Dissociative Disorders

Dissociative Disorders is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • According to Diagnostic and Statistical Manual of Mental Disorders (DSM-5), dissociative disorders are manifested by a disruption in the continuity of normal integration of consciousness, memory, identity, emotion, body representation, motor control, perception of self and reality, and behavior (1).
  • Common symptoms to all dissociative disorders include depersonalization, derealization, fragmentation of identity, episodes of amnesia, dysphoria, and maladaptive behaviors.
  • Disorders include dissociative identity disorder, dissociative amnesia, depersonalization/derealization disorder, other specified dissociative disorder, and unspecified dissociative disorder.
  • System(s) affected: nervous
  • Synonym(s): hysteria, hysterical neurosis—dissociative type; Ganser syndrome

Geriatric Considerations
Decrease in frequency and intensity of dissociative symptoms; medication side effects are more likely.

Pediatric Considerations
Suspect abuse or neglect.

Epidemiology

Incidence
  • Predominant age: adolescents and young to middle-aged adults; rare as a new illness in the elderly. If untreated, it may linger from childhood into adulthood and old age.
  • Predominant sex: female > male (2:1)

Prevalence
  • Transient symptoms of depersonalization or derealization in the general population are common.
  • Lifetime prevalence rate is 26–74%.
  • 31–66% occurring at the time of a traumatic event
  • Up to 70% of young adults report short periods of dissociative experiences that are self-limiting and resolve spontaneously without any treatment.
  • Dissociative amnesia occurs in 2–7% of the general population.

Etiology and Pathophysiology

Common link to a history of emotional/physical trauma

Risk Factors

  • Exposure to neglect, abuse, and trauma in childhood (2)[A],(3)[B]
  • Physical, emotional, verbal, or sexual abuse in childhood and adolescent years
  • Sudden and severe trauma or threat to psychological or physical integrity
  • Sudden and unexpected exposure to watching others being killed or severely injured (as in industrial or car accident)
  • Tendency to cope with life’s stresses by excessively using an escape mechanism of daydreaming and/or dissociation
  • A tendency of coping with trauma, internal, and interpersonal conflicts by the use of dissociation
  • Psychological/social support to cope with the trauma/abuse was unavailable.
  • Family history of dissociative disorders or posttraumatic stress disorder (PTSD)

General Prevention

  • Child abuse prevention via parent education and community agency intervention
  • Crisis intervention following individual trauma or disasters may prevent dissociative disorders.

Commonly Associated Conditions

PTSD, anxiety disorders, depression, somatoform disorders, chronic pain, insomnia, gender dysphoria

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Dissociative Disorders ID - 816180 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816180/all/Dissociative_Disorders PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -