Dissociative Disorders:

Marked by a dissociation from or interruption of a person's fundamental aspects of waking consciousness (such as one's personal identity, one's personal history, etc.). Dissociative disorders come in many forms including:
  • Dissociative Amnesia
  • Dissociative Fugue
  • Dissociative Identity Disorder
  • Depersonalization Disorder

DSM IV:

Dissociative disorders seem to be triggered as a response to trauma or abuse. The dissociative aspect is thought to be a coping mechanism -- the person literally dissociates himself from a situation or experience too traumatic to integrate with his conscious self. Symptoms of these disorders, are also seen in a number of other mental illnesses, including post-traumatic stress disorder, panic disorder, and obsessive compulsive disorder.

Treatment:

Treatment for individuals with such a disorder may stress psychotherapy, although a combination of psychopharmacological and psychosocial treatments is often used. Many of the symptoms of dissociative disorders occur with other disorders, such as anxiety and depression, and can be controlled by the same drugs used to treat those disorders.

Medications: There are no medications that specifically treat Dissociative disorders, medications such as anti-depressants or tranquilizers are a common treatment because the patients may have anxiety or mood disorders and the medications can help control the symptoms associated with the disorders. Generally medications are not recommended because maintenance and effective use of prescriptions given to multiple personality states is difficult to attain. If medication is prescribed, it should be carefully monitored (Psych Central, 2006).

Complications: Dissociative disorders have also been associated with significant difficulties in relationships and work. People suffering from dissociative disorders often have a hard time coping with the emotional stress of a relationship, or the professional stress they feel at work...Found at the MayoClinic.com. In addition, clients with sever cases of dissociative disorders can develop DID (disassociative identity disorder) in which case, the individual can suffer from randomized black outs. To the main personality, they just black out, but while they black out, another personality comes about. These altered personalities are seen as "fragments" of one's psyche or personality. These other personalities where created when the client suffered a traumatic event early in their life as a defense mechanism by the brain in order to protect our emotional stablility.
People suffering with Dissociative disorders are at high risk of severe complications, and gaining other disorders, such as:
  • Self-mutilation
  • Suicide attempts
  • Sexual dysfunction, including sexual addiction and sexual aviodance
  • Alcoholism and substance abuse
  • Depression
  • Sleeping disorders:
  • nightmares
  • insomnia
  • sleepwalking
  • Anxiety disorders
  • Eating disorders
  • Severe headaches
  • Dissociative Amnesia



Dissociative Amnesia:

This disorder is characterized by a blocking out of critical personal information, usually of a traumatic or stressful nature. Dissociative amnesia, unlike other types of amnesia, does not result from other medical trauma (e.g. a blow to the head). Dissociative amnesia has several subtypes:
  • Localized Amnesia is present in an individual who has no memory of specific events that took place, usually traumatic.(such as war, abuse, accidents, or disasters.) The loss of memory is localized with a specific window of time. For example, a survivor of a car wreck who has no memory of the experience until two days later is experiencing localized amnesia.
  • Selective Amnesia happens when a person can recall only small parts of events that took place in a defined period of time. For example, an abuse victim may recall only some parts of the series of events around the abuse.
  • Generalized Amnesia is diagnosed when a person's amnesia encompasses his or her entire life.
  • Systematized Amnesia is characterized by a loss of memory for a specific category of information. A person with this disorder might, for example, be missing all memories about one specific family member.

Symptoms:

Primary symptom of dissociative amnesia is the sudden inability to remember past experiences or personal information, usually relating to traumatic events. Some people with this disorder also might appear confused and suffer from depression and/or anxiety.
http://www.webmd.com/mental-health/dissociative-amnesia

Diagnostics:

If symptoms of Dissociative Amnesia are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose dissociative disorders, the doctor might use various diagnostic tests, such as X-rays and blood tests, to rule out physical illness, medication side effects, or drug-use as the cause of the symptoms. Certain conditions, including brain diseases, head injuries, drug and alcohol intoxication, and sleep deprivation, can lead to symptoms similar to those of dissociative disorders, including amnesia. but may not actually be a disorder as classified by the DSM IV.

If no physical illnesses are found, the person might be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a dissociative disorder.


