Dissociation (psychology)

from Wikipedia, the free encyclopedia
Classification according to ICD-10
F44.0 Dissociative amnesia
F44.1 Dissociative fugue
F44.2 Dissociative stupor
F44.3 Trance and possession states
F44.4 Dissociative movement disorders
F44.5 Dissociative seizures
F44.6 Dissociative sensitivity and sensation disorders
F44.7 Dissociative disorders [conversion disorders], mixed
F44.8 Other dissociative disorders [conversion disorders]
F44.80 Ganser's Syndrome
F44.81 Multiple personality disorder)
F44.82 Transient dissociative disorders [conversion disorders] in childhood and adolescence
F44.88 Other dissociative disorders [conversion disorders]
F44.9 Dissociative disorder [conversion disorder], unspecified
ICD-10 online (WHO version 2019)

The term dissociation describes the (partial to complete) disintegration of psychological functions that are normally related. The areas of perception , consciousness , memory , identity and motor skills are mostly affected by dissociative splitting , but sometimes also body sensations (such as pain and hunger).

Dissociative phenomena exist on a continuum: there are mild symptoms that can affect almost everyone at least once in their lifetime, and severe symptoms that lead to impairment and suffering and are therefore referred to as disorders.

In the case of dissociative disorders, functional and anatomical deviations in the brain - when comparing group data - were found. With regard to the causes, there is broad agreement that certain personal requirements and - as a rule - traumatic experiences should work together. However, temporary dissociative states can also be caused by some chemical substances .

distribution

The lifetime prevalence of serious dissociative symptoms in the general population is 2 to 4%, in outpatient psychiatric patients around 15% and in inpatient psychiatric patients up to 30%. By contrast, almost everyone has mild symptoms, at least once in a lifetime. In general, the frequency of symptoms decreases with age.

Forms of dissociative disorders

In ICD-10 different types of dissociative disorders are (partly synonymous conversion disorders ) described. A common characteristic is that no physical illness can be identified to explain the symptoms.

Dissociative amnesia

In dissociative amnesia (F44.0), the person concerned completely or partially lacks memories of their past. a. stressful or traumatic events. The amnesia is far beyond normal forgetfulness; H. lasts longer or is more pronounced. However, the level of amnesia can vary over time. Memories can also mix and thus be falsified . The person concerned cannot then distinguish whether memories are true or not.

Dissociative fugue

A dissociative fugue (F44.1) (also psychogenic fugue ) is understood as the unexpected departure from the familiar environment (home, workplace). The trip is organized normally from the outside, self-sufficiency is largely maintained. There is partial or total amnesia for all or part of the past (especially for traumatic events).

According to DSM-IV , confusion about one's own identity or the assumption of a new identity is required as an additional criterion. However, the latter is rarely the case. If so, then the new identity is usually characterized by more sociability and less restraint. The duration can range from a few hours to several months.

Dissociative stupor

In dissociative stupor (F44.2), voluntary movements, speech, and normal reactions to light, noise, and touch are reduced or absent. Normal muscle tension, upright posture and breathing are maintained, however, and the coordination of eye movements is often restricted.

Trance and possession states

Pathological states of trance and possession are coded in the ICD-10 under F44.3.

Dissociative trance states are a temporary change in consciousness with the loss of the feeling of personal identity, a narrowing of consciousness to the immediate environment or certain environmental stimuli. Movements, postures and spoken words are limited to a repetition of the same few things or actions.

In a dissociative obsession trance, a new identity is assumed over a limited period of time instead of the usual identity that is ascribed to a spirit or a deity. Pathological trance and obsession occur in different cultures, and cultures with religious trancerites also know trance states that deviate from normal trance and are therefore assessed as pathological disorders.

Dissociative movement disorders

In dissociative (also: psychogenic) movement disorders (F44.4), either

Dissociative movement disorders account for 2.6 to 25% of movement disorders in neurological departments. Of these, 32.8% were psychogenic tremor , 25% psychogenic dystonia , 25% psychogenic myoclonia , 6.1% psychogenic parkinsonism and 10.9% psychogenic gait disorder .

Dissociative seizures

Dissociative seizures (F44.5) involve sudden and unexpected convulsive movements that may be similar to an epileptic seizure. However, there is no loss of consciousness. Instead, however, a stupor or trance-like state is possible. Only rarely does this result in a tongue bite, severe bruises , injuries due to a fall or urinary incontinence .

The classic arc de cercle belongs to the dissociative seizures .

Dissociative sensitivity and sensation disorders

In dissociative sensory and sensory disorders (F44.6) there is either a loss (partial or complete)

  • normal skin sensations (part or all of the body) or
  • eyesight, hearing or smell.

Other dissociative disorders

These include B.

