Mental Dissociation and Dissociative Disorders. These are topics of interest to psychology researchers of our century. What is mental dissociation? How is it manifested? What are these characteristics? What do we call dissociative disorders? How to identify them? These are some of the questions that will be the subject of our article. We will discuss these two terms together.

“Dissociation” mental, or psychic, etymologically opposes association (mental or psychic). Association refers to the harmonious and coordinated way in which the brain works and the psyche organizes itself. The different psychic devices coordinate and exchange basic information to ensure a congruent presence in the world. In the case of dissociation, there is a lack of congruence of words or attitudes. The term “schizophrenia” (schizo: “separation”, and phrenia, phren, -phrenia, -phrenia: “spirit”) has the same etymological origin. That of dissociation was also used first of all to designate early psychoses, known as “schizophrenia”.

In lessons, 18 to 22 of the Lessons on Nervous System Diseases, which deals with seven cases of male hysteria, Jean-Martin Charcot (1825-1893) states that hysterical symptoms are due to a traumatic “shock” causing dissociation of consciousness, and whose memory, by the very fact, remains unconscious or subconscious. It lays the foundations of the “traumatico-dissociative” theory of neuroses, which will be developed by Pierre Janet, Josef Breuer, Jean Leguirec and Sigmund Freud.

The French philosopher and psychiatrist Pierre Janet (1859-1947) are considered to be the author of the concept of dissociation. Contrary to some conceptions of dissociation, Janet did not believe that dissociation was a psychological defense.

The Prevalence of Dissociative DisorderDissociative Disorders

With regard to dissociative disorders: Since the 1980s in the United States and 1990 in Europe, dissociative disorders have been the subject of intense research programs at the international level. Although these disorders were initially modeled by the French psychologist Pierre Janet from 1885 to 1887, France remains paradoxically still largely away from this research. As a result, dissociative patients are very rarely diagnosed in France, where their treatment, therefore, is not sufficiently adapted to their disorders. However, the prevalence of dissociative disorders in the population of the industrialized countries is estimated at about 10%, taking into account that the diagnosis must still progress (with the training of clinicians and the effectiveness of evaluation scales).

I – Mental Dissociation

In psychology, dissociation is a “functional separation between psychic or mental elements that are usually brought together”. Thus, the taking into account of the reality and the lived experience is inhibited (thought, judgment, feeling), temporarily or durable, to support a psychic trauma.

Dissociation is contrasted with psychosis, which is a loss of contact with reality, and there are several levels of dissociation:

– The primary dissociation isolates the experience, it is the situation of post-traumatic stress

– Secondary dissociation is a disintegration of experience, with an “observing self” and an “experimenting self”.

– Tertiary dissociation is the genesis of independent ego states (see Dissociative Disorder of Identity).

But we also distinguish different types of dissociations, especially in relation to:

– The reason: “The schizophrenic sees or feels things in a psychic zone inaccessible to his reason”

– Memory is post-traumatic amnesia

– The personality, in the case of Dissociative Disorder of Identity.

1 – What Is Mental Dissociation?What Is Mental Dissociation

Mental dissociation is a psychological and psychiatric symptom that affects memory, identity, and perception of the environment. It is characterized by a lack of coherence in the behavior, the thoughts or the talk, in relation to the emotions, or to the environment.

In normal psychological functioning, psychic devices coordinate and exchange information between themselves to ensure congruence with the external environment, memories, and language. In the case of a mental dissociation, the person presents a loss of congruence of his words, his memory, or his behavior.

In some cases, mental dissociation is a defense mechanism that allows one to break away from a particularly stressful or traumatic situation. It is sometimes used involuntarily in cases of abuse or psycho-traumatism (car accident, attack, assault, rape, etc.).

2 – Characteristics of Mental Dissociation

Mental dissociation is characterized by a separation between the psychic elements that usually communicate. This lack of psychological congruence results in:

– The inability to perceive external events and act accordingly;

– The impossibility of acting in competition with one’s emotions;

– The loss of his identity;

– The loss of contact with reality;

When the episode of mental dissociation is not permanent, the person does not remember what she did, giving her the impression of a double personality. The amnesia of events is characteristic of mental dissociation since the loss of congruence prevents the brain from making the different structures communicate with each other.

3 – Mental Dissociation: Consequences on the Entourage

Mental dissociation, because of language disorders and the behavior it engenders, has negative consequences on the environment and on social relations in general. The loss of congruence with the environment and emotions can sometimes be misunderstood by others who think of a simulation.