Depersonalization Disorder:

Marked by a feeling of detachment or distance from one's own experience, body, or self. These feelings of depersonalization are recurrent. Of the dissociative disorders, depersonalization is the one most easily identified with by the general public; one can easily relate to feeling as they in a dream, or being "spaced out." They have a feeling of watching their life happening like it's a movie. Feeling out of control is something that people describe when intoxicated. An individual with depersonalization disorder has this experience so frequently and so severely that it interrupts his or her functioning and experience. A person's experience with depersonalization can be so severe that he or she believes the external world is unreal or distorted.

Any individual can develop depersonalization disorder; individuals who are more prone to developing a disorder are:
  • Individuals who have been part of or have seen a life-threatening, traumatic event. Ex. Car accident
  • Individuals in their middle age teens or early adulthood, because this is the time period when sense of being one's self and having social interactions with others changes the most.
  • Individuals who also have panic disorders, depression, schizophrenia, post-traumatic stress disorder, or multiple personality disorder.

Feelings of Depersonalization may begin with no apparent reason, be triggered by a fear of having another depersonalization experience, or after a seriously traumatic event. Depersonalization feelings can happen to anyone, but are considered a disorder when they are extremely distrubing or emotionally disruptive, do not go away, are recurring, or interfere with work, relationships, or daily activities. Found at MayoClinic.com

Case Study:

Two groups had their brains scanned by a PET, to see if there were abnormalities. Both of the groups were the same except for one group was healthy patients and the other group contained patients who were DSM-IV diagnosed with depersonalization disorder. The group with depresonalization disorder showed abnormalities in the part of the brain that deals with ones sense of his own body. This shows that people with depresonalization disorder have distorted views of certain parts of their body.




Dissociative Fugue (Psychogenic Fugue):

Dissociative Fugue is characterized by sudden, unexpected travel away from home or one's customary place of work, accompanied by an inability to recall one's past. Patients who suffer from this disorder have no conscious understanding or knowledge of the reason for the flight. This is accompanied by confusion about personal identity or even the complete assumption, or partial assumption, of a new identity. The "travel" must not be related to physiological effects of a substance, such as medication, or a general medical condition. The symptoms associated with the disorder must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.


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Diagnostic Features:

  • Travel: the fugue may range from brief trips over relatively short periods of time (hours or days) to substantial periods of wandering (weeks or months). In specific cases individuals have reported crossing various international borders and traveling across the country away from home. Although for some people the travel is long distance, it does not need to be far from their home. The travel only needs to interrupt their daily activities. During the episode the individual usually appears normal, showing no signs of illness, and attracting no attention by blending in to their new surroundings. The individual is usually brought to clinical attention due to an inability to recall personal identity or lack of awareness. Also, once the return to pre-fugue state is maintained, there may be amnesia for recent events, or no memory of the time that elapsed during the fugue.
  • New Identity: The formation of a new identity is not essential for the diagnosis of Dissociative Fugue. If a new identity is created it is usually the less social, and outwardly version of the individuals former identity. A new name, new home, and new social activities ranging in complexity may be assumed and integrated.

→ Their new identity must not possess the characteristics of a mental or psychopathic disorder.


  • How it's Diagnosed: If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose dissociative disorders, the doctor might use various diagnostic tests—such as X-rays and blood tests—to rule out physical illness or medication side effects as the cause of the symptoms. Certain conditions—including brain diseases, head injuries, drug and alcohol intoxication, and sleep deprivation—can lead to symptoms similar to those of dissociative disorders, including amnesia (loss of memory).
    • If no physical illness is found, the person might be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a dissociative disorder.

Symptoms:

A fugue may last from hours to weeks, months, or occasionally even longer. People in a fugue state, having lost their customary identity, usually disappear from their usual haunts, leaving their family and job. If the fugue is brief, they may appear simply to have missed some work or come home late. If the fugue lasts several days or longer, people may travel far from home and begin a new job with a new identity, unaware of any change in their life. During the fugue, they may appear normal and attract no attention. However, at some point, they may become aware of the memory loss or confused about their identity. If they are confused, they may come to the attention of medical or legal authorities. During the fugue, people often have no symptoms or are only mildly confused. However, when the fugue ends, they may experience depression, discomfort, grief, shame, intense conflict, and suicidal or aggressive impulses.

