Download Dissociation Disorder: What is it and Is There Treatment for it? A

Dissociation Disorder: What is it and Is There Treatment for it?
A Whole Day Workshop, Cervia, Italy May 2014
Fugen Neziroglu, Ph.D., ABBP, ABPP USA
In DSM 5 under the classification of Dissociative Disorders (DD) there are five distinct
disorders: Dissociative Identity Disorder (DID); Dissociative Amnesia (DA) with or
without Dissociative Fugue; Depersonalization/Derealization Disorder; Other specified
Dissociative Disorder (OSDD); and Unspecified Dissociative Disorder. Some changes have
occurred from DSM lV to 5 such as dissociative fugue has been subsumed under dissociative
amnesia because all fugue states have amnesia and depersonalization disorder has added
derealization since they usually occur together. ICD 10 includes the following categories:
Dissociative Stupor; Trance and Possession Disorders; Dissociative Motor Disorders;
Dissociative Convulsional Dissociative Anesthesia and Sensory Loss; Mixed Dissociative
[Conversion] Disorders; Ganser's syndrome; Transient Dissociative [Conversion] Disorders
occurring in childhood and adolescence; Other Specified Dissociative [Conversion] Disorders;
and Dissociative [Conversion] Disorder, Unspecified.
This workshop will deal with dissociation as a symptom in a variety of disorders and not
just as a disorder itself. Perhaps one of the reasons dissociative disorders have not been widely
studied is because they are usually thought of as being rare and until recently the symptom of
dissociation had not been looked as a natural protective phenomena that may at times becomes
dysfunctional and become a disorder. The workshop will begin by briefly reviewing DSM 5 and
ICD 10 classifications emphasizing differential diagnosis, however, the emphasis of the
workshop will be on the symptom of dissociation that is present in a variety of disorders and
primarily in depersonalization/derealization disorder. A very general introduction to dissociation
including its history and phenomenology will be provided followed by a brief discussion of its
development. The neuropsychology of dissociation is very important in understanding how the
symptoms of dissociation are related in a variety of disorders. The emphasis will be on the role
of dissociation in the following disorders: eating disorders, borderline personality disorder,
posttraumatic disorder and psychosis. Treatment approaches in each of these disorders will be
discussed, but again the primary focus will be on dissociation in depersonalization/derealization
disorder.
Depersonalization/derealization is the most commonly seen disorder among the
dissociative disorders classification . It is the one disorder that most clinicians run across in their
practice and often confuse with major depression. Over time, depersonalization disorder leads to
despondence and obsessiveness about experiential abnormalities. Individuals with
depersonalization become preoccupied by what is wrong with them, what precipitated their state
of altered perception, and how to fix their discomfort. Similarities and differences between
depersonalization, depression and obsessive compulsive spectrum disorders will be presented.
Traditional cognitive approaches may be ill-suited for this population, as experiential
discomfort and perceptual disturbances are not necessarily irrational. The chronic and
debilitating nature of depersonalization disorder suggests that ACT might be ideal for use with
this population. Emphasis on willingness to experience the discomfort of depersonalization while
engaging in value-oriented behaviors may help individuals resist the urge to avoid situations that
tend to exacerbate discomfort. Furthermore, mindfulness meditation and grounding activities
help individuals with depersonalization redirect their focus to the present moment. It is believed
that mindfulness strategies help individuals manage the obsessive thinking that is common to
depersonalization and obsessive compulsive spectrum disorders.
Exposure-based treatments will be discussed as a means to alleviate depersonalization
associated with other acute psychological distress. Exposure and response prevention may help
individuals with DPD to habituate to the discomfort associated with extreme emotions. Exposure
activities that will be discussed include: extreme perceptual experiences; intense emotional
experiences; interoceptive cue exposure; flooding exposures to unpleasant thoughts.
Finally different treatment approaches will be presented and the audience will have a
chance to role play the application of these approaches. Participants are encouraged to bring
their own cases to discuss.
Learning Objectives:
1. Classification, types, history and neurology of dissociation
2.
Identify triggers and diagnostic features of depersonalization disorder
3. Compare and contrast depersonalization disorder and obsessive compulsive spectrum
disorders
4. Apply effective treatment strategies