Dissociative Disorders

Dissociative Disorders
Dr. MAHASIN KHALIFA

MBBS KU FM Sudan
Clinical MD Psychiatry SMSB
Consultant Psychiatrist –Alfashir
Teaching Hospital
Assistant Professor of Psychiatry FU
Definition
 characterized by a disruption of and/or discontinuity
in the normal integration of consciousness, memory,
identity, emotion, perception, body representation,
motor control, and behavior. It includes:
 Dissociative identity disorder
 Dissociative amnesia
 Depersonalization/derealization disorder
 Other specified dissociative disorder,
 Unspecified dissociative disorder.
Dissociative Identity Disorder
 previously called multiple personality disorder
 Characterized by the presence of two or more
distinct identities or personality states
 Personalities take control of the individual's
behavior
 Accompanied by an inability to recall important
personal information
 ‌The identities or personality states, sometimes
called alters, self-states, alter identities
Diagnostic Criteria
 A. Disruption of identity characterized by two or
more distinct personality states
 The disruption in identity involves marked
discontinuity in sense of self accompanied by related
alterations in affect, behavior, consciousness,
memory, perception, cognition, and/or sensory-
motor functioning.
 These signs and symptoms may be observed
 by others or reported by the individual.
 B. Recurrent gaps in the recall of everyday events,
important personal information and
or traumatic events that are inconsistent with
ordinary forgetting
C. The symptoms cause clinically significant
distress or impairment in social, occupational,
or other important areas of functioning
D. The disturbance is not a normal part of a
broadly accepted cultural or religious practice
E. The symptoms are not due to the physiological
effects of a substance
Over 70% of outpatients with the diosorder have
attempted suicide.
Dissociative Amnesia
 an inability to recall important personal information,
usually of a traumatic or stressful nature,it could be;
 localized –losses all memory within a period of time (most
common)
 selective- remember some but not all
 generalized- may forget identity
 Continuous- unlike others there is not an end
Interference is primarily with episodic memory (ones

autobiographical memory) while semantic memory (facts)
remains intact
Diagnostic Criteria
• A. An inability to recall important autobiographical
information, usually of a traumatic or stressful nature,
 B. The symptoms cause clinically significant distress or
impairment in social, occupational functioning.

 C. The disturbance is not attributable to the physiological
effects of a substance or a neurological or other medical

condition or other neurological condition).
 D. The disturbance is not better explained by dissociative
identity disorder, posttraumatic

stress disorder, acute stress disorder, somatic symptom
disorder.
Dissociative Fugue
 Forget personal details, identity, and flee to an
entirely new location
 Tend to end abruptly
 Majority regain most of memories without a
recurrence
 Must face consequences of their fugue
 Illegal or violent activity etc…
Depersonalization/Dereallzation
Disorder
 A. The presence of persistent or recurrent experiences
of depersonalization ,derealization or both,
 1. Depersonalization: Experiences of unreality,
detachment, or being an outside observer with respect
to one’s thoughts, feelings, sensations, body, or
actions
 2. Derealization: Experiences of unreality or
detachment with respect to surroundings
 B. During the depersonalization or derealization
experiences, reality testing remains intact.
 C. The symptoms cause clinically significant
distress or impairment in social, occupational,
 functioning.
 D. The disturbance is not attributable to the
physiological effects of a substance or another
medical condition
 E. The disturbance is not better explained by
another mental disorder
Treatments for Dissociative
Amnesia and Fugues
 Psychodynamic therapy
 Hypnotic therapy
 Drug therapy
 Sodium pentobarbital (“truth serums”).
Medication decreases inhibitions making recall
more likely but may forget again upon awake.
 All focus on uncovering memories
Treatment of Dissociative
Disorder
 Three Major Goals
 1) Help recognize fully the nature of their
disorder
 2) Recover gaps in their memory
 3) Integrate their personalities into one
functioning personality
 Fusion- final merging of 2 or more alters
 Goal is integration
 Help each alter to understand they are
part of one person
 Use alters names for convenience not to
confirm existence of separate autonomy
 All alters should be treated with fairness
 Encourage empathy amongst the alters
 Gentleness and supportiveness are
needed in consideration of childhood
traumas

Dissociative Disorders

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Dissociative Disorders

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Dissociative Disorders

Dr. MAHASIN KHALIFA

 generalized- may forget identity

 Continuous- unlike others there is not an end

Interference is primarily with episodic memory (ones

impairment in social, occupational functioning.

effects of a substance or a neurological or other medical

identity disorder, posttraumatic

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