Causes:

Dissociative fugue is usually triggered by severe trauma, such as wars, accidents, natural disasters, or sexual abuse during childhood. Many fugues seem to represent disguised wish fulfillment (for example, an escape from overwhelming stresses, such as divorce or financial ruin). Other fugues are related to feelings of rejection or separation, or they may develop as an alternative to suicidal or homicidal impulses.

Associated Features:

Once the pre-fugue state is maintained it is common for the individual to experience additional amnesia of their past, most commonly associated with traumatic events, such as the recollection of a soldier who witnessed the death of their friend in battle. A variety of aggressive emotions may become present such as depression, dysphoria, anxiety, grief, shame, guilt, psychological stress, conflict, and suicidal motives.
(Ganser Syndrome: a common side affect of the fugue in which the individual is unable to provide accurate answers to simple questions.)

Diagnosis:

Dissociative fugue cannot be diagnosed until people abruptly return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances. A fugue in progress is rarely recognized. It is suspected when a person seems confused over his identity, puzzled about his past, or confrontational when his new identity or the absence of an identity is challenged. The diagnosis is usually made retroactively when a doctor reviews the history and collects information that documents the circumstances before people left home, the travel itself, and the establishment of an alternate life.


Did You Know...
Dissociative fugue is often mistaken for malingering because it enables people to escape their responsibilities or undesirable or dangerous situations, such as a bad marriage or a battle.

Classification:

Dissociative Disorders consist of a disruption, usually in the functions of consciousness, memory, identity, or perception. The disruption may be sudden or gradual, transient, or chronic. Dissociative Fugue contains both features classified under a Dissociative Disorder. It is specifically characterized as a sudden, unexpected travel away. A transient to chronic disruption occurs in their life, ranging from hours to months. During this “travel” the individual is unable to recollect their memory and are unaware of their personal identity.

Associated Disorders:

The extent and duration of the fugue may determine the severity of additional problems, for example, the loss of one's job, personal crisis, or extreme disruption of relationships. Dissociative Fugue is often linked to Mood Disorder, Post-traumatic Stress Disorder, or a Substance-Related Disorder.

Prevalence:

The prevalence of dissociative fugue has been estimated at 0.2%, but it is much more common in connection with wars, accidents, and natural disasters. Persons with dissociative identity disorder frequently exhibit fugue behaviors.

Treatment:

The goal of treatment is to help the person come to terms with the stress or trauma that triggered the fugue. Treatment also aims to develop new coping methods to prevent further fugue episodes. The best treatment approach depends on the individual and the severity of his or her symptoms, but most likely will include some combination of the following treatment methods:
  • Psychotherapy: This type of counseling, is the main treatment for dissociative disorders. This treatment uses techniques designed to encourage communication of conflicts and increase insight into problems.
  • Cognitive therapy: This type of therapy focuses on changing dysfunctional thinking patterns and resulting feelings and behaviors.
  • Medication: There is no medication to treat the dissociative disorders themselves. However, a person with a dissociative disorder who also suffers from depression or anxiety might benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine.
  • Family therapy: This helps to teach the family about the disorder and its causes, as well as to help family members recognize symptoms of a recurrence.
  • Creative therapies (art therapy, music therapy): These therapies allow the patient to explore and express his or her thoughts and feelings in a safe and creative way.
  • Clinical hypnosis: This is a treatment method that uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness (awareness), allowing people to explore thoughts, feelings and memories they might have hidden from their conscious minds. The use of hypnosis for treating dissociative disorders is controversial due to the risk of creating false memories.

http://www.mayoclinic.com/health/dissociative-disorders/DS00574/DSECTION=symptoms
http://www.merckmanuals.com/home/au/sec07/ch106/ch106d.html
http://my.clevelandclinic.org/disorders/dissociative_disorders/hic_dissociative_fugue.aspx
http://psychcentral.com/disorders/sx87.htm


Dissociative Fugue:

