Dissociation

For other uses, see dissociation (chemistry) and dissociation (neuropsychology).

Dissociation is an altered state of consciousness characterized by partial or complete disruption of the normal integration of a person’s normal conscious or psychological functioning.^[1] Dissociation is most commonly experienced as a subjective perception of one's consciousness being detached from one's emotions, body and/or immediate surroundings.^[2] Van der Kolk et al.^[3] describe dissociation as a "compartmentalization of experience." Under normal conditions, consciousness, memory, emotions, sensory awareness, affect, etc., are integrated; with dissociation, in contrast, these traits are discretely compartmentalized to greater or lesser degrees.

Dissociation describes a wide array of experiences that can affect any aspect of a person’s mental functioning.^[4][5][6][7] Although some dissociative disruptions involve amnesia, other dissociative events do not.^[8] At one end of a continuum, dissociation describes such common events as becoming lost in thought while driving a vehicle and not recalling parts of the journey. At the other end of the continuum are a cluster of dissociative disorders, such as dissociative amnesia, that can occur in response to severe psychological trauma such as rape or military combat. In such cases of abuse or trauma, dissociation can be regarded as a coping mechanism to help with an overwhelming experience.^[9]

Since dissociations are normally unanticipated, they are typically experienced as startling, autonomous intrusions into the person's usual ways of responding or functioning. Due to their unexpected and largely inexplicable nature, they tend to be quite unsettling. Different dissociative disorders have different relationships to stress and trauma.^[10] Dissociative amnesia and fugue states are often triggered by life stresses that fall far short of trauma.^[11][12] Depersonalization disorder is sometimes triggered by trauma, but may be preceded only by stress, psychoactive substances, or no identifiable stress at all.^[13] The ICD-10 but not the the DSM-IV classifies conversion disorder as a dissociative disorder.

History

The French philosopher and psychiatrist Pierre Janet (1859–1947) is considered to be the author of the concept of dissociation.^[14] Contrary to some conceptions of dissociation, Janet did not believe that dissociation was a psychological defense.^[15][16][17] Psychological defense mechanisms belong to Freud's theory of psychoanalysis, not to Janetian psychology. Janet claimed that dissociation occurred only in persons who had a constitutional weakness of mental functioning that led to hysteria when they were stressed. Although it is true that many of Janet's case histories described traumatic experiences, he never considered dissociation to be a defense against those experiences. Quite the opposite: Janet insisted that dissociation was a mental or cognitive deficit. Accordingly, he considered trauma to be one of many stressors that could worsen the already-impaired "mental efficiency" of a hysteric, thereby generating a cascade of hysterical (in today's language, "dissociative") symptoms.^{[14][18][19][20]}

Although there was great interest in dissociation during the last two decades of the nineteenth century (especially in France and England), this interest rapidly waned with the coming of the new century (Ellenberger, 1970). Even Janet largely turned his attention to other matters. On the other hand, there was a sharp peak in interest in dissociation in America from 1890 to 1910, especially in Boston as reflected in the work of William James, Boris Sidis, Morton Prince, and William McDougall. Nevertheless, even in America, interest in dissociation rapidly succumbed to the surging academic interest in psychoanalysis and behaviorism. For most of the twentieth century, there was little interest in dissociation. Discussion of dissociation only resumed when Ernest Hilgard (1977) published his neodissociation theory in the 1970s and when several authors wrote about multiple personality in the 1980s.

Carl Jung described pathological manifestations of dissociation as special or extreme cases of the normal operation of the psyche. This structural dissociation, opposing tension, and hierarchy of basic attitudes and functions in normal individual consciousness is the basis of Jung's Psychological Types.^[21] He theorized that dissociation is a natural necessity for consciousness to operate in one faculty unhampered by the demands of its opposite.

