Dissociative disorders

Dissociation is the core feature of the dissociative disorders it is defined by the DSM-IV as a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment (American Psychiatric Association, 1994, p. 477). Dissociation is usually assessed as a continuum, most often using the Dissociative Experiences Scale (DES Bemstein-Carlson Putnam, 1986), a 28-item self-report measure. The DES items are rated on a scale reflecting the frequency of dissociative experiences (O-to-100% in 10% intervals). Factor analyses of DES items have led to the development of three subscales (Carlson et al., 1993 Frischholz, Braun, Sachs, Schwartz, 1991 Ross, Joshi, Currie, 1991). They are (a) Absorption, which reflects dissociation from surroundings (e.g., daydreaming) (b) Amnesia, which reflects dissociation from past experiences and (c) Depersonalization-Derealization, which reflects dissociation from the body or senses. 

Frischholz, E. J., Braun, B. G., Sachs, R. G., Schwartz, D. R. (1991). Construct validity of the Dissociative Experiences Scale (DES) I. The relationship between the DES and other self-report measures of DES. Dissociation Progress in the Dissociative Disorders, 4, 185-188. 

Dissociative Disorders. Many of the reexperiencing symptoms of PTSD are, in fact, dissociative phenomena. The numbing symptoms of PTSD also resemble the depersonalization and derealization experienced by those with dissociative disorders. Furthermore, dissociative symptoms are the principal manifestation of acute stress disorder, the predecessor to PTSD that arises in the first month after a trauma. The diagnosis of a dissociative disorder is warranted when dissociative symptoms exceeding the PTSD criteria, (e.g., amnesia or profound identity disturbance) are present. 

The observation that certain regressive forms of psychotherapy may contribute to the emergence of personalities lends some credence to this argument. Some argue that DID is an iatrogenic ally created when the shifting mood states of a borderline patient are assigned personalities. This issue obviously needs further research, and its resolution is beyond the scope of our discussion. However, it reminds us that those with severe dissociative disorders should carefully be screened for BPD. 

The book concludes with Chapter 13 and Chapter 14 on disorders that require separate consideration. The first group includes Panic, Obsessive-Compulsive, Post-Traumatic Stress, Somatoform, and Dissociative disorders. Although traditionally these are classified as anxiety disorders, their symptoms and varied treatment responsivity require a separate series of discussions. Finally, certain groups of patients are considered in light of their specialized needs when contemplating psychotropic drug therapy. They include the pregnant patient, children and adolescents, the elderly, the personality disordered, as well as patients whose conditions are complicated by medical problems (e.g., the alcoholic patient the HIV-infected patient). 

Formerly known as hysterical neuroses of the dissociative type, dissociative disorders are currently classified into five categories by the DSM-IV ... 

Dissociative disorder not otherwise specified ( 302) (see also Appendix I and Appendix L)... 

Nemiah JC. Dissociative disorders (hysterical neuroses, dissociative type). In Kaplan HI, Sadock BJ, eds. Comprehensive textbook of psychiatry, 5th ed, Vol 1. Baltimore Williams Wilkins, 1989 1028-1024. 

What are the basic areas affected and impaired by the problems In answering this question, Goldman suggests that the clinician is able to distinguish between behavioral, mood, and dissociative disorders. 

ADHD should not be diagnosed if the symptoms can be better accounted for by other mental disorders, such as mood disorder, Tourette s syndrome, anxiety disorder, dissociative disorder, personality disorder, personality change due to a general medical condition, or a substance-related disorder (e.g., due to bronchodilators, isoniazid, akathisia from neuroleptics). Moreover, ADHD is not diagnosed when symptoms occur exclusively during the course of a pervasive developmental disorder or psychotic disorder (American Psychiatric Association, 2000). Conditions other than ADHD, such as neurofibromatosis, fetal alcohol syndrome and lead poisoning, of which ADHD features are typical symptoms (Pearl et al., 2001), should also be ruled out. 

Dissociative disorders Loss of integration between Dissociative fugue. 

Feng Z, Huang J, Xu Y, Zhang M, Hu S. Dissociative disorder induced by clarithromycin combined with rabeprazole in a patient with gastritis. J Int Med Res 2013 41(1) 239 3. 

---