ways ranging from suppressing memories to assuming alternate identities. The patterns of disssociative disorders usually develop as a reaction to trauma and function to keep difficult memories at bay."

Probably, we are interested to know how people get these types of disorders. People who experience brief dissociative experiences are those who have skipped their sleep for a long period of time. If you will notice, those who have met accidents may also experience the same disorder. This also happens to those who are so focused in reading a book or watching a movie as they tend to neglect the passage of time. In these cases, the person's consciousness is temporarily altered. This gap in the patient's memory for long period of times requires serious attention. The patient may have the feeling of being unreal, that his or her body and the other this around is changing, or is dissolving.

It may even come to a point that the patient will act differently, answer in a different name, or appear confused with his or her surroundings (Real Mental Health.com). According to the Awareness Center, "the switching of personalities and the amnesic barriers between them frequently result in chaotic lives. Because the personalities often interact with each other, patients with dissociative identity disorder often report hearing inner conversations and voices of other personalities, which often comment on or address the patient. The voices are experienced as hallucinations."

Once a person shows one or more of the symptoms that we have mentioned above, it is best to seek professional help. As part of the diagnosis, personal history will be taken, together with a series of tests to check on the person's physical condition such as intoxication, head injuries, brain diseases, sleep deprivation and other factors that may affect the loss of memory and unconsciousness in the normal state. The person may be referred to a psychiatrist so that the symptoms and syndromes of mental illness may be described. A neuroscientist, on the other hand, may take charge on the brain changes related to mental illness. These professionals are psychopathologists, who aim to diagnose the individual patient's condition and to see whether the patient's experience fits any pre-existing classification.

At present, mental illness is classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV), published by the American Psychiatric Association (1994). AllPsych Online has provided below, the different multiaxial or multidimensional approach to diagnosing that is used by the DSM. We will discuss it one by one, correlating it to each of the many dissociative disorders such as Dissociative Amnesia, Dissociative Fugue, Depersonalization Disorder, and Dissociative Identity Disorder (DID). In assessing the diagnoses, five dimensions are used: Axis I, Axis II, Axis III, Axis IV and Axis V.

Axis I covers the clinical syndromes, were the diagnosis stage is done. For Dissociative Amnesia, the patient experiences sudden loss of memory. The patient becomes unable to remember important personal information to a degree that is beyond explanation of normal forgetfulness. This is commonly associated by severe stress and the mind of the patient has been preoccupied with so much repeated anxiety. The patient sees amnesia as the solution so he or she actively forgets because remembering only brings so much mental pain. The amnesia may be localized or circumscribed, selective, generalized, or continuous.

Localized amnesia, as explained by health-cares.net, "is present in an individual who has no memory of specific events that took place, usually traumatic. The loss of memory is localized with a specific window of time." In the example presented, a survivor of a car wreck who has no memory of the experience until two days later is experiencing localized amnesia. Although the patient with dissociative amnesia may develop depersonalization or trance states a part of the disorder, they do not experience a change in identity. Circumscribed amnesia, on the other hand, is a dissociation of memory in patients whose medial temporal lobe or midline diencephalic brain structure has been damaged. Patients with circumscribed amnesia were observed to perform normally. (Trster: 175,210).

With regard to selective amnesia, American and French CNRS scientists conducted studies to be used to cure patients suffering from post-traumatic stress. They have shown that a memory of a traumatic event can be wiped out, although other, associated recollections remain intact. They further say that recalling an event stored in the long-term memory triggers a reprocessing phase: the recollection then becomes sensitive to pharmacological disturbances before being once more stored in the long-term memory. They used rats to test the effect on the neuronal activity, and found out that a memory can be modified or even wiped out at the cellular level, permanently and independently of other memories associated with it (Centre National de la Recherche Scientifique: 2007).

People with generalized amnesia cannot recall who they are, including anything in their entire life. They are usually found by the police or taken by others to a hospital emergency room. Generalized amnesia may be lifelong or may extend from a period in the more recent past, such as six months or a year previously. In an article originally written in Japanese by Takahashi, there were six cases of generalized amnesia were reported. Generalized amnesia caused by phenomena of genuinely psychogenic origin is a rare psychological disorder and spontaneous recovery from amnesia in a comparatively short period of time is one of the characteristics of this disorder. A comparison between the six cases and previously reported cases of amnesia exposed the general characteristics of this disorder. Three of the patients believed they had names of other persons; and the two of the recalled personal histories completely different from their own (Seishin Shinkeigaku Zasshi: 1989; 91(4):260-93).

