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Dissociation
&
Dissociative Disorders?
Have you ever experienced a
total internal focusing on
something you have been doing
which makes the external seem to
drift away? When watching the
television, reading a book or
driving the car, have you ever
gone through a period of time
where you have lost time when
engrossed in a good book?
To dissociate is the wonderful
ability to loose oneself at a
particular moment and escape the
day to day humdrum reality, and
this is the ability that many of
use during childhood.
As adults reading this article I
encourage you to think back to
times where you may have used
your imagination to 'make'
things seem different. I
remember when a child, a
cardboard box had endless
possibilities; a castle, a
car….. which were only limited
by imagination!
These kinds of normal
dissociative responses begin to
decrease with age, with its peak
in terms of dissociative
responses being around about the
age of ten years. Dissociation
for the child who is
experiencing severe enduring
trauma provides a coping
mechanism to help them get
through overwhelming experiences
by separating themselves from
the full impact of the immediate
trauma which they are
experiencing. In this way the
child can ‘escape’ when there is
no means of escape.
These dissociative patterns
usually develop as a reaction to
trauma and function to keep
difficult memories at bay. An
estimated 3 percent of U.S.
adults are affected
Treatment may include
psychotherapy, hypnosis and
medication. Although the course
of therapy can be difficult,
many people with dissociative
disorders are able to learn new
ways of coping and lead healthy,
productive lives and treatment
outcomes can be positive.
Signs and
Symptoms.
The major dissociative disorders
are:
- Dissociative amnesia
- Dissociative identity
disorder (DID)
- Dissociative fugue
- Depersonalization
disorder
- Dissociative Disorder
not otherwise specified
(DDNOS)
Symptoms common to all types
of dissociative disorders
include:
-
Memory loss (amnesia) of
certain time periods, events
and people
-
Mental health problems,
including depression and
anxiety
- A
sense of being detached from
yourself (depersonalization)
- A
perception of the people and
things around you as
distorted and unreal
(derealization)
- A
blurred sense of identity
Each of the four major
dissociative disorders is
characterized by a distinct mode
of dissociation. Signs and
symptoms of each disorder may
include:
-
Dissociative
amnesia. Memory
loss that's more extensive
than normal forgetfulness
and can't be explained by a
physical or neurological
condition is the hallmark of
this condition. Sudden-onset
amnesia following a
traumatic event, such as a
car accident, happens
infrequently. More commonly,
conscious recall of
traumatic periods, events or
people in your life —
especially from childhood —
is simply absent from your
memory.
-
Dissociative
identity disorder.
This condition, formerly
known as multiple
personality disorder, is
characterized by "switching"
to alternate identities when
you're under stress. In
dissociative identity
disorder, you may feel the
presence of one or more
other people talking or
living inside your head.
Each of these identities may
have their own name,
personal history and
characteristics, including
marked differences in
manner, voice, gender and
even such physical qualities
as the need for corrective
eyewear. There often is
considerable variation in
each alternate personality's
familiarity with the others.
People with dissociative
identity disorder typically
also have dissociative
amnesia.
-
Dissociative fugue.
People with this condition
dissociate by putting real
distance between themselves
and their identity. For
example, you may abruptly
leave home or work and
travel away, forgetting who
you are and possibly
adopting a new identity in a
new location. People
experiencing dissociative
fugue typically retain all
their faculties and may be
very capable of blending in
wherever they end up. A
fugue episode may last only
a few hours or, rarely, as
long as many months.
Dissociative fugue typically
ends as abruptly as it
begins. When it lifts, you
may feel intensely
disoriented, depressed and
angry, with no recollection
of what happened during the
fugue or how you arrived in
such unfamiliar
circumstances.
-
Depersonalization
disorder. This
disorder is characterized by
a sudden sense of being
outside yourself, observing
your actions from a distance
as though watching a movie.
It may be accompanied by a
perceived distortion of the
size and shape of your body
or of other people and
objects around you. Time may
seem to slow down, and the
world may seem unreal.
Symptoms may last only a few
moments or may wax and wane
over many years.
-
DDNOS. (Dissociative
Disorder not otherwise
specified), an earlier
stage or less serious form
of other disorders that
often precedes DID.

Information
on treatment
Treatment of Dissociative Identity
Disorder typically includes the following
components: a strong therapeutic relationship, a
safe therapeutic environment, appropriate
boundaries, development of no self- or
other-harm contracts, an understanding of the
personality structures, working through
traumatic and dissociated material, the
development of more mature psychological
defences, and the integration of states of self.
Guidelines for
treatment of adults and children are available
from the International Society for the Study of
Dissociation,
www.issd.org.
I am currently a member of
both the ISSD and UKSSD. I have also completed
the Dissociative Disorder Psychotherapy Training
Programme (DDPTP / Advanced -DDPTP). I am also currently
undertaking a PhD (School of Medicine University
of Aberdeen) looking at
areas related to Dissociation.
Integration of traumatic memories is an essential
aspect of treatment (Fine, 1999; Kluft, 1999; Lazrove & Fine, 1996;
Maldonado et al., 2002). Hypnosis can aid in allowing the client to gain
control over the dissociative episodes and in the integration of
memories (Fine & Berkowitz, 2001; Maldonado et al., 2002)
Treatment of Dissociative Identity Disorder is
typically long and challenging. Spontaneous
remission will not occur (Kluft, 1985b, 1999).
Studies have shown that cognitive behavioural
treatment of Dissociative Identity Disorder can
be beneficial (Fine, 1999; Maldonado et al.,
2002).
Practice Profile
-
Individuals - Teens to Seniors
-
Couples - Married, partners, parent and
child
-
Groups - Both personal growth groups and
therapy groups, mixed and men's groups.
How We Begin To Work Together
Clients are referred by friends, previous
clients, physicians, other therapists etc.
Self-referrals are also welcome.
Generally a first session is scheduled to
discuss reasons for seeking therapy and to
determine if we feel comfortable beginning to
work together. Times for sessions, ethical
issues, safety and confidentiality are
discussed. Your questions are welcome. In the
first or second session we establish our goals
and focus for our sessions together. To initiate
this process please phone to arrange an
appointment.
Selecting a therapist is an important task. It
should be done with care. The client has the
right to shop around and sample the people
offering this important service. Initial visits
are frequently for the express purpose of
determining the appropriateness and the comfort
of the working relationship.
More reasons people seek to speak to a
psychotherapist:
Children's Behaviour - Emotional, Physical and
Sexual Abuse issues - Substance Abuse and
Addiction - Eating Disorders - Mood Disorders -
Phobias, Anxiety and Panic Attacks - Personality
Disorders - Sexual Problems - Marriage and
Family Problems - Parenting Skills - Life
Management Skills - Stress Management -
Help with Decision Making - Reality Check
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