* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Dissociation and the dissociative disorders
Mental disorder wikipedia , lookup
Conduct disorder wikipedia , lookup
Attachment measures wikipedia , lookup
History of attachment theory wikipedia , lookup
Schizoid personality disorder wikipedia , lookup
Pyotr Gannushkin wikipedia , lookup
History of mental disorders wikipedia , lookup
Spectrum disorder wikipedia , lookup
Classification of mental disorders wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Attachment in children wikipedia , lookup
Child psychopathology wikipedia , lookup
Reactive attachment disorder wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Conversion disorder wikipedia , lookup
Personality disorder wikipedia , lookup
Depersonalization disorder wikipedia , lookup
Dissociation and the dissociative disorders Martin Dorahy NZAP AGM, May 8th, 2014 Nowadays Amnesia – inability to recall seemingly unforgettable events Depersonalisation – alterations in perception of self Derealisation – alterations in perception of world Trance/drifting Identity alterations Pseudoneurological symptoms (temp. blindness, deafness, paralysis, anesthesia, pain) Pierre Janet (1859-1947) “a form of mental depression [i.e., lowered integrative capacity] characterized by the retraction of the field of consciousness and a tendency to the dissociation and emancipation of the systems of ideas and functions that constitute personality” (Janet, 1907, p. 332). Dissociation Primary structural dissociation Dividedness amongst dissociative self-aware systems Trauma Emotional part of the personality (EP) Driven by animal defense-like psychobiological systems. E.g., • Fight • Freeze • Flight • Submit • Attachment cry Apparently normal part of the personality (ANP) Driven by psychobiological systems of daily functioning • Attachment • Play • Seeking • Self definition Survival of the individual, Functioning under threat Survival of the species, Functioning in daily life Van der Hart et al., 2006; Nijenhuis, Van der Hart & Steele, 2002 Breuer & Freud (1893) …we have become convinced that the splitting of consciousness which is so striking in the well known classical cases [of DID] is present in a rudimentary degree in every hysteria… In these views we concur with Binet and the two Janets... What is dissociation? Symptom/phenomenology (continuum model) Process (breakdown in integrative functioning), corollary defense Structure of the personality/identity/mind Dissociative disorders Dissociation Secondary structural dissociation Dividedness amongst dissociative self-aware systems Trauma Emotional part of the personality (EP): e.g., Submit Fight Freeze flight Apparently normal part of the personality (ANP) Driven by psychobiological systems of daily functioning • Attachment • Play • Seeking • Self definition Van der Hart et al., 2006; Nijenhuis, Van der Hart & Steele, 2002 Tertiary Structural dissociation Emotional part of the personality (EP) Fight Submit Freeze flight ________________________________ functions dedicated to the survival of the individual Apparently normal part of the personality (ANP): e.g., Worker Mother Lover __________________________ functions dedicated to the survival of the species & daily life Van der Hart et al., 2006; Nijenhuis, Van der Hart & Steele, 2002 Core features of DID The existence of 2 or more personalities/ identities that take recurrent control of behaviour Psychogenic amnesia for seemingly unforgettable autobiographical events Dissociative identities Identities: cognitions, emotions, behaviours, defenses -Trauma fixated & trauma avoidant. Two-way (symmetric) amnesia A One-way (asymmetric) amnesia A Mutual awareness A I I (Janet, 1907; Ellenberger,1970; Putnam, 1989; Huntjens et al., 2003, 2012) B B B Dissociative disorders DSM-IV/DSM-IV-TR DSM-5 Dissociative amnesia Dissociative amnesia • Without Fugue • With Fugue (purposeful travel with amnesia for identity/autobio mem.) Depersonalisation disorder Dissociative Fugue Dissociative Disorder NOS (DDNOS) Dissociative Identity Disorder (DID; Formerly MPD Depersonalisation/derealisation disorder With amnesia Other Specified Dissociative Disorders Unspecified dissoc. disorders Dissociative identity disorder Pathways to dissociation Child A&N Adult Dissociation Disrupted parent-infant dialogue Psychological unavailability of caregiver -Lack of positive maternal affective involvement/attunement -- maternal flatness --disrupted communication -Flashback -Amnesia -Depersonal. -Derealisat. Attachment & Dissociation Disorganised/disoriented attachment strong predictor of dissociative symptoms (e.g., Ogawa et al., 1997; Lyons-Ruth, 2008) Conflictual (non-fluid) behaviours in infant in presence of parent Quality of early maternal care (emotional unavailability) predicts ≈ 50% of variance in dev.of dissociative symptoms Therefore abuse not only causal factor for dissociation, but also infant disorganisation/parental emotional withdrawal Attachment and dissociation (cont). How does D-type come about Frightened or frightening care giving (‘fright without solution’)-parents communicating fear (Main, Hesse) Failure to serve as source of comfort/containment after fear - Thus fear from anyone/anything and failure of parents to soothe (LyonsRuth) Dissociation as intrapsychic defense/process and interpersonal phenomena (way of relating to others) not to know (intrapsychic), not to speak (interpersonal) Thus, dissociation is fragmentation of coherent relational self (Lyons Ruth, 2008) Frightened & Frightening caregiving Frightened Backing away Frightened voice Dazed expression Exaggerated startle Withdrawn Non-responsive Lyons-Ruth, 2000; Fisher, 2003 Frightening Looming, attack posture Sudden movements Mocking, teasing Intrusive Emotionally reactive Loud, startling noises Dissociation in the transference Thus, dissociative experiences become a means of regulating interpersonal contact and therefore become transferentially important Experiences like trance, drifting, switching (or even flashback, bodily pain) are evident in transference Experiences like amnesia, depersonalisation and derealisation may not be evident, and need to be inquired about Still face http://www.youtube.com/watch?v=apzXGEbZht0