Dissociative Disorder

Introduction:

Dissociation in a complex neuropsychological process. It is the disconnection from one's surroundings when one loses all sense of time and place. It can occur for example, when one gets totally immersed in a movie or gets lost in a book, and fails to maintain a balance between the real and unreal. A person may be driving somewhere, and then he may later remember that he can not recall which road he came from because his mind was busy paying attention to the song he was listening to on the radio. It is simply a mental process which leads to an incoherence and dissonance in the person's mind - in his thoughts, memories, emotions, actions, and sense of self.

Dissociation can occur within the normal span of events and does not always threaten to disrupt the equilibrium of one's life. However, it can also be a serious medical condition, known as dissociative disorder. When a person reverts to dissociating, information which is in reality connected to other information becomes disjoint from it. When a person undergoes a traumatic experience, he may dissociate the memory of the place and happenings of that trauma from his present memory. The consequences of this would be that he would experience a temporary mental relief from the fright and pain of the trauma and, in some situations, in his mind, there would be a distinct memory lapse surrounding that experience. Hence, the memory lapses and changes which this process results in, dissociative disorders occur in various forms and people who frequently dissociate often find that their senses of past events and self are influenced (Turkus, 1992).

It is the belief of scientists and researchers that dissociation is commonly practiced by children and serves as a guard against childhood trauma. In most cases, it is a practice which children resort to, but as they turn into adults, it may become a defense mechanism, a pattern which results in serious disorders. Dissociative disorders are usually linked with situations causing overwhelming stress, which may be the result of traumatic life events, accidents, or disasters that are experienced or witnessed or by extreme cases of inner conflict which lead the mind to detach incompatible or undesirable information and emotions (Turkus, 1992).

How people become victims of dissociative disorders:

In the previous paragraph, it was mentioned that it is often children who dissociate. When a child is confronted with a situation that overwhelms him, that is beyond his control and he can not find physical relief from it, he may try to mentally distance himself from it. In atypical case, dissociation is usually an effective resort because it can often protect the child from experiencing severe physical and emotional pain, because he has 'gone away' from the situation at hand. Through this process, the child continues to function and behave normally, as if nothing out of the ordinary has happened - his thoughts, feelings, emotions and memories of this painful experience have been mentally discarded and separated from his memory.

According to clinicians, dissociative disorders should even be looked upon as creative and effective survival techniques because they ensure that the person behaves normally and does not experience a breakdown during the highly painful course of events. A child who continues to experience traumatic events, dissociation becomes a natural process as it is repeatedly reinforced and learnt. Since it helps them and provides much-needed relief, children often get in the habit of dissociation and begin to automatically resort to it - even when the situation at hand is not acutely serious or traumatic. As these children grow up and the trauma becomes a story of the past, the pattern of seeking relief from dissociation persists. They can even find themselves unable to function normally in everyday activities (Dissociative Disorders, 2003).

Kinds of Dissociative Disorders and their Diagnosis:

There are different kinds of Dissociative disorders. Most researchers agree that dissociation occurs on a continuum, ranging from mild to serious. Mild dissociative disorders may be as mentioned above, getting lost in a book or movie, while the serious ones may actually cause impairment or disability to interact normally with people. According to Joan A. Turkus (Turkus, 1992), there exists a whole spectrum of dissociative disorders with increasing levels of intensity, starting from normal dissociation and ending with Poly-fragmented DID which is the most serious of all.

Today, there are a number of diagnostic tests available to doctors and clinicians like the Dissociative Experiences Scale (DES), Dissociative Disorders Interview Schedule (DDIS), and the Structured Clinical Interview for Dissociative Disorders (SCID-D), Diagnostic Drawing Series (DDS) (Turkus, 1992).

Normal dissociation has been mentioned earlier on in the text and is not generally a cause of serious worry, often thought of as a natural mental process.

Dissociative Amnesia and Fugue -Dissociative Amnesia and Fugue are next in terms of intensity of disorder. A dissociative amnesia may be the case when an individual can not recall important personal information which is linked with a particularly traumatic event in his or her life. In his mind, there exists gaps in his personal history and these gaps can not be attributed to general forgetfulness. Usually, this forgotten period of time is clearly demarcated. A rape victim may be suffering from dissociative disorder because she has no memory of how it happened. However, some stimuli like color or smell might bring back disturbing notions. Common symptoms of dissociative amnesia are short term memory loss, depression and feelings of confusion. If dissociative amnesia is a result of another psychiatric disorder, it is not considered a discrete problem. Its diagnosis is based on a physical and psychiatric examination with blood and urine tests so that other causes for amnesias like illicit drug use can be excluded. An EEG is also done so that it can be confirmed that a seizure disorder was not the cause. Psychological tests and therapy can help define the nature of the dissociative experiences (Merck & Co., 2004).

A dissociative fugue is what happens when a person impulsively wanders or goes away from home and then he realizes that he can not recall his past. He is confused and his sense of self is vague. This is also generally after a stressful or traumatic occurrence. There are no symptoms and during the fugue the person is only a little confused. When the fugue ends, an avalanche of feelings like grief, shame, discomfort