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Chapter 34. Dissociative Disorders and Depersonalization

Richard P. Kluft, M.D.; Richard J. Loewenstein, M.D.
DOI: 10.1176/appi.books.9781585622986.259195

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Excerpt

Dissociative amnesia, dissociative fugue, and dissociative identity disorder are characterized by theoretically reversible lesions of autobiographic memory associated with overwhelming actual, anticipated, or feared experiences. Characteristic subtypes of amnesia and the features of classic versus nonclassical amnesia and fugue are found in Tables 34–1 and 34–2. Overwhelming experiences associated with dissociative amnesia and dissociative fugue may relate to powerful and intolerable affects, intense intrapsychic conflict, terrifying external circumstances, or explicit traumatic events. Overwhelming experiences associated with dissociative identity disorder almost invariably involve childhood traumatization, such as abuse, neglect, terrifying external circumstances, or painful medical conditions and treatments. Confusion and/or alteration of identity is associated with dissociative identity disorder and cases of dissociative fugue involving the formation of an alternate identity. In dissociative amnesia and cases of dissociative fugue without the formation of an alternate identity, identity is impacted because the individual's sense of himself or herself is distorted by the failure to integrate important information and/or intrapsychic conflicts and/or powerful and intolerable affect.

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Table Reference Number
Table 34–1. Types of dissociative amnesia
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Table 34–2. Two syndromes of dissociative amnesia and fugue
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Table 34–3. Stages of treatment for traumatized individuals and for dissociative identity disorder
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Table 34–4. Hypnotic interventions useful in the treatment of dissociative identity disorder

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