Textbook of Psychiatry/Dissociative Disorders/Introduction

Dissociative disorders are a fascinating group of disorders which is considered a myth by some and by some, a reality. Dissociation is defined as a disruption in the usually integrated functions of consciousness, memory, identity and perception of the environment (Mulder et al. 1998) leading to a fragmentation of the coherence, unity and continuity of the sense of self. Dissociative disorders were first officially classified as a separate diagnostic group in DSM-III (Tutkun et al. 1998). Besides being a disorder on its own, dissociation may accompany several psychiatric disorders as a confounding factor or co morbid disorder (Evren et al. 2007). Dissociative disorders may accompany several psychiatric disorders (Sar & Ross, 2006) including borderline personality disorder (Sar et al. 2003; Sar, Akyuz, Kugu, Ozturk, & Ertem-Vehid, 2006), obsessive–compulsive disorder (Lochner et al. 2004), posttraumatic stress disorder (Briere, Scott, & Weathers, 2005), acute stress disorder (Spiegel, Classen, & Cardena, 2000), eating disorders (Farrington et al. 2002), pathological gambling (Grant & Kim, 2003), kleptomania (Grant, 2004), and schizophrenia (Ross & Keyes, 2004). Traumatic childhood experiences play a major role in the development of dissociative disorders (Tutkun et al. 1998; Kluft, 1991; Spiegel, 1991). Regression analysis done in one of the studies indicated that dissociation in young adulthood was significantly predicted by observed lack of parental responsiveness in infancy, while childhood verbal abuse was the only type of trauma that added to the prediction of dissociation (Dutra et al. 2009). Substance use is suggested to be an important problem among patients with dissociative disorder (Evren et al. 2007; Ellason et al. 1996).

Other conditions that can mimic similar symptoms as dissociative disorders are Dementia, Substance induced, certain medical conditions such as Multiple sclerosis, temporal lobe epilepsy, head trauma and other psychiatric conditions such as Post Traumatic Stress Disorder, somatoform disorders, affective illnesses, anxiety disorders as well as malingering (Chu et al. 2005).

This chapter gives an overview of Dissociative disorders including clinical symptoms and classification, pathogenesis and management (assessment and treatment).