B E H Chapter 7 A V I O Dissociative and R Somatoform Disorders D I S O R Sheila K. Grant, Ph.D. D E R S B E Dissociative Disorders H A Dissociative disorder - A disorder characterized by V disruption, or dissociation, of identity, memory, or I consciousness. O R The major dissociative disorders include dissociative identity disorder, dissociative amnesia, D dissociative fugue, and depersonalization I disorder. S O In each case, there is a disruption or dissociation R (“splitting off ”) of the functions of identity, memory, or D consciousness that normally make us whole. E R S B Overview of Dissociative Disorders E H A V I O R D I S O R D E R S 1 B E Dissociative Disorders H A Dissociative identity disorder - A dissociative V disorder in which a person has two or more distinct, or I alter, personalities. O R In dissociative identity disorder, two or more personalities—each with well-defined traits and D memories—“occupy” one person. I S In the film, The Three Faces of Eve , Eve White is a O timid housewife who harbors two other personalities: Eve R Black, a sexually provocative, antisocial personality, and D Jane, a balanced, developing personality who could E balance her sexual needs with the demands of social R acceptability. S B E The Three Faces of Eve H A V I O R D I S O R D E R S B E The Three Faces of Eve H A V I O R D I S O R D E R “Let us hear the various personalities speak…” S 2 B E Dr. Holiday Milby H A V I O R D I S O R D E R Dissociative Identity Disorder S B E Dissociative Disorders H A Dissociative identity disorder - A dissociative V disorder in which a person has two or more distinct, or I alter, personalities. O R In dissociative identity disorder, two or more personalities—each with well-defined traits and D memories—“occupy” one person. I S In the film, The Three Faces of Eve , Eve White is a O timid housewife who harbors two other personalities: Eve R Black, a sexually provocative, antisocial personality, and D Jane, a balanced, developing personality who could E balance her sexual needs with the demands of social R acceptability. S B E Features H A In some cases, the host (main) personality is unaware of V the existence of the other identities, whereas the other I identities are aware of the existence of the host. O R In other cases, the different personalities are completely unaware of one another. D I Sometimes two personalities vie for control of the S person. O R D E R S 3 B E Controversies H A Although multiple personality is generally considered V rare, the very existence of the disorder continues to I arouse debate. O R Many professionals express profound doubts about the diagnosis. D I Only a handful of cases worldwide were reported from S 1920 to 1970, but since then the number of reported O cases has skyrocketed into the thousands. R D E R S B E H A V I O R D I S O R D E R S B E Dissociative Amnesia H A Amnesia derives from the Greek roots a-, meaning “not,” V and mnasthai, meaning “to remember.” I O Dissociative amnesia - A dissociative disorder in R which a person experiences memory loss without any identifiable organic cause. D I Unlike some progressive forms of memory impairment, S the memory loss in dissociative amnesia is reversible, O although it may last for days, weeks, or even years. R D E R S 4 B “Jane Doe.” E H A This woman, called “Jane V Doe” by rescue workers, was I found wandering in a O Florida park in a dazed R state. She reported she had no memory of her D background or even who she I was. Her parents recognized S her after she appeared on a O national TV program. She R reportedly never regained D her memory. E R S B E Dissociative Amnesia H A Dissociative amnesia is divided into five distinct types of V memory problems: I O 1. Localized amnesia. R 2. Selective amnesia. 3. Generalized amnesia. D 4. Continuous amnesia. I 5. Systematized amnesia. S O R D E R S B E Dissociative Fugue H A Fugue derives from the Latin fugere, meaning “flight.” V The word fugitive has the same origin. I O Fugue is like amnesia “on the run.” R Dissociative fugue - A dissociative disorder in which D one suddenly flees from one’s life situation, travels to a I new location, assumes a new identity, and has amnesia S for personal material. O R D E R S 5 B E Elizabeth Loftus. H A V I O R D I S O R Research by Loftus and others has demonstrated that false memories D of events that never actually occurred can be induced experimentally. E This research calls into question the