  • the Ganser syndrome (also past answers Pseudodebilität , F44.80) and
  • the dissociative identity disorder (also: multiple personality disorder , F44.81). According to the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders), two or more separate, different identities or personality states must exist and determine the behavior of the same person alternately. This disorder has to be differentiated from psychotic illnesses such as schizophrenia .

Further dissociative phenomena, which are listed under ICD-10 F48.1 and are only expressly assigned to dissociations from DSM-5 , are:

  • Depersonalization : This is a change in self-perception: the person feels strange in their own body - they observe themselves from outside. The people react completely appropriately to their environment. However, sensory perceptions or even body feelings such as hunger and thirst can be disturbed.
  • Derealization : The environment is perceived as strange or changed due to a feeling of unreality. Both depersonalization and derealization are rarely isolated. Most often they appear as a symptom of other disorders, e.g. B. in connection with panic attacks .

Diagnostic instruments

There are several tools that can be used to diagnose dissociation. These can be divided into questionnaires for self-assessment and for external assessment:

Self-assessment:

External assessment:

  • Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D)
  • AMDP module on dissociation and conversion (AMDP-DK)
  • Dissociative Disorders Interview Schedule (DDIS)
  • Heidelberg Dissociation Inventory (HDI)
  • Clinican-Administred Dissociative States Scale (CADSS) - 19 questions in self-assessment and 5 in third-party assessment.

Neurobiology

With imaging methods , both functional deviations - for example with connections to the amygdala - and anatomical deviations in the brain were determined in group data of patients with dissociative symptoms. According to a hypothesis from 2016, dissociative symptoms are based on deviations in resting activity within and between central networks of the brain, which are important for higher cognitive processes.

causes

The triggering of dissociative symptoms is influenced by various factors. A number of personal characteristics, such as hypnotizability , dreaminess, a tendency to fantasize and a particular openness to experiences increase the likelihood of dissociative symptoms. An extensive twin study also showed that the tendency to dissociate has a hereditary component.

An intensely researched and much discussed factor is the influence of traumatic experiences, especially during childhood. However, it turned out that the statistical correlation was surprisingly small here. Only 8% of the general population exposed to trauma showed symptoms of dissociation. However, 90% of those people who experienced at least one severe symptom also had a traumatic experience. Only 2% of those without a traumatic experience had experienced such a symptom. It has been concluded that trauma is an important but not a sufficient factor in triggering dissociative reactions. Other risks, such as post-traumatic stress or reduced ability to regulate affect, are likely to be a decisive factor in whether a dissociative disorder occurs.

treatment

Since the causes of dissociative disorders cannot generally be viewed as pathological deviations, treatment is generally promising. It is often necessary because spontaneous improvements cannot be expected and there is a considerable risk of deterioration. The recommended treatments are basically psychotherapeutic, similar to those described for dissociative identity disorder .

history

A case from the 16th century was first analyzed in 1896 and then again in 1996. Discussions about split personality were a frequent topic among French psychiatrists and philosophers from 1840 to 1880. The term dissociation as the “disintegration and fragmentation of consciousness” was coined in particular by a work by the French psychiatrist Pierre Janet (1859–1947) published in 1889 . Before that, however, it had already been used in 1845 by the French psychiatrist Jacques-Joseph Moreau (1804-1884) in an extensive book on the splitting off of strange ideas in experiments with hashish .

In the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA), dissociations - under this name - have been listed since 1980 (DSM-III). They have been included in the classifications of the World Health Organization (WHO) since 1992 ( ICD-10 ).

Since 1995, magnetic resonance imaging (MRI ) has repeatedly been used to determine anatomical changes in the brain of patients with permanent post-traumatic stress disorder (PTSD) in group data - for the first time in Vietnam veterans . Further research showed that PTSD was partly linked to dissociative disorders.

literature

Guidelines

  • International Society for the Study of Trauma and Dissociation: Guidelines for the Evaluation and Treatment of Dissociative Symptoms in Children and Adolescents , in: Journal of Trauma & Dissociation, Vol. 5 (3), 2004, pp. 119-150, PDF (accessed August 29, 2016).

Introductions

  • Kathlen Priebe, Christian Schmahl, Christian Stiglmayr: Dissociation: Theory and Therapy , Springer-Verlag, Berlin 2013, ISBN 9783642350665 .
  • Peter Fiedler : Dissociative disorders , 2nd revised edition, Hogrefe Verlag, Göttingen 2013, ISBN 9783840924828 .
  • Romuald M. Brunner: Dissociative and conversion disorders , Springer-Verlag, Berlin 2012, ISBN 9783540488491 .
  • Luise Reddemann , Arne Hofmann , Ursula Gast (eds.): Psychotherapy of dissociative disorders: disease models and therapy practice - disorder-specific and cross-school , 3rd revised edition, Georg Thieme Verlag, Stuttgart 2011, ISBN 9783131581839 .
  • Eric Vermetten, Martin J. Dorahy, David Spiegel (Eds.): Traumatic Dissociation: Neurobiology and Treatment , American Psychiatric Pub, Washington DC 2007, ISBN 9781585627141 .
  • Kathy Steele, Suzette Boon, Onno van der Hart: The Treatment of Trauma-Based Dissociation. A practice-oriented, integrative approach. Probst, Lichtenau 2017, ISBN 978-3-944476-22-3 .

