What are dissociative disorders ?

Dissociative disorders are a group of mental disorders that can cause physical and psychological issues. Dissociation is a form of maladaptive coping which becomes apparent in periods of distress. It is a form of escape from reality, which may include some form of loss or change in memory, sensations or identity. All forms of dissociation are meant to protect the sufferer from some form of real or perceived harm.

Dissociative amnesia

Chitra is 25 years old. She lives with her parents. Chitra is a works as a quality control executive in a government office. During an official audit, a file that she is responsible for goes missing. As her manager is grilling her, Chitra suddenly forgets where she is. She is unable to recognize her colleagues and repeats that she does not remember anything. She was taken to several doctors, all her tests came back normal. Despite a inability to even identify her parents. She is able to sleep, bathe, cook, eat and even enjoy some music. She is taken to a psychiatrist, who is able to help her talk about how scary it was in office during the audit. Gradually Chitra begins recollecting her memories, and in able to resume her functioning.

This is an example of dissociative amnesia.

Dissociative disorders primarily involve a lack of continuity between thoughts, memories, surroundings, actions and identity. People with dissociative disorders escape reality in ways that are involuntary and unhealthy and cause problems with functioning in everyday life. While undergoing a subjectively traumatic experience such as an accident, disaster or even expectation of criticism, dissociation can help a person tolerate what might otherwise be too difficult to handle. In such stressful situations, a person may involuntarily push away from consciousness one’s memory and feelings and may try to escape the fear and pain by forgetting it, ignoring it or taking up an alternate identity that can deal with it. A dissociative fugue is a state wherein a person engages in some form of unexpected travel while amnestic for the same.

In some people, psychological pain manifests as physical symptoms such as muteness, deafness, paralysis, seizures or blindness. This phenomenon is also termed conversion or functional neurological symptom disorder.

Conversion disorder

Raja had an abusive childhood. He is now 30 years old. He is in an abusive relationship and is unable to find a way to deal with it. During an intense argument with his partner, Raja suddenly becomes blind. He is bumping into walls and is completely incapable of seeing. He is taken to a doctor and after all physical causes are ruled out, he is referred to a psychiatrist. His doctor helps him become more vocal with his needs, his coping styles are identified and modified.

This is an example of conversion

Before we discuss dissociative identity disorder, we need to get familiar with the terms primary gain and secondary gain. These are subconscious psychological motivations behind behavior patterns. Identifying primary and secondary gains can help loved one’s understand dissociation better.

Primary gain – Is the internal motivation behind the dissociative symptom, the removal of emotional conflict or relief of anxiety that is the immediate benefit. “Chitra did not have to go through the guilt of being irresponsible”.

Secondary gain – In an external motivation behind behavior. “Chitra’s problems save her from being grilled by her superiors at work”

In dissociation, the sufferer has very little control over their symptoms. They are not feigned..

Dissociative identity disorder

Ramya is 36. Over the last week, she has been noticed to speaking in a peculiar accent. Her dressing is different, she claims to be her long-gone grandmother. She behaves in all manners like her grandmother, dresses like her and even speaks like her. Her family conducts several religious rituals before seeking the help of a doctor. The doctor is able to identify the illness and helps Ramya and her family deal with this difficult time.

This is an example of a trance and possession state

In trance and possession states there is a loss of personal identity and full awareness of the surroundings; in some instances the individual acts as if taken over by another personality, spirit, deity, or “force”. Dissociative identity disorder involves 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.

How is dissociative disorder treated ?

The primary problem underlying all dissociative disorders is the presence of an event that is subjectively so stressful that the available coping mechanisms are ineffective. Abreaction techniques (the expression and consequent release of a previously repressed emotion, achieved through reliving the experience that caused it ) are often used to help people let go of difficult events. Treatment involves improving coping strategies and getting rid of pathological defence mechanisms. Medication can sometimes help underlying conditions such as depression and anxiety disorders.

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Dissociative disorders can mimic neurological problems and require evaluation by a qualified professional.