4.2. Personality Disorders
Master Psychology
________________________________________________________________
, Theme 3. Me, Myself and I
Sources
DSM-5 (2013) – Dissociative Disorders
Comer (2013) – Chapter 7. Dissociative Disorders (p. 202-217)
Boysen et al. (2013)
DSM-5 Dissociative Disorders
- Dissociative disorders are characterized by a disruption of and/or discontinuity in the
normal integration of consciousness, memory, identity, emotion, perception, body
representation, motor control, and behavior, disrupting almost every area of functioning.
- Dissociative symptoms are experienced as:
- Unbidden intrusions into awareness and behavior, with losses of continuity in
subjective experience (with positive symptoms such as fragmentation of identity,
depersonalization, and derealization).
- Inability to access information or to control mental functions that normally are
readily amenable to access or control (the negative symptoms such as amnesia).
- Dissociative disorders are mostly found in the aftermath of trauma, and the proximity of
trauma is associated with desire to hide the symptoms.
- Not the same as trauma- and stress related disorders, but close to.
- Both acute stress disorder and PTSD contain dissociative symptoms (e.g., amnesia,
flashbacks, numbing, and depersonalization/derealization.
__________________________________________________________________________________
Dissociative Identity Disorder
Associated features supporting diagnosis
- The overtness or covertness of personality states is dependent on psychological motivation,
current levels of stress, culture, internal conflicts and dynamics, and emotional resilience.
, - In most non-possession-form dissociative identity disorder, the discontinuity of identity is
not overtly displayed for a long period of time.
- Sense of self and sense of agency are strongly affected, feeling emotions that are not
his/hers and one cannot control, these emotions are reported as ego-dystonic and puzzling.
- Attitudes, outlooks, and personal preferences may suddenly shift and shift back again, and
the body mostly ‘feels’ different or from someone else.
- Non-epileptic seizures and other conversion symptoms are prominent, especially in non-
Western settings.
- Dissociative amnesia manifests in 3 ways:
- Gaps in remote memory of personal life events.
- Lapses in dependable memory.
- Discovery of evidence of their everyday actions and tasks that they do not recollect
doing.
- Dissociative fugues (= dissociated travel) are common.
- Individuals with dissociative identity disorder vary in their awareness and attitudes toward
their amnesias, it is common that they minimize the amnestic symptoms.
- Possession-form identities typically manifest as behaviors that appear as if a spirit,
supernatural being, or outside person has taken control.
- However, to meet criteria for dissociative identity disorder, the identities that arise
during possession-form dissociative identity disorder present recurrently, are
unwanted and involuntary, cause distress or impairment, and are not a normal part
of a broadly accepted cultural or religious practice.
- They often have comorbid depression, anxiety, substance abuse, self-injury, non-epileptic
seizures, or another common symptom.
- They often have dissociative flashbacks of an event in the past as if it was happening in the
present.
- They often report multiple types of interpersonal maltreatment during childhood and
adulthood.
- Nonmaltreatment forms of overwhelming early life events, such as multiple long, painful
medical procedures, are also often reported.
- Self-mutilation and suicidal behavior often occur, high hypnotizability.
- Sometimes transient psychotic phenomena.
- Brain regions implicated in pathophysiology of dissociative identity disorder are OFC,
hippocampus, parahippocampal gyrus, and amygdala.
Prevalence
- 12-Month prevalence among adults in a small US community study was 1.5%, prevalence
across genders in that study was 1.6% for males and 1.4% for females.
Development and course
- Associated with overwhelming experiences, traumatic events, and/or abuse occurring in
childhood.
- Full disorder may manifest at almost any age (from earliest childhood to late life), although
children do not present with identity changes, but more overlap and interference among
mental states.
Master Psychology
________________________________________________________________
, Theme 3. Me, Myself and I
Sources
DSM-5 (2013) – Dissociative Disorders
Comer (2013) – Chapter 7. Dissociative Disorders (p. 202-217)
Boysen et al. (2013)
DSM-5 Dissociative Disorders
- Dissociative disorders are characterized by a disruption of and/or discontinuity in the
normal integration of consciousness, memory, identity, emotion, perception, body
representation, motor control, and behavior, disrupting almost every area of functioning.
- Dissociative symptoms are experienced as:
- Unbidden intrusions into awareness and behavior, with losses of continuity in
subjective experience (with positive symptoms such as fragmentation of identity,
depersonalization, and derealization).
- Inability to access information or to control mental functions that normally are
readily amenable to access or control (the negative symptoms such as amnesia).
- Dissociative disorders are mostly found in the aftermath of trauma, and the proximity of
trauma is associated with desire to hide the symptoms.
- Not the same as trauma- and stress related disorders, but close to.
- Both acute stress disorder and PTSD contain dissociative symptoms (e.g., amnesia,
flashbacks, numbing, and depersonalization/derealization.
__________________________________________________________________________________
Dissociative Identity Disorder
Associated features supporting diagnosis
- The overtness or covertness of personality states is dependent on psychological motivation,
current levels of stress, culture, internal conflicts and dynamics, and emotional resilience.
, - In most non-possession-form dissociative identity disorder, the discontinuity of identity is
not overtly displayed for a long period of time.
- Sense of self and sense of agency are strongly affected, feeling emotions that are not
his/hers and one cannot control, these emotions are reported as ego-dystonic and puzzling.
- Attitudes, outlooks, and personal preferences may suddenly shift and shift back again, and
the body mostly ‘feels’ different or from someone else.
- Non-epileptic seizures and other conversion symptoms are prominent, especially in non-
Western settings.
- Dissociative amnesia manifests in 3 ways:
- Gaps in remote memory of personal life events.
- Lapses in dependable memory.
- Discovery of evidence of their everyday actions and tasks that they do not recollect
doing.
- Dissociative fugues (= dissociated travel) are common.
- Individuals with dissociative identity disorder vary in their awareness and attitudes toward
their amnesias, it is common that they minimize the amnestic symptoms.
- Possession-form identities typically manifest as behaviors that appear as if a spirit,
supernatural being, or outside person has taken control.
- However, to meet criteria for dissociative identity disorder, the identities that arise
during possession-form dissociative identity disorder present recurrently, are
unwanted and involuntary, cause distress or impairment, and are not a normal part
of a broadly accepted cultural or religious practice.
- They often have comorbid depression, anxiety, substance abuse, self-injury, non-epileptic
seizures, or another common symptom.
- They often have dissociative flashbacks of an event in the past as if it was happening in the
present.
- They often report multiple types of interpersonal maltreatment during childhood and
adulthood.
- Nonmaltreatment forms of overwhelming early life events, such as multiple long, painful
medical procedures, are also often reported.
- Self-mutilation and suicidal behavior often occur, high hypnotizability.
- Sometimes transient psychotic phenomena.
- Brain regions implicated in pathophysiology of dissociative identity disorder are OFC,
hippocampus, parahippocampal gyrus, and amygdala.
Prevalence
- 12-Month prevalence among adults in a small US community study was 1.5%, prevalence
across genders in that study was 1.6% for males and 1.4% for females.
Development and course
- Associated with overwhelming experiences, traumatic events, and/or abuse occurring in
childhood.
- Full disorder may manifest at almost any age (from earliest childhood to late life), although
children do not present with identity changes, but more overlap and interference among
mental states.
