Dissociation is the feeling of being detached from one’s surroundings. We may all have such moments in our life like ‘daydreaming’ or ‘floating away’. However clinically dissociation is the lack of continuity in one’s thoughts, memory, identity, consciousness, perceptions, behavior, and actions. Episodes of dissociation can occur when faced with severe stress, a traumatic event, or intense emotion. Dissociation can also be one of the symptoms of other psychological disorders. However, dissociation disorders represent a group of specific conditions.
Dissociative disorders are somewhere between the realm of psychosis (disconnect with reality, as seen in schizophrenia), and psychological conditions related to stress, mood, and anxiety. Dissociation is regarded as a kind of coping mechanism for severe or overwhelming anxiety, trauma, and stress. To diagnose a dissociation disorder, it is important to rule out other psychological conditions, and substance abuse and the symptoms should be causing significant impairment of social and occupational functioning.
Depersonalization and Derealization
These refer to dissociative conditions where one’s sense of self and reality of the outside world respectively is temporarily lost. In depersonalization, one feels like an outside observer of one’s thoughts, emotions, feelings, and perceptions, and a sense of numbing and detachment. In derealization, the surroundings seem hazy, distorted, or unreal.
Dissociative Amnesia
It is an inability to recall events information or events that are stressful, disturbing, or traumatic in nature, that are ordinarily and normally re-collectible. The type of memory affected is autobiographical (experienced by self) and episodic (pertaining to specific events experienced).
Dissociative fugue is a condition where further to dissociative amnesia, the person leaves his surroundings, may travel with confusion, loss of identity and memory, and may even take on a new identity and life. This state may last for any length of time from a few days to years. Coming out of the state of dissociative amnesia and fugue may happen on repeated questioning, reminders of their identity and events. However, there then remains amnesia of the fugue state.
Dissociative Identity Disorder (DID)
This has been made famous by films as split or multiple personality disorder and refers to a person who displays two or more different identities or personalities. There is a discontinuity between these identities and frequent gaps in recalling events and information. The identity most encountered and frequented is the host identity though it may not be the most comfortable or adjusted identity. The other identities are called alter identities and some of these identities may know more about certain alter identities than others.
In cultural and religious terms, such people are said to be possessed, or in a trance (altered state of consciousness). People with DID may sometimes display dangerous behaviors like self-injury and suicide. There may be other associated symptoms like headaches, depression, and erratic behavior.
Treatment
It consists of facilitating the recall of suppressed memories. This is done by hypnosis techniques and with drugs of the benzodiazepine group (alprazolam, chlordiazepoxide, clonazepam, etc.) or barbiturates (sodium pentobarbital, etc.). Thereafter the person works with a therapist with counseling sessions, and CBT (cognitive and behavioral therapy). Treatment for associated depression or anxiety with antidepressants, antianxiety medicines, and sometimes atypical psychotics may also be given.
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