Attention to dissociation as a clinical feature has been growing in recent years as knowledge of post-traumatic stress disorder increased, due to interest in dissociative identity disorder and the multiple personality controversy, and as neuroimaging research and population studies show its relevance.^[22]

Diagnosis of dissociative disorder

Main article: dissociative disorder

The DSM-IV considers symptoms such as depersonalization, derealization and psychogenic amnesia to be core features of dissociative disorders.^[23] However, in the normal population dissociative experiences that are not clinically significant are highly prevalent, with 60% to 65% of the respondents indicating that they have had some dissociative experiences.^[24] The SCID-D is a structured interview used to assess and diagnose dissociation.

Relation to trauma and abuse

Dissociation has been described as one of a constellation of symptoms experienced by some victims of multiple forms of childhood trauma, including physical, psychological, and sexual abuse.^[25][26] This is supported by studies which suggest that dissociation is correlated with a history of trauma.^[27] Dissociation appears to have a high specificity and a low sensitivity to having a self-reported history of trauma, which means that dissociation is much more common among those who are traumatized, yet at the same time there are many persons who have suffered from trauma but who do not show dissociative symptoms.^[28]

Adult dissociation when comorbid with a history of child abuse and otherwise interpersonal violence-related posttraumatic stress disorder (PTSD) has been shown to contribute to disturbances in parenting behavior, such as exposure of young children to violent media. Such behavior may contribute to cycles of familial violence and trauma.^[29]

Symptoms of dissociation resulting from trauma may include depersonalization, psychological numbing, disengagement, or amnesia regarding the events of the abuse. It has been hypothesized that dissociation may provide a temporarily effective defense mechanism in cases of severe trauma; however, in the long term, dissociation is associated with decreased psychological functioning and adjustment.^[26] Other symptoms sometimes found along with dissociation in victims of traumatic abuse (often referred to as "sequelae to abuse") include anxiety, PTSD, low self-esteem, somatization, depression, chronic pain, interpersonal dysfunction, substance abuse, self-mutilation and suicidal ideation or actions.^[25][26][30] These symptoms may lead the victim to erroneously present the symptoms as the source of the problem.^[25]

Child abuse, especially chronic abuse starting at early ages, has been related to high levels of dissociative symptoms in a clinical sample,^[31] including amnesia for abuse memories.^[32] A non-clinical sample of adult women linked increased levels of dissociation to sexual abuse by a significantly older person prior to age 15,^[33] and dissociation has also been correlated with a history of childhood physical as well as sexual abuse.^[34] When sexual abuse is examined, the levels of dissociation were found to increase along with the severity of the abuse.^[35] The level of dissociation has been found to be related to abuse.^[35]

Psychoactive substances

Main article: Dissociative drug

Psychoactive drugs can often induce a state of temporary dissociation. Substances with dissociative properties include ketamine, nitrous oxide, alcohol, LSD, tiletamine, marijuana, dextromethorphan, 2C-E, PCP, methoxetamine, salvia, muscimol, atropine, and ibogaine.^[36]

See also

Psychology portal

• Altered state of consciousness
• Emotional detachment
• Psychological numbing
• Splitting (psychology)
• Dissociative Substance
• Repressed memory

