Disorders of

Dissociation

Assessment & Diagnosis

SW 593
Introduction

 Dissociation refers to instances in which

the normally integrated aspects of
cognitive functioning are disrupted.
 Consciousness
 Memory
 Identity
 Perception
 Dissociative symptoms might be present
in a number of other diagnoses (PTSD).
Dissociative Amnesia

 Client has one or more episodes in

which they cannot remember important
personal information.
 Forgotten material is too extensive to be
attributed to normal forgetfulness.
 Material forgotten is of a traumatic or
stressful nature.
 Symptoms must be associated with
distress or psychosocial impairment.
Dissociative Fugue

 Also unable to recall some or all of their

personal history.
 Sudden and unexpected travel that
removes the person from their
home/usual surroundings occurs.
 Has some degree of confusion about
their identity and may actually assume a
new identity.
Dissociative Fugue

 The episode may not be part of

Dissociative Identity Disorder or be a
result of substance abuse or some
general medical condition.
 Significant distress and/psychosocial
impairment is experienced.
Dissociative Identity Disorder

 Two or more distinct identities or

personalities are present and recurrently
take control of the individual’s behavior.
 There is an inability to recall personal
information while the client is in at least
one of the distinct identities.
 The situation is not due to substance
abuse or a general medical condition.
Dissociative Identity Disorder

 Results in distress and/or psychosocial

impairment.
 Formerly known as Multiple Personality
Disorder.
 Clients will have a primary identity that carries
the individual’s legal name.
 Each alternative frequently has a different name
and can vary from the primary identity in terms
of age, gender, knowledge, and affect.
Dissociative Identity Disorder

 Each identity has an enduring pattern of

viewing and relating to the environment
and the self.
 The primary and alternative identities
may or may not be aware of the
existence or experiences of one another.
 Persons with this disorder may have
frequent gaps in memory for both recent
and remote events.
Depersonalization Disorder

 Depersonalization is characterized by feeling

detached or estranged from one’s self.
 Described as feeling outside the self as if
viewing a movie.
 Reality testing must remain intact during the
episodes.
 Brief instances of depersonalization are not
unusual or may be associated with another
mental disorder.
Depersonalization Disorder

 Depersonalization is the major symptom

necessary in order to meet the
diagnostic criteria.
 Causes distress and/or psychosocial
impairment.
Assessment

 The first clue that a dissociative disorder

is occurring is “holes” or unaccounted
periods of time.
 Careful history focused around times of
stress can be particularly informative.
 Several psychometric instruments can
be utilized including:
 Dissociation Questionnaire (DIS-Q)
 Child Dissociative Checklist (CDC)
Cultural Considerations

 Dissociative experiences, particularly

fugue-like states, may occur within a
number of cultural groups as an
accepted expression of cultural activities
or religious practices.
 No clinical distress or psychosocial
impairment occurs.
 Dissociative Identity Disorder is
diagnosed much more frequently in
women than men.
Cultural Considerations

 Men with this disorder tend to have fewer

distinct identities.
 In children, the data suggests that the
occurrence is more evenly distributed between
the sexes.
 “Spells” are not diagnosable according to the
DSM.
 Spells is a trance-like state in which the
individual may communicate with deceased
relatives.
Cultural Considerations

 Another condition seen around the world

is that of “zar”.
 Zar episodes are characterized by
persons appearing to be in a dissociative
state where they may shout, cry, laugh,
sing, or hit their heads against a wall.
 The belief is that they are possessed by
a spirit, and the state is not considered
pathological.
Cultural Considerations

 Scott (1999) suggests that persons

experiencing dissociative disorders are
individuals who are unable to resolve
past histories of childhood trauma, pain,
ritualized physical and sexual abuse.