Martin Dorahy NZAP AGM May 8 th 2014 Nowadays Amnesia inability to recall seemingly unforgettable events Depersonalisation alterations in perception of self Derealisation alterations in perception of world ID: 261195
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Slide1
Dissociation and the dissociative disorders
Martin Dorahy
NZAP AGM, May 8
th
, 2014 Slide2Slide3
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)Slide4
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).
Slide5
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, 2002Slide6
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... Slide7
What is dissociation?
Symptom/phenomenology (continuum model)
Process (breakdown in integrative functioning), corollary defense
Structure of the personality/identity/mind
Dissociative disordersSlide8
Secondary structural dissociation
Dividedness amongst dissociative self-aware systems
Trauma
Emotional part of the personality (EP): e.g.,
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
Fight
flight
Freeze
Submit
DissociationSlide9
Tertiary Structural dissociation
Emotional part of the personality (EP)
Apparently normal part of the personality (ANP): e.g.,
Van der Hart et al., 2006; Nijenhuis, Van der Hart & Steele, 2002
Fight
flight
Freeze
Submit
__________________________
functions dedicated to the survival of the species & daily life
________________________________
functions dedicated to
the survival of the individual
Mother
Worker
LoverSlide10
Core features of DID
The existence of 2 or more personalities/ identities that take recurrent control of behaviour
Psychogenic amnesia for seemingly unforgettable autobiographical eventsSlide11
Dissociative identities
Identities: cognitions, emotions, behaviours,
defenses
-Trauma fixated & trauma avoidant.
Two-way (symmetric)
amnesia
A I B
One-way (asymmetric)
amnesia
A I BMutual awarenessA B
(Janet, 1907; Ellenberger,1970; Putnam, 1989; Huntjens et al., 2003, 2012)Slide12
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
disorderDepersonalisation/derealisation disorderDissociative FugueWith amnesiaDissociative Disorder NOS (DDNOS)Other Specified Dissociative DisordersUnspecified dissoc. disordersDissociative Identity Disorder (DID; Formerly MPDDissociative
identity disorderSlide13
Pathways to dissociation
Adult Dissociation
Child A&N
Disrupted parent-infant dialogue
Psychological unavailability of caregiver
Lack of positive maternal affective involvement/attunement
- maternal flatness
-disrupted communication
Flashback
Amnesia
Depersonal
.
Derealisat.Slide14
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 withdrawalSlide15
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 (Lyons-Ruth)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)Slide16
Frightened & Frightening caregiving
Frightened
Backing away
Frightened voice
Dazed expression
Exaggerated startle
Withdrawn
Non-responsive
Frightening
Looming, attack posture
Sudden movementsMocking, teasing
IntrusiveEmotionally reactiveLoud, startling noises
Lyons-Ruth, 2000; Fisher, 2003Slide17
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 Slide18
Still face
http://
www.youtube.com
/
watch?v
=apzXGEbZht0