It is a partial or complete loss of the normal interaction between memories of the past, awareness of identity and immediate sensations and control of bodily movements.
• F44.0 Dissociative amnesia
• F44.1 Dissociative fugue
• F44.2 Dissociative stupor
• F44.3 Trance and possession disorders
• F44.4 Dissociative motor disorders
• F44.5 Dissociative convulsions
• F44.6 Dissociative anesthesia and sensory loss
• F44.7 Mixed dissociative (conversion) disorders
• F44.8 Other dissociative (conversion) disorders
.80 Ganser’s syndrome
.81 Multiple personality disorder
.82 Transient dissociative disorder occurring in childhood and adolescence
.88 other specified dissociative (conversion) disorder
• F44.9 Dissociative (conversion) disorder, unspecified
• Commonest type
• Occur in adolescent and young adults
• Sudden inability to recall important personal information usually concerning stressful or traumatic events
• Not as everyday forgetfulness
• No medical illness
Dissociative amnesia, Types
ü Localized amnesia : inability to recall events related to a circumscribed period of time.
ü Selective amnesia : ability to remember some but not all of the events occurring during a circumscribed period of time.
ü Generalized amnesia : failure to recall one’s entire life
ü Continuous amnesia : failure to recall successive events as they occur
ü Systematized amnesia: amnesia for certain category of memory, such as all memories relating to one’s family or to a particular person
Differential diagnosis of dissociative amnesia
• Organic mental disorder
• Alcohol or drug abuse black outs
• Head injury
• Post ictal amnesia
• It is characterized by episodes of wandering away. During the episode, person adopts a new identity.
• Onset is sudden and end abruptly with amnesia about the episode.
• May last from less than an hour to a year or more, but generally last in the range of days to weeks
Differential diagnosis of dissociative fugue
• Post ictal fugue
• Alcoholic black-outs
• Patients are motionless and mute and do not respond to stimulation, but they are aware of their surroundings.
TRANCE AND POSSESSION DISORDERS
• Disorders in which there is a temporary loss of both the sense of personal identity and full awareness of the surroundings;
• When associated with religious rituals the individual acts as if taken over by another personality, spirit, god or ‘force’
DISSOCIATIVE MOTOR DISORDER
• Loss of ability to move the whole or part of a limb or limbs
• Paralysis may be partial or complete
• Various forms and degrees of incordination may be evident, particularly in legs, resulting in bizarre gait or inability to stand
• May mimic epileptic seizures very closely in terms of movements; but tongue biting, serious bruising due to falling and incontinence of urine are rare
• And loss of consciousness is absent or replaced with a state of stupor or trance
• Hemianesthesias, blindness or contracted visual fields and deafness are the common complaints
• Glove & stocking anesthesia
MIXED DISSOCIATIVE (conversion) DISORDERS (F44.0-F44.6)
• These are combination of any of the types
OTHER DISSOCIATIVE DISORDERS
• Ganser’s syndrome
v Characterized by ‘approximate answers’
v Suggest a psychogenic etiology
v The answers are wrong , but show that the person understands the nature of question asked
• Multiple personality disorder/ Dissociative identity disorder
v Essential feature is the apparent existence of two or more distinct personalities within an individual, with only one of them being evident at a time.
v Each personality is complete, with its own memories, behavior and preferences
v Change from one personality to another is usually sudden and closely associated with traumatic incident
v In the common form with two personalities one personality is usually dominant, but neither has the access to the memories of the other and the two are almost always unaware of each other’s existence
• Psychodynamic theory: Failure to repress the stressful event resulting in activation of secondary defense mechanism such as dissociation or conversion.
• Behavioral theory: dissociative or conversion symptoms are learned responses to stress. Initially the symptom will be learned from environment.
• Biological :Conversion symptoms are seen in epilepsy, cerebral cortical lesions.
• Lack of concern towards the symptoms even if it causes severe disability.
• Behavioural therapy
v Free association
v IV amytal/thiopentone/diazepam
• Psychotherapy with abreaction
• Supportive psychotherapy
• Psycho analysis
• Monitor for organic pathology
• Identify primary and secondary gain
• Don’t focus on disability
• Don’t allow manipulation
• Withdraw attention when focusing on disability
• Encourage expression of feelings
• Positive reinforcement when using adaptive coping
• Identify unresolved conflicts and assist for resolution