However, the person suffering from a mental dissociation has no memory and is still less aware of what is happening to him. She cannot control her emotions or behavior.

The appearance of such an episode must alert the entourage, in order to consult as quickly as possible a psychiatrist or a psychologist, to seek and treat the cause.

4 – Different Disorders Associated with Mental Dissociation

Mental dissociation is associated with many psychological and psychiatric disorders. In some cases, it may be transient for a few minutes, a few hours, or several days. In the case of chronic illness such as schizophrenia, it is usually permanent, outside periods of treatment.

Mental dissociation can occur during different mental disorders:

– Schizophrenia;

– Psycho-traumatism, intense stress or abuse;

– Dissociative disorder, such as amnesia, depersonalization, derealization, or dissociative identity disorder;

– Mood disorders such as depression;

– Anxiety disorders, panic attacks, phobias;

– Intense physical pain;

– Memory problems;

– Addictions to psychotropic drugs;

– Eating disorders.

In all cases, care by a psychiatrist and / or psychologist is essential to limit the risks associated with behavioral disorders (endangerment, aggression) and to seek the cause of the mental dissociation.

II – Dissociative DisordersDissociative Disorders

In the field of neuroscience, the notions of trauma and dissociation remain among the most open to many changes and debates for more than a century in clinical fields, nosological, therapeutic and for twenty years at the neurobiological level. Dissociation is defined as a disturbance of the identity, memory, consciousness and perception of the environment (normally integrated functions). It is a transnosographic entity observed in several psychiatric disorders: somatoform disorders, anxiety and mood disorders, personality disorders, multi-substance dependence. Dissociative phenomena are frequently found during suicidal crises, difficulty in managing impulsivity, chronic pain syndromes, fibromyalgia and in epileptic disorders.

Dissociative disorders are well-defined nosological entities, thanks to recent advances in the development of standardized diagnostic tools. Epidemiological studies find a prevalence of dissociative disorders ranging around 10% in the general population and 16% among patients hospitalized in psychiatry, with a predominance of women. There is consensus in the literature about the importance of early detection of these disorders, in order to improve the management of patients.

1 – History of the Concept of Dissociative Disorders: Dissociation Towards Dissociative Disorders

The story of the concept of dissociation combines hysteria and hypnosis with the work of Charcot, Janet, and Freud. In the rest of Charcot’s work on hysteria, Janet develops a new concept, that of mental dissociation, as the basis of the set of hysterical phenomena. Janet postulates that dissociation is the result of “psychological misery”, which is a pathological process, probably a poverty or a genetic deficit of basic mental energy that allows healthy people to combine different mental functions (sensations, memories wills) in a stable, unified psychological structure, under the conscious control of the Self.

Contrary to this perspective of Janet, who considered dissociation as a deficit of integration of an ego too weak, or weakened following traumas, Freud proposed a conflictual model of psychic functioning, in which a strong ego tries to protect itself traumatic experiences by a defense mechanism, repression, which he associates with dissociation as a fundamental element in hysteria. Despite their different theoretical models of dissociation, Janet and Freud shared the idea of the importance of traumatic events and their mnemic traces, as determining factors for the appearance of dissociative symptoms. However, in a second step, Freud abandoned the idea of a real trauma for a model of imaginary trauma derived from sexual fantasies, as being the source of unconscious psychological conflicts. Freud, however, remained attached to the historical reality of the factors of the conflicts and formulated strong criticisms towards the overestimation of the role of the fantasies in the analysis of the neuroses. Later he emphasized the importance of traumatic personality deformity linked to the vicissitudes of infantile sexuality.

The development of psychodynamic techniques and the attribution of the notion of “dissociation” to the symptoms of schizophrenic disorders (Bleuler) gradually plunged into oblivion Janet’s hypnosis and theories of dissociation. The decline of the dissociation concept culminates before the middle of the twentieth century, with theories that dissociative phenomena are either diagnostic errors (between hysteria and schizophrenia), or side effects caused by misused hypnotic techniques.

The researchers’ interest in the “rediscovery” of dissociative disorders is to be linked both to the increase in stress and trauma disorders and to certain political and social events in the United States (the Vietnam War and the birth of the feminist movement in the 1960s-1970s), which made it possible to recognize the hidden and ignored endemic of physical and sexual abuse of children and to establish links between traumatic experiences, post-traumatic symptoms and dissociative symptoms. In the early 1990s, still in the United States, a reaction rises against the increase of public revelations of child abuse with the creation of the “Association of false memory syndrome”. Despite efforts to validate the concept of dissociative disorders, there are still many controversies in the literature regarding the interest and clinical relevance of the concept, as well as potential links to real traumatic experiences.

2 – Definition of the Concept: “Dissociative Disorders”

Dissociative disorders are a set of psychiatric disorders characterized by the occurrence of a disturbance affecting normally integrated functions, such as memory, consciousness, and identity.

There are several types of dissociative disorders, but in this article, we have chosen to present two of them, in the following lines: this is post-traumatic stress disorder and that of identity.

Post-Traumatic Stress Disorder (Synonym: PTSD)

A disorder characterized by an inability to recover after experiencing or witnessing a terrifying event. The illness can last for several months or years, with triggering events that bring back memories of the trauma and are accompanied by intense emotional and physical reactions.

*** Symptoms

Possible symptoms are nightmares and flashbacks, avoidance of situations that re-emerge trauma, exacerbated reactivity to stimuli, anxiety, or depressed mood.

Sufferers may have the following symptoms:

– Behavioral: irritability, agitation, self-destructive behavior, hostility or hypervigilance

– Psychological: flashbacks, severe anxiety, mistrust or fear

– Mood: loss of interest or pleasure in various activities, guilt or loneliness

Sleep: nightmares or insomnia

– Other common symptoms: emotional detachment or unwanted thoughts

*** Care and treatment

Treatment includes medication and therapy. The treatment includes different types of psychotherapy as well as medications to manage the symptoms.

– Therapies

Cognitive Behavioral Psychotherapy: A speech therapy focused on modifying negative thoughts, emotional reactions, and behaviors associated with psychological distress.

EMDR: Psychological treatment to reduce stress related to traumatic events by eye movements.

– Medications

Selective serotonin reuptake inhibitor (SSRI): Relieves symptoms of depressed mood and anxiety.

– Specialists

Clinical Psychologist: Treatment of mental disorders, mainly through speech therapy.

Psychiatrist: Treatment of mental disorders, mainly with drugs.

Dissociative Disorder of Identity (Synonym: Multiple Personality Disorder)

A disorder characterized by the presence of at least two distinct personality states. Dissociative Identity Disorder (TDI, or ICD-10 Multiple Personality Disorder) is a mental disorder defined in 1994 in the DSM by a set of diagnostic criteria as a particular type of dissociative disorder.

Dissociative identity disorder, formerly known as multiple personality disorder, generally refers to a reaction to trauma as a way to help a person avoid bad memories.

The dissociative disorder of identity is characterized by the existence of at least two distinct personalities, each of which may have its own name, its own history, and its own character traits.

*** Symptoms

The dissociative disorder of identity is characterized by the existence of at least two distinct personalities, each of which may have its own name, its own history, and its own character traits.

Sufferers may have the following symptoms:

– Behavioral: self-harm, self-destructive behavior or impulsivity

– Mood: anxiety, self-detachment or moodiness

– Psychological: alteration of consciousness, depression or flashbacks

– Other common symptoms: amnesia or loss of consciousness

*** Care and Treatments

The treatment is based on therapy. Treatment consists of following psychotherapy sessions.

– Therapies

Cognitive Behavioral Psychotherapy: A speech therapy focused on modifying negative thoughts, emotional reactions, and behaviors associated with psychological distress.

Family Therapy: Psychological support that helps families resolve their conflicts and communicate more effectively.

Psychotherapy: Treatment of mental or behavioral disorders through psychotherapy.

– Specialists

Clinical Psychologist: Treatment of mental disorders, mainly through speech therapy.

Psychiatrist: Treatment of mental disorders, mainly with drugs.

As a Summary

There is a nuance between dissociation and dissociative disorders. In this article, we just gave an overview of these topics.

The importance of knowledge of the epidemiological, clinical, co-morbidities and differential diagnosis of dissociative disorders by clinicians is illustrated by the consensus that exists in the literature concerning the interest of specific and early management of these disorders. , to improve their prognosis. The integration of neuroanatomical, biochemical and endocrinological data into an etiopathogenic model of dissociative disorders seems to be a new challenge for neuroscience. Therapeutically, there are currently no consensus-based therapeutic guidelines validated empirically despite efforts to synthesize data from the literature, particularly at the initiative of the ISSD.

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