Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Dissociative Disorders

adequate stress and duress, individuals can be made to comply with the demands of those in power, thereby undergoing major changes in their personality, beliefs, and behaviors. Persons subjected to such conditions may experience consider able harm, including loss of health and life, and they typically manifest a variety of posttraumatic and dissociative symptoms. Acute dissociative reactions to stressful events Similar to acute stress disorder, this category refers to patients who experience dissociative symptoms (perceptual disturbances, micro-amnesias, alterations in sensory-motor functioning, or depersonalization/derealization) for less than 1 month and sometimes for only a few hours or days. Dissociative trance disorder Disturbances in consciousness, identity, or memory with markedly diminished or selectively focused responsiveness to environmental stimuli. In children, such states may follow physical abuse or trauma. In some cultures, it may be paired with other behaviors (eg, amok [rage reaction], pibloktoq [self-injurious behav ior]). The dissociative trance state must not occur exclusively during the course of a psychotic disorder and is not the result of any substance use or general med ical condition. Moreover, it must not be a practice that is broadly accepted by the patient’s cultural or religious group. Treatment No systematic treatment studies have been conducted, given the rarity of these conditions. In most case reports, the patient has been hospitalized and has been provided with a protective and supportive environment. In some instances, low doses of antipsychotic medications have been reported to be beneficial. See Table 16-11 for an overview of all the dissociative disorders.

Dissociative Disorders

TABLE 16-11. Summary of Dissociative Disorders Dissociative Amnesia Dissociative Fugue

Dissociative Identity Disorder More than one distinct personality within one person, each of which dominates person’s behavior and thinking when it is present Sudden transition from one personality to another Generally amnesia for other personalities

Depersonalization Disorder Persistent sense of unreality about one’s body and self Intact reality testing Ego-dynamic

Signs and symptoms

Loss of memory, usually with abrupt onset Patient aware of loss Alert before and after loss

Purposeful wandering, often long distances Amnesia for past life Often unaware of loss of memory Often assumes new identity Normal behavior during fugue

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