credibility of reports of R recovered memories. S B E Depersonalization Disorder H A Depersonalization - Feelings of unreality or V detachment from one’s self or one’s body. I O Derealization - A sense of unreality about the outside R world. D Depersonalization disorder - A disorder I characterized by persistent or recurrent episodes of S depersonalization. O R D E R S B E Depersonalization Disorder H A Depersonalization - Feelings of unreality or V detachment from one’s self or one’s body. I O Derealization - A sense of unreality about the outside R world. D Depersonalization disorder - A disorder I characterized by persistent or recurrent episodes of S depersonalization. O R D E R S 6 B E H A V I O R D I S O R D E R S B Culture-Bound Dissociative E H Syndromes A Similarities exist between the Western concept of V dissociative disorder and certain culture-bound I syndromes found in other parts of the world. O R For example, amok is a culture-bound syndrome occurring primarily in southeast Asian and Pacific Island D cultures that describes a trancelike state in which a I person suddenly becomes highly excited and violently S attacks other people or destroys objects. O R People who “run amuck” may later claim to have no D memory of the episode or recall feeling as if they were E acting like a robot. R S B E Psychodynamic Views H A V To psychodynamic theorists, dissociative disorders I involve the massive use of repression, resulting in the O “splitting off” from consciousness of unacceptable R impulses and painful memories. D Dissociative amnesia may serve an adaptive function of I disconnecting or dissociating one’s conscious self from S awareness of traumatic experiences or other sources of O psychological pain or conflict. R D In dissociative amnesia and fugue, the ego protects itself E from anxiety by blotting out disturbing memories or by R dissociating threatening impulses of a sexual or S aggressive nature. 7 B E Social-Cognitive Theory H A V From the standpoint of social-cognitive theory, we I can conceptualize dissociation in the form of dissociative O amnesia or dissociative fugue as a learned response R involving the behavior of psychologically distancing oneself from disturbing memories or emotions. D I Some social-cognitive theorists, such as the late S Nicholas Spanos, believe that dissociative identity O disorder is a form of role-playing acquired through R observational learning and reinforcement. D E R S B E Brain Dysfunction H A Might dissociative behavior be connected with V underlying brain dysfunction? I O Research along these lines is still in its infancy, but R preliminary evidence shows structural differences in brain areas involved in memory and emotion between D patients with dissociative identity disorder (DID) and I healthy controls (Vermetten et al., 2006). S O Another study showed differences in brain metabolic R activity between people with depersonalization disorder D and healthy subjects (Simeon et al.,2000). E R S B E Diathesis–Stress Model H A Despite widespread evidence of severe physical or sexual V abuse in childhood in the great majority of cases of I dissociative identity disorder, very few severely abused O children develop multiple personalities. R Consistent with the diathesis–stress model, certain D personality traits, such as proneness to fantasize, high I ability to be hypnotized, and openness to altered states S of consciousness, may predispose individuals to develop O dissociative experiences in the face of extreme stress, R such as traumatic abuse in childhood. D E R S 8 B Treatment of E H Dissociative Disorders A Dissociative amnesia and fugue are usually fleeting V experiences that end abruptly. I O Episodes of depersonalization can be recurrent and R persistent, and they are most likely to occur when people are undergoing periods of mild anxiety or depression. D I Psychoanalysts seek to help people with dissociative S identity disorder uncover and learn to cope with early O childhood traumas. R D E R S B Diathesis–stress model of E H dissociative identity disorder. A V I O R D I S O R D E R S B E Somatoform Disorders H A V The word somatoform derives from the Greek soma, I meaning “body.” O R Somatoform disorders - A disorder characterized by complaints of physical problems or symptoms that D cannot be explained by physical causes. I S The concept of somatoform disorder presumes that the O physical symptoms reflect psychological factors or R conflicts.