We work with all dissociative disorders, including Dissociative Amnesia, Dissociative Fugue, OSDD (Other Specified Dissociative Disorder) and complex and acute traumatised states including PTSD, Acute Stress Disorder and Dissociative Identity Disorder (D.I.D.).
Under the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, edition 5 (DSM-V), the symptons and criteria for Dissociative Amnesia are:
- An inability to recall important autobiographic information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not attributable to the physiological effects of a substance or a neurological or other medical condition.
- The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder.
Dissociative Fugue is defined as a sub-type of Dissociative Amnesia under DSM-V. During a Dissociative Amnesia with Fugue, a person normally acts in a way which is purposeful and has a specific goal; fugue states may last for days, weeks, or longer. A fugue occurs when there is sudden and unexpected travel away from home or work in combination with amnesia for a person’s past, and either identity confusion or assumption of a new identity.
DSM5 describes Depersonalisation/Derealisation Disorder as being characterised by clinically significant persistent or recurrent feelings of depersonalisation, derealisation or both as predominant symptoms.
Depersonalisation is the feeling of being detached or disconnected from one’s body and/or mental and emotional processes. People often describe feeling unreal or numb, like an outside observer of their own life or having “out of body” experiences.
Derealisation includes feelings of unreality or detachment from the environment and/or people in it, sometimes described as “living in a fog” . There may be sensory distortions, such as a narrowed visual field, seeing things as smaller or bigger than they actually are, or sounds feeling either heightened or muted.
These alterations of experience are accompanied by intact reality testing.
Other Specified Dissociative Disorder (OSDD)
This category applies to presentations in which symptoms characteristic of a dissociative disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the dissociative disorders diagnostic class. Example presentations include the following:
- Chronic and recurrent syndromes of mixed dissociative symptoms.
- Identity disturbance due to prolonged and intense coercive persuasion.
- Acute dissociative reactions to stressful events.
- Dissociative trance.
Dissociative Identity Disorder
D.I.D. often follows the experience of significant, reported, childhood trauma, including abuse, from an immediate caregiver
The DSM-V specifies the following criteria for D.I.D.:
- The presence of two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
- The occurrence of amnesia, defined as gaps in the recall of everyday events, important personal information and/or traumatic events.
- The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
- The disturbance is not part of normal cultural or religious practices.
- The symptoms are not due to the direct physiological effects of a substance (such as blackouts or chaotic behaviour during alcohol intoxication) or a general medical condition (such as complex partial seizures)
Professor Peter Fonagy and others have shown that the most common cause of D.I.D. is a disorganised attachment, with abuse at the hands of a care-giver reported in over 80% of cases (McQueen, D; Kennedy, R; Itzin, C; Sinason, V; Maxted, F, 2009).
Whilst some people with D.I.D. have ‘alters’ that can communicate with each other, others can experience partial or total amnesia between personality states. Particular events may trigger flashbacks or bring other personalities to the fore. The results can have a devastating impact on an individual’s ability to maintain relationships and jobs and even to carry out everyday tasks.
Because D.I.D. is a complex and rare disorder, and because people with D.I.D. very often have a ‘main’ personality that is very capable and highly intelligent, misdiagnosis is common. D.I.D. can coexist with other physical or mental health conditions and consequently a specialist assessment can be the only way that D.I.D. is identified.
International research has shown that long-term specialist therapy is the most effective treatment option and that, as with work with extreme post-traumatic stress, short-term interventions are unlikely to have a lasting effect if used in isolation. For some patients, particularly those coming to treatment early, the prognosis can be good. For others, particularly if they are still being exposed to trauma and abuse, treatment needs to be approached in a similar way to that for long-term conditions, with the aim of minimising further psychological damage, improving quality of life and reducing risk.
Major research from the Albert Einstein College of Medicine (Foote, Smolin, Neft and Lipschitz, 2008) has shown that adults with dissociative disorders are at high risk of suicide or self-harm, as well as sectioning and other unplanned psychiatric admissions. As a result of its clinical and theoretical understanding of this subject the risk of suicide or involuntary psychiatric admissions of our patients has been substantially reduced.