Research overviews

  • Ulrich Sachsse : Do mental damage in childhood leave any neurobiological traces in the adult brain? In: Practice of child psychology and child psychiatry. Volume 62, number 10, 2013, pp. 778–792, PMID 24505860 , PDF (click on: "PDF: Review articles - Vandenhoeck & Ruprecht") , (accessed September 1, 2016).
  • MC McKinnon, JE Boyd, PA Frewen, UF Lanius, R. Jetly, JD Richardson, RA Lanius: A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions. In: Neuropsychologia. [electronic publication before printing] July 2016, doi : 10.1016 / j.neuropsychologia.2016.07.017 , PMID 27444881 (free full text) (review).
  • V. Şar: The many faces of dissociation: opportunities for innovative research in psychiatry. In: Clinical psychopharmacology and neuroscience: the official scientific journal of the Korean College of Neuropsychopharmacology. Volume 12, number 3, December 2014, pp. 171-179, doi : 10.9758 / cpn.2014.12.3.171 , PMID 25598819 , PMC 4293161 (free full text) (review).
  • K. Fritzsche, K. Baumann, K. Götz-Trabert, A. Schulze-Bonhage: Dissociative seizures: a challenge for neurologists and psychotherapists. In: Deutsches Ärzteblatt international. Volume 110, number 15, April 2013, pp. 263-268, doi : 10.3238 / arztebl.2013.0263 , PMID 23667393 , PMC 3647137 (free full text) (review).
  • M. Bedard-Gilligan, LA Zoellner: Dissociation and memory fragmentation in post-traumatic stress disorder: an evaluation of the dissociative encoding hypothesis. In: Memory. Volume 20, number 3, 2012, pp. 277-299, doi : 10.1080 / 09658211.2012.655747 , PMID 22348400 , PMC 3310188 (free full text) (review).

counselor

  • Suzette Boon, Kathy Steele, Onno van der Hart: Coping with trauma-induced dissociation: A skills training for clients and their therapists. From the American (2011) by Elisabeth Vorspohl, Junfermann Verlag, Paderborn 2013, ISBN 9783955712259 .

Web links

  • International Society for the Study of Trauma and Dissociation
  • Cambridge Depersonalization Scale free of charge for research purposes on the website of the ZPID - Leibniz Institute ( [1] )
  • Dissociation Stress Scale (DSS) in the limited preview of Google Book Search ( [2] )
  • Impact-of-Event-Scale-Revised (IES-R) on the website of the University of Zurich ( [3] )

Individual evidence

  1. ^ Pschyrembel clinical dictionary , Verlag De Gruyter, 267th edition 2017 ( ISBN 978-3-11-049497-6 ). ( Keyword dissociation )
  2. ↑ Kathlen Priebe, Christian Schmahl, Christian Stiglmayr: Dissociation: Theory and Therapy , Springer-Verlag, Berlin 2013, ISBN 9783642350665 , p. 34f.
  3. ↑ JM Miyasaki, DS Sa, N. Galvez-Jimenez, AE Lang: Psychogenic movement disorders. In: The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques. Volume 30 Suppl 1, March 2003, pp. S94-100, PMID 12691482 (review).
  4. ↑ Olaf Blanke, Nathan Faivre, Sebastian Dieguez: Leaving Body and Life Behind: Out-of-Body and Near-Death Experience . In: Steven Laureys, Olivia Gosseries, Giulio Tononi: The Neurology of Consciousness: Cognitive Neuroscience and Neuropathology , 2nd edition, Academic Press, Amsterdam 2015, ISBN 978-0-12-801175-1 , pp. 323–347 (English) . online (accessed July 15, 2016).
  5. ↑ Sierra & Berrios, 1996; German version Michal, 2002: Cambridge Depersonalization Scale. SPID - Leibniz Institut, accessed on July 15, 2017 .
  6. ↑ Kathlen Priebe, Christian Schmahl, Christian Stiglmayr: Dissociation: Theory and Therapy . Springer-Verlag, 2014, ISBN 978-3-642-35066-5 , pp. 52–54 ( limited preview in Google Book search).
  7. ↑ Peter Fiedler: Dissociative disorders . Hogrefe Verlag, 2013, ISBN 978-3-8409-2482-8 , pp. 25 ( google.de ).
  8. ↑ AA Nicholson, M. Densmore, PA Frewen, J. Théberge, RW Neufeld, MC McKinnon, RA Lanius: The Dissociative Subtype of Posttraumatic Stress Disorder: Unique Resting-State Functional Connectivity of Basolateral and Centromedial Amygdala Complexes. In: Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology. Volume 40, number 10, September 2015, pp. 2317–2326, doi : 10.1038 / npp.2015.79 , PMID 25790021 , PMC 4538346 (free full text).
  9. ↑ D. Nardo, G. Högberg, RA Lanius, H. Jacobsson, C. Jonsson, T. Hällström, M. Pagani: Gray matter volume alterations related to trait dissociation in PTSD and traumatized controls. In: Acta psychiatrica Scandinavica. Volume 128, Number 3, September 2013, pp. 222-233, doi : 10.1111 / acps.12026 , PMID 23113800 .
  10. ↑ JK Daniels, P. Frewen, J. Theberge, RA Lanius: Structural brain aberrations associated with the dissociative subtype of post-traumatic stress disorder. In: Acta psychiatrica Scandinavica. Volume 133, Number 3, March 2016, pp. 232-240, doi : 10.1111 / acps.12464 , PMID 26138235 .
  11. ↑ MC McKinnon, JE Boyd, PA Frewen, UF Lanius, R. Jetly, JD Richardson, RA Lanius: A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions. In: Neuropsychologia. [electronic publication before printing] July 2016, doi : 10.1016 / j.neuropsychologia.2016.07.017 , PMID 27444881 (free full text) (review).
  12. ↑ JF Kihlstrom, ML Glisky, MJ Angiulo: Dissociative tendencies and dissociative disorders. In: Journal of abnormal psychology. Volume 103, Number 1, February 1994, pp. 117-124, PMID 8040473 (review).
  13. ^ KL Jang, J. Paris, H. Zweig-Frank, WJ Livesley: Twin study of dissociative experience. In: The Journal of nervous and mental disease. Volume 186, Number 6, June 1998, pp. 345-351, PMID 9653418 .
  14. ↑ J. Briere: Dissociative symptoms and trauma exposure: specificity, affect dysregulation, and posttraumatic stress. In: The Journal of nervous and mental disease. Volume 194, Number 2, February 2006, pp. 78-82, doi : 10.1097 / 01.nmd.0000198139.47371.54 , PMID 16477184 .
  15. ↑ V. Şar: The many faces of dissociation: opportunities for innovative research in psychiatry. In: Clinical psychopharmacology and neuroscience: the official scientific journal of the Korean College of Neuropsychopharmacology. Volume 12, number 3, December 2014, pp. 171-179, doi : 10.9758 / cpn.2014.12.3.171 , PMID 25598819 , PMC 4293161 (free full text) (review).
  16. ↑ Kathlen Priebe, Christian Schmahl, Christian Stiglmayr: Dissociation: Theory and Therapy , Springer-Verlag, Berlin 2013, ISBN 9783642350665 , pp. 131–150.
  17. ↑ Onno van der Hart, Ruth Lierens, Jean Goodwin: Jeanne Fery: A Sixteen Century Case of Dissociative Identity Disorder. In: The Journal of Psychohistory. 24 (1), 1996, pp. 1–12, PDF (accessed July 29, 2016).
  18. ↑ According to: Ursula Gast, Frauke Rodewald, Arne Hofmann , Helga Mattheß, Ellert Nijenhuis, Luise Reddemann, Hinderk M. Emrich: The dissociative identity disorder - often misdiagnosed . In: Deutsches Ärzteblatt. 2006, 103 (47), pp. A-3193, B-2781, C-2664.
  19. ↑ Pierre Janet : L'automatisme psychologique . Félix Alcan, Paris 1889 (Reprint: Société Pierre Janet, Paris 1889/1973). According to: Ursula Gast, Frauke Rodewald, Arne Hofmann, Helga Mattheß, Ellert Nijenhuis, Luise Reddemann, Hinderk M. Emrich: The dissociative identity disorder - often misdiagnosed . In: Deutsches Ärzteblatt. 2006, 103 (47), pp. A-3193, B-2781, C-2664.
  20. ↑ a b Kathlen Priebe, Christian Schmahl, Christian Stiglmayr: Dissociation: Theory and Therapy , Springer-Verlag, Berlin 2013, ISBN 9783642350665 , p. 7f.
  21. ↑ Ulrich Sachsse : Do mental damage in childhood leave any neurobiological traces in the adult brain? In: Practice of child psychology and child psychiatry. Volume 62, number 10, 2013, pp. 778–792, PMID 24505860 , PDF (click on: "PDF: Review articles - Vandenhoeck & Ruprecht") , (accessed September 1, 2016).