Dissociative disorder
- DISSOCIATIVE DISORDERS
You must have seen films and read stories where, after a psychological shock, the
hero seems to have lost his memory. He cannot recognize people. Nor can he
remember his own identity. Then suddenly, after a chain of events that make up the
story, his memory returns and everything ends happily. Such stories reflect, often in
an exaggerated and over-simplified fashion, the essence of Dissociative Disorders. The term ‘dissociation’ refers to the separation of the activities of a person from
conscious awareness. While psychoanalysis has long since highlighted the irrational
aspects of human mind, cognitive psychology has also been concerned in recent
years with non-conscious processes..
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- SYMPTOMS:
1) Dissociative Amnesia and Fugue.
2) Depersonalization Disorder.
3) Dissociative Identity Disorder.
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- PREVALENCE OF DISSOCIATIVE
DISORDERS
The prevalence of Dissociative disorders in population is not well researched. Amnesia
probably occurs in about 5% to 7% of the population. Fugue is much less common,
about 0.2%. Depersonalization disorder occurs in about 2% to 3%. Dissociative
Identity disorder was once considered to be very rare. Later on its diagnosis has
been influenced by the scientific culture of the time. Some doctors diagnose it more,
some merge it with schizophrenia. It may be prevalent in 1% to 2 % of the population.
- AETIOLOGY OF DISSOCIATIVE DISORDERS
- Biological Factors
Like Somatoform disorder, biological factors are of secondary importance in
Dissociative disorders also. At best a vulnerable personality with greater suggestibility
may have some genetic implication.
- The psychological causes are at the root of dissociative disorders.:
- psychoanalytic Approach:
The psychoanalytic explanation highlights the operation of the defense’s of repression and denial in amnesia and fugue. When
certain unconscious conflicts are extremely painful, and no acceptable escape
route is left open, the ego may take resort to repression, making the content of
the conflict unavailable, at least temporarily. Another important defense mechanism
is operative in all Dissociative disorders, which is isolation of emotion and event.
This is most prominent in Depersonalization disorder.
- TREATMENT OF DISSOCIATIVE DISORDERS
Dissociation is an escape from stress. Therefore, when you are dealing with a person
with Dissociative amnesia and fugue, the first thing you must make sure is to keep
her in a safe environment. If you can elicit from her case history the precipitating
stressful event, you may assure her that she is safe from that danger. Sometimes,
staying away from perceived danger leads to spontaneous recovery. Psychoanalytically
oriented therapies and hypnotherapy may help to bring out the lost memory. Sometimes
anxiolytic medicines are also used as adjunct to psychotherapy.
One word of caution here. Not all memories that are retrieved from the person with
amnesia are reliable. You need to cross validate them from independent sources. And
you must remember that simply reviving the memory is not the end of treatment. You
need to work through the retrieved material so that the memories are properly
contextualized.