In a continuous amnesia, the amnesia covers the entire period without interruption from a traumatic event in the past to the present. The individual has no memory for events beginning from a certain point in the past continuing up to the present.

The significant distress within the individual is caused by the malfunction of his or her consciousness, memory, identity, or perception. This disorder is characterized by gaps related to traumatic or stressful events which are too extreme to be accounted for by normal forgetting. A traumatic event is typically a precursor to this disorder and memory is often restored. Typically, the memory returns by the help of therapy, although it is not always needed. Therapy is only administered when the individual develops excessive fears or worries, or the memory loss has a drastic effect on their everyday functioning.

When the person shows a loss of autobiographical memory and a flight to a new locale, that person has a Dissociative Fugue. A person temporarily loses his or her sense of personal identity and travels to another location where the person acquires a new identity. This includes a new name, profession, and other personal details. Again, this type of disorder represents an illness where an individual has experienced an extreme stress or traumatic event. An example of a traumatic event include wartime or after a natural disaster. Aside from the inability of the person to recall their past or personal information, patients with dissociative fugue do not behave strangely or appear disturbed to others. Note, however, this disorder is very rare and typically runs its course within a month.

The Depersonalization Disorder is a disturbance in which the patient's primary symptom is the sense of detachment from his or her "self.' Take note that depersonalization is a symptom, and not a disorder. It is triggered by an acute stressor and is common in college-age population. It is divided into two segments: the Depersonalization and the Derealization. The former refers to the stage where the patient reaches the feeling that he or she is "unreal" and that his or her body does not belong to him or to her. The person may also feel that he or she is in a dreamlike state.

On the other hand, the latter refers to the stage where the person may feel that other things around him or her, including other people, are unreal or alien. It is often associated with sleep deprivation or 'recreational' drug use. This has been termed 'derealization' because objects in an environment appear altered. Patients characterized themselves as feeling like a robot or watching themselves from the outside. Other patients involve feelings of numbness. The disorder will typically dissipate on its own after a period of time. To strengthen the coping skills, a therapy will be of great help.

The Dissociative Identity Disorder (DID) is also known as Multiple Personality Disorder or MPD. In the book, Interviewing Children and Adolescents, it was mentioned that dissociation as a term has originated 400 years ago, but only during the 20th century has it been applied to thought (2001: 390). The disorder is considered as the most severe dissociative disorder. This disorder involves all of the major dissociative symptoms. There are two or more distinct personalities residing within an individual's consciousness. These separate personalities vary and take control of the individual at different intervals, thus, creating a gap in memory between memories.

In other word, there is an "altering" memory in between the two personalities. The shifts between personalities are abrupt and spontaneous and only one personality dominates consciousness at one time. Each personality appears to function as an autonomous individual with different traits, talents, capacities, different social networks, and different physical responses. The individual personalities are clustered into core personalities, alter personalities, and intermediary personalities.

This type of disorder is quite uncommon and is associated with severe psychological stress in childhood and a significant trauma such as extended sexual abuse and the chance to witness a violent death of another are usually the precursor. There is no biological explanation for this type of disorder, but only mere responses to stress. However, people with dissociative identity disorder usually have close relatives who have also had similar experiences. The symptoms usually appear in childhood and adolescence stage.

As mentioned by Vitkus (1993) in his Casebook in abnormal psychology, in treating DID, the patient must be assisted to recognize and control dissociations. The use of hypnosis will help the patient to remember the abuse and express old rages and fears directly. Patients can also be taught to set limits on self-destructive behavior.

The treatment of DID is difficult for a variety of reasons, which include the confidentiality of the patient's personality, which makes him or her unwilling to seek help, and the complexity involved in diagnosing the disorder.

On the average, this type of disorder is longstanding and it can be very difficult to treat. Most of the time, individuals have several 'ups' and 'downs' in treatment. When the patient agrees to be cured, the therapist assists the patient to remember. There should be a focus on relationship between the patients and therapist. It is also best to consider that because of the patient's traumatic experience, developing real trust in another person is difficult for him or her.