References

1. ^ Dell, P. F., & O'Neil, J. A. (2009). Preface. In P. F. Dell & J. A. O'Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. xix-xxi). New York: Routledge.
2. ^ Lynn, Stephen and Judith W. Rhue (1994). Dissociation: clinical and theoretical perspectives Guilford Press, ISBN 9780898621860, p. 19.
3. ^ Van der Kolk, B. A., Van der Hart, O., & Marmar, C. R. (1996). Dissociation and information processing in posttraumatic stress disorder. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth, (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 303–327). New York: The Guilford Press.
4. ^ Dell PF (March 2006). "A new model of dissociative identity disorder". Psychiatr. Clin. North Am. 29 (1): 1–26, vii. doi:10.1016/j.psc.2005.10.013. PMID 16530584. 
5. ^ Butler LD, Duran RE, Jasiukaitis P, Koopman C, Spiegel D (July 1996). "Hypnotizability and traumatic experience: a diathesis-stress model of dissociative symptomatology". Am J Psychiatry 153 (7 Suppl): 42–63. PMID 8659641. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=8659641. 
6. ^ Gleaves DH, May MC, Cardeña E (June 2001). "An examination of the diagnostic validity of dissociative identity disorder". Clin Psychol Rev 21 (4): 577–608. doi:10.1016/S0272-7358(99)00073-2. PMID 11413868. http://linkinghub.elsevier.com/retrieve/pii/S0272-7358(99)00073-2. 
7. ^ Dell PF (2006). "The multidimensional inventory of dissociation (MID): A comprehensive measure of pathological dissociation". J Trauma Dissociation 7 (2): 77–106. doi:10.1300/J229v07n02_06. PMID 16769667. 
8. ^ Van IJzendoorn MH, M; Schuengel C (1996). "The measurement of dissociation in normal and clinical populations: meta-analytic validation of the dissociative experiences scale (DES)". Clinical Psychology Review 16 (5): 365–382. doi:10.1016/0272-7358(96)00006-2. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VB8-3VWPY4Y-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=b8c345ff2241770546d7b757fecf6ef9. 
9. ^ Haines, Staci. Healing Sex : A Mind-Body Approach to Healing Sexual Trauma. Ed. Felice Newman. New York: Cleis P, 2007
10. ^ American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV TR (Text Revision). Arlington, VA, USA: American Psychiatric Publishing, Inc.. pp. 943. doi:10.1176/appi.books.9780890423349. ISBN 978-0890420249. http://www.psychiatryonline.com/resourceTOC.aspx?resourceID=1. 
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12. ^ Kritchevsky M, Chang J, Squire LR (2004). "Functional amnesia: clinical description and neuropsychological profile of 10 cases". Learn. Mem. 11 (2): 213–26. doi:10.1101/lm.71404. PMC 379692. PMID 15054137. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=379692. 
13. ^ Abugel J & Simeon D (2006). Feeling unreal: depersonalization disorder and the loss of the self. Oxford [Oxfordshire]: Oxford University Press. pp. 17. ISBN 0-19-517022-9. http://books.google.com/?id=M-Cgs_T7Cl8C&pg=PA17. 
14. ^ ^{a b} Ellenberger, HF (1970). The discovery of the unconscious: the history and evolution of dynamic psychiatry. New York: BasicBooks. ISBN 0-465-01673-1. 
15. ^ Janet, P (1889/2005). L'automatisme psychologique: essai de psychologie expérimentale sur les formes inférieures de l’activité humaine [Psychological automatism: Experimental-psychological essay on the inferior forms of human activity]. Paris: Félix Alcan. ISBN 2747590488. http://books.google.com/?id=5kaxseSnF3QC&printsec=frontcover. 
16. ^ Janet, P (1893/1901/1977). The mental state of hystericals: A study of mental stigmata and mental accidents. Washington, DC: University Publications of America. ISBN 0890931666. http://books.google.com/?id=6OctAAAAIAAJ. 
17. ^ Janet, P (1920/1929/1965). The major symptoms of hysteria. New York: Hafner Publishing Company. ISBN 1432504312. http://books.google.com/?id=yyQ6AAAAMAAJ. 
18. ^ McDougall, W (1926). Outline of abnormal psychology. New York: Charles Scribner's Sons. http://books.google.com/?id=86pWAAAAMAAJ. 
