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Dissociation is an unexpected partial or complete disruption of the normal integration of a person’s conscious or psychological functioning that cannot be easily explained by the person. Dissociation is a mental process that severs a connection to a person's thoughts, memories, feelings, actions, or sense of identity.[1] Dissociation is a normal response to trauma, and allows the mind to distance itself from experiences that are too much for the psyche to process at that time.[2] Dissociative disruptions can affect any aspect of a person’s functioning.[3][4][5][6] Although some dissociative disruptions involve amnesia, the vast majority of dissociative events do not.[7] 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. Dissociation is often a coping mechanism for survivors of trauma.

Different dissociative disorders have different relationships to stress and trauma.[8] Dissociative amnesia and fugue states are often triggered by life stresses that fall far short of trauma.[9][10] Depersonalization disorder is sometimes triggered by trauma, but may be preceded by only stress, a bad drug experience, or no identifiable stress at all.[11]

History

The French philosopher and psychiatrist Pierre Janet (1859-1947) is considered to be the author of the concept of dissociation.[12] Contrary to most current conceptions of dissociation, Janet did not believe that dissociation was a psychological defense,[13][14][15]. Psychological defence mechanisms belong to Freud's theory of psychoanalysis, not to Janetian psychology. Although dissociation is now typically considered to be a defense (usually against extreme stress or trauma), Janet never thought this.[citation needed] 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. Janet's descriptions of dissociation and dissociative symptoms are generally considered to be ground-breaking (and much superior to Freud's descriptions of those phenomena).[12][16][17][18] Despite this, clinicians have routinely preferred Freud's motivational explanation of dissociation as a defense against pain or displeasure to Janet's explanation that dissociation is due to constitutionally-impaired mental efficiency. Clinicians' preference for the Freudian explanation is directly reflected in today's most popular understanding of dissociation; namely, that dissociation is a defense against trauma.

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.[19] 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.[20]

Diagnosis

The DSM-IV considers symptoms such as depersonalization, derealization and psychogenic amnesia to be core features of dissociative disorders.[21] 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.[22] The SCID-D is a structured interview used to assess and diagnosis 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 abuse and child sexual abuse.[23][24] This is supported by studies which suggest that dissociation is correlated with a history of trauma.[25] Dissociation appears to have a high specificity and low sensitivity to having a self-reported history of trauma.[26]

Symptoms of dissociation resulting from trauma may include depersonalization, psychic 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.[24] 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.[27][24][23] These symptoms may lead the victim to erroneously present the symptoms as the source of the problem.[23]

Child abuse, especially chronic abuse starting at early ages, has been related to high levels of dissociative symptoms in a clinical sample,[28] including amnesia for abuse memories.[29] A non-clinical sample of adult women linked increased levels of dissociation to sexually abuse by a significantly older person prior to age 15,[30] and dissociation has also been correlated a history of childhood physical as well as sexual abuse.[31] When sexual abuse is examined, the levels of dissociation were found to increase along with the severity of the abuse.[32] The level of dissociation has been found to be related to abuse.[32]

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, tiletamine, dextromethorphan, PCP, salvia, muscimol, diphenhydramine, atropine, and ibogaine.[33]

See also

Template:Psychology portal

References

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  2. ^ Haines, Staci. Healing Sex : A Mind-Body Approach to Healing Sexual Trauma. Ed. Felice Newman. New York: Cleis P, 2007
  3. ^ Dell PF (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. ((cite journal)): Unknown parameter |month= ignored (help)
  4. ^ Butler LD, Duran RE, Jasiukaitis P, Koopman C, Spiegel D (1996). "Hypnotizability and traumatic experience: a diathesis-stress model of dissociative symptomatology". Am J Psychiatry. 153 (7 Suppl): 42–63. PMID 8659641. ((cite journal)): Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  5. ^ Gleaves DH, May MC, Cardeña E (2001). "An examination of the diagnostic validity of dissociative identity disorder". Clin Psychol Rev. 21 (4): 577–608. PMID 11413868. ((cite journal)): Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
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  8. ^ American Psychiatric Association (2000). [[Diagnostic and Statistical Manual of Mental Disorders]] DSM-IV TR (Text Revision). Arlington, VA, USA: American Psychiatric Publishing, Inc. p. 943. doi:10.1176/appi.books.9780890423349. ISBN 978-0890420249. ((cite book)): URL–wikilink conflict (help)
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  10. ^ 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.((cite journal)): CS1 maint: multiple names: authors list (link)
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  14. ^ Janet, P (1893/1901/1977). The mental state of hystericals: A study of mental stigmata and mental accidents. Washington, DC: University Publications of America. ((cite book)): Check date values in: |year= (help)
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  23. ^ a b c Salter, Dr, Anna C. (1995). Transforming Trauma: A Guide to Understanding and Treating Adult Survivors. Sage Publications Inc. p. 220. ISBN 080395509X. ((cite book)): Unknown parameter |coauthors= ignored (|author= suggested) (help)
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  27. ^ 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. Vol. 60. No. 2: p196–203. ((cite journal)): |pages= has extra text (help); |volume= has extra text (help)CS1 maint: multiple names: authors list (link)
  28. ^ Merckelbach H, Muris P (2001). "The causal link between self-reported trauma and dissociation: a critical review". Behav Res Ther. 39 (3): 245–54. PMID 11227807. Retrieved 2008-05-13. ((cite journal)): Unknown parameter |month= ignored (help)
  29. ^ Chu, J (1999). "Memories of childhood abuse: dissociation, amnesia, and corroboration". American Journal of Psychiatry. 156 (5): 749–55. PMID 10327909. ((cite journal)): |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  30. ^ Briere J, Runtz M (1988). "Symptomatology associated with childhood sexual victimization in a nonclinical adult sample". Child Abuse Negl. 12 (1): 51–9. PMID 3365583.
  31. ^ 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. PMID 2231257.
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  33. ^ Giannini, AJ (1997). Drugs of Abuse (2nd edition ed.). Los Angeles: Practice Management Information Corp. ISBN 1570660530. ((cite book)): |edition= has extra text (help)

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