Dissociative fugue is a rare disorder where an individual suddenly and unexpectedly takes physical leave of his or her home, work, or surroundings and sets off on a journey. These journeys are called episodes and can last for hours, days or even months. Individuals who suffer from dissociative fugue may travel over thousands of miles. They are unaware or are confused about his identity, and in some cases will assume a new one. These people may be capable of blending in wherever they end up and are extremely had to tell apart from an average person. And when an episode lifts the person may feel disoriented, depressed, angry and with no recollection of what happened during the episode.
Dissociative Fugue is often caused by traumatic events, or severe stress in one's life such as war, natural disaster, or the death of a loved one. It can be treated by psychotherapy that includes hypnosis as well as with drugs. However, the treatment most common involves the treating of the depression or other life events that led to the fugue state first. To be diagnosed with this disorder individuals must show the following, according to the DSM IV:
  • Unexpected and sudden travel away from one's home, work and surroundings without any recollection of one's past
  • Uncertainty or confusion about one's identity, which may include assuming a completely new identity
  • The flight and amnesia are not the result of substance abuse, physical abuse, or Dissociative Identity Disorder
  • Somtimes when coming out of this state without clothes on or the ablitly to remember where they left them
  • The result must be enough stress to interfere with the person's living or working life
  • News stories where people appear lost far away from their home and unaware of who they are can often be cases of dissociative fugue.

Case Study:

"Joe":
While cases of dissociative fugue could last for years and end up with someone establishing a completely new life and identity for themselves, most are similar to this case. These types of stories that you often read about are examples of dissociative fugue.
"Joe" went to work at his usual time of 4:30 a.m. on Monday morning. On the following Tuesday evening at 10:00 p.m., he wandered into a K-Mart 150 miles from home and said, "Could you please help me? I don't know who I am or how I got here. Would you call the police for me?"
The police took his truck keys and located his truck. They discovered his identity took him to the emergency room, and called his hometown where his wife had reported him missing. When he returned, he did not recognize his home, his wife, or his children.
Video about dissociative fugue:
{YouTube Video}
Agatha Christie:
On December 3, 1926 Agatha Christie, after having disappeared for 11 days, was found. Her car had been discovered abandoned on the road with some of her belongings strewn around the area. She was then later found to be living in a hotel in Harrogate under a different name. She had no memory of the events which happened during the time span. And in 2006, when Andrew Norman wrote her biography, he attributed this to an episode of dissociative fugue.

Dissociative identity disorder (DID):
http://www.youtube.com/watch?v=weLvkZGr9Tw
Known as multiple personality disorder, it is the most famous of the dissociative disorders. However, it is still one of the most rare, affecting only 1-3% of the population. An individual suffering from DID has more than one distinct identity or personality state that surfaces in the individual on a recurring basis. This disorder is also marked by differences in memory which vary with the individual's "alters," or other personalities. The other personalities present themselves with differences in posture, voice, mood, energy, interests, talents, capabilities, and manifest age. One thing that cannot fall under DID is a child's imaginary friends during imaginary play. This is just a normal way for a child to have fun. For more information on this, see the NAMI factsheet on dissociative identity disorder or emedicine.com.
Treatment
Goal: bring all the personalities into one
  • Treated as a complex, chronic, trauma-based disorder
  • Develop healthy coping behaviors - setting goals, keeping time schedules, being organized
  • Log and monitor emotions - keep journal to write down feelings, food consumed, and activities
  • Want to find triggers for the other personalities
  • Develop a crisis plan - help in out of control situations
  • There is no true cure; however, personalities can be supressed

Causes:

It is a fairly common effect of severe trauma during early childhood, usually extreme, repetitive physical, sexual, or emotional abuse.

Symptoms of DID:
  • Depression
  • Mood swings
  • Suicidal tendencies
  • Sleep disorders, such as insomnia, nigh terrors, and sleep walking
  • Panic Attacks, Phobias, and Anxiety
  • Flashbacks, reactions to triggers
  • Alcohol and drug abuse
  • Compulsions and rituals
  • Psychotic-like symptoms (including auditory and visual hallucinations)
  • Eating disorders
Fight Club DID
{YouTube Video}
Man with disassociative fugue
Diagnosis at DSM-IV
{YouTube Video}
{YouTube Video}
{YouTube Video}
Reviewed by Jack D. Maser, Ph.D. of the National Institute of Mental Health, Rockville, MD
Permission is granted for this fact sheet to be reproduced in its entirety, including the NAMI name, service mark, and contact information. (June 2000)
From the NAMI
emedicine.com
Mayo Clinic


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