19. ^ Mitchell, TW (1921). The psychology of medicine. London: Methuen & Co. ISBN 0827442408. http://books.google.com/?id=k1cwAAAACAAJ. 
20. ^ Mitchell, TW (1923/2007). Medical psychology and psychical research. New York: E. P. Dutton and Company. ISBN 1406735000. http://books.google.com/?id=pxsZIg6_yhMC&printsec=frontcover. 
21. ^ Jung, C.G. (1991). Psychological types. Routledge London. ISBN 978-0710062994. 
22. ^ Scaer, Robert C. (2001). The Body Bears the Burden: Trauma, Dissociation, and Disease. Binghamton, NY: Haworth Medical Press. pp. 97–126. ISBN 0-78901246-4. http://books.google.com/?id=C30EbO7GDMIC&pg=PA97. 
23. ^ Dissociative Disorders ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition )
24. ^ Waller, N.G.; Putnam, F.W.; Carlson, E.B. (1996). "Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences" (pdf). Psychological Methods 1 (3): 300–321. doi:10.1037/1082-989X.1.3.300. Archived from the original on 2008-04-14. http://web.archive.org/web/20080414011336/http://www.psych.umn.edu/faculty/waller/classes/mult06/taxometrics/wallerputnam.pdf. Retrieved 2008-01-31. 
25. ^ ^{a b c} Salter, Dr, Anna C.; Hilary Eldridge (1995). Transforming Trauma: A Guide to Understanding and Treating Adult Survivors. Sage Publications Inc. pp. 220. ISBN 080395509X. 
26. ^ ^{a b c} Myers, John E.B. (2002). The APSAC Handbook on Child Maltreatment, Second Edition. Sage Publications. pp. 63. ISBN 0761919929. 
27. ^ van der Kolk BA, Pelcovitz D, Roth S, Mandel FS, McFarlane A, Herman JL (July 1996). "Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma". Am J Psychiatry 153 (7 Suppl): 83–93. PMID 8659645. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=8659645. Retrieved 2008-05-13. 
28. ^ Briere J (February 2006). "Dissociative symptoms and trauma exposure: specificity, affect dysregulation, and posttraumatic stress". J. Nerv. Ment. Dis. 194 (2): 78–82. doi:10.1097/01.nmd.0000198139.47371.54. PMID 16477184. http://www.johnbriere.com/JNMD%2006%20paper.html. 
29. ^ Schechter DS, Gross A, Willheim E, McCaw J, Turner JB, Myers MM, Zeanah CH, Gleason MM (2009). Is maternal PTSD associated with greater exposure of very young children to violent media? J Trauma Stress. 22(6), 658-62.
30. ^ John Briere, Department of Psychiatry, USC School of Medicine (1992). "Methodological Issues in the Study of Sexual Abuse Effects" (PDF). Journal of Consulting and Clinical Psychology 60. No. 2: 196–203. doi:10.1037/0022-006X.60.2.196. PMID 1592948. http://www.johnbriere.com/methodological%20csa%20jccp%201992.pdf. 
31. ^ Merckelbach H, Muris P (March 2001). "The causal link between self-reported trauma and dissociation: a critical review". Behav Res Ther 39 (3): 245–54. doi:10.1016/S0005-7967(99)00181-3. PMID 11227807. http://linkinghub.elsevier.com/retrieve/pii/S0005-7967(99)00181-3. Retrieved 2008-05-13. 
32. ^ Chu, J; Frey L, Ganzel B, Matthews J (May 1999). "Memories of childhood abuse: dissociation, amnesia, and corroboration". American Journal of Psychiatry 156 (5): 749–55. PMID 10327909. 
33. ^ Briere J, Runtz M (1988). "Symptomatology associated with childhood sexual victimization in a nonclinical adult sample". Child Abuse Negl 12 (1): 51–9. doi:10.1016/0145-2134(88)90007-5. PMID 3365583. http://linkinghub.elsevier.com/retrieve/pii/0145-2134(88)90007-5. 
34. ^ Briere J, Runtz M (1990). "Augmenting Hopkins SCL scales to measure dissociative symptoms: data from two nonclinical samples". J Pers Assess 55 (1-2): 376–9. doi:10.1207/s15327752jpa5501&2_35. PMID 2231257. 
35. ^ ^{a b} Draijer, N; Langeland W (March 1999). "Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients". Am J Psychiatry 156 (3): 379–85. doi:10.1016/j.biopsych.2003.08.018. PMID 10080552. 
36. ^ Giannini, AJ (1997). Drugs of Abuse (2nd ed.). Los Angeles: Practice Management Information Corp. ISBN 1570660530. 

External links

• International Society for the Study of Trauma and Dissociation
• The official journal of the International Society for the Study of Dissociation (ISSD), published between 1988 and 1997