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==Diagnosis and prevalence==
==Diagnosis and prevalence==
According to a 2002 meta-analysis by Ross et al.,<ref>{{cite journal|last=Ross et al.|title=Prevalence, Reliability and Validity of Dissociative Disorders in an Inpatient Setting|journal=Journal of Trauma and Dissociation|year=2002|pages=pp.7–17|url=http://www.tandfonline.com/doi/abs/10.1300/J229v03n01_02|doi=10.1300/J229v03n01_02}}</ref> the lifetime prevalence of dissociative disorders varies from 10% in the general population to 46% in psychiatric inpatients, based on testing using the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. Some diagnostic tests have also been adapted and/or developed for use with children and adolescents such as the Children's Version of the Response Evaluation Measure (REM-Y-71), Child Interview for Subjective Dissociative Experiences, Child Dissociative Checklist (CDC), [[Child Behavior Checklist]] (CBCL) Dissociation Subscale, and the Trauma Symptom Checklist for Children Dissociation Subscale.<ref name=Steiner />
According to a 2002 meta-analysis by Ross et al.,<ref>{{cite journal|last=Ross et al.|title=Prevalence, Reliability and Validity of Dissociative Disorders in an Inpatient Setting|journal=Journal of Trauma and Dissociation|year=2002|pages=pp.7–17|url=http://www.tandfonline.com/doi/abs/10.1300/J229v03n01_02|doi=10.1300/J229v03n01_02}}</ref> the lifetime prevalence of dissociative disorders varies from 10% in the general population to 46% in psychiatric inpatients, based on testing using the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. Depersonalization Disorder is estimated to affect 1-2% of the population making it more common than Schizophrenia. Some diagnostic tests have also been adapted and/or developed for use with children and adolescents such as the Children's Version of the Response Evaluation Measure (REM-Y-71), Child Interview for Subjective Dissociative Experiences, Child Dissociative Checklist (CDC), [[Child Behavior Checklist]] (CBCL) Dissociation Subscale, and the Trauma Symptom Checklist for Children Dissociation Subscale.<ref name=Steiner />


There are problems with classification, diagnosis and therapeutic strategies of dissociative and conversion disorders which are only understood by the historic context of hysteria. Even current systems used to diagnose them such as the DSM-IV and ICD-10 differ in the way the classification is determined in such disorders.<ref>{{cite journal|last=Splitzer|first=C|coauthors=Freyberger, H.J.|title=Dissoziative Störungen (Konversionsstörungen)|journal=Psychotherapeut|year=2007}}</ref>
There are problems with classification, diagnosis and therapeutic strategies of dissociative and conversion disorders which are only understood by the historic context of hysteria. Even current systems used to diagnose them such as the DSM-IV and ICD-10 differ in the way the classification is determined in such disorders.<ref>{{cite journal|last=Splitzer|first=C|coauthors=Freyberger, H.J.|title=Dissoziative Störungen (Konversionsstörungen)|journal=Psychotherapeut|year=2007}}</ref>

Revision as of 07:10, 17 June 2012

Dissociative disorders
SpecialtyPsychiatry, clinical psychology Edit this on Wikidata

Dissociative disorders can be defined as conditions that involve disruptions or breakdowns of memory, awareness, identity and/or perception. People with dissociative disorders use dissociation, a defense mechanism, pathologically and involuntarily. Dissociative disorders are thought to primarily be caused by psychological trauma.

The five dissociative disorders listed in the DSM IV are as follows[1]:

  • Depersonalization disorder: periods of detachment from self or surrounding which may be experienced as "unreal" (lacking in control of or "outside of" self) while retaining awareness that this is only a feeling and not a reality.
  • Dissociative amnesia: (formerly Psychogenic Amnesia): noticeable impairment of recall resulting from emotional trauma
  • Dissociative fugue: (formerly Psychogenic Fugue): physical desertion of familiar surroundings and experience of impaired recall of the past. This may lead to confusion about actual identity and the assumption of a new identity.
  • Dissociative identity disorder: (formerly Multiple Personality Disorder): the alternation of two or more distinct personality states with impaired recall, among personality states, of important information.
  • Dissociative disorder not otherwise specified: which can be used for forms of pathological dissociation not covered by any of the specified dissociative disorders.

The ICD-10 classifies conversion disorder as a dissociative disorder[2] while the DSM-IV classifies it as a somatoform disorder.

Diagnosis and prevalence

According to a 2002 meta-analysis by Ross et al.,[3] the lifetime prevalence of dissociative disorders varies from 10% in the general population to 46% in psychiatric inpatients, based on testing using the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. Depersonalization Disorder is estimated to affect 1-2% of the population making it more common than Schizophrenia. Some diagnostic tests have also been adapted and/or developed for use with children and adolescents such as the Children's Version of the Response Evaluation Measure (REM-Y-71), Child Interview for Subjective Dissociative Experiences, Child Dissociative Checklist (CDC), Child Behavior Checklist (CBCL) Dissociation Subscale, and the Trauma Symptom Checklist for Children Dissociation Subscale.[4]

There are problems with classification, diagnosis and therapeutic strategies of dissociative and conversion disorders which are only understood by the historic context of hysteria. Even current systems used to diagnose them such as the DSM-IV and ICD-10 differ in the way the classification is determined in such disorders.[5]

Children and adolescents

Dissociative disorders are widely believed to have roots in traumatic childhood experience, but symptomology often goes unrecognized or misdiagnosed in children and adolescents.[4][6][7][8] Researchers cite several reasons why recognizing symptoms of dissociation in children is challenging: it may be difficult for children to describe their internal experiences;[8] caregivers may miss signals or desire to conceal their own abusive or neglectful behaviors;[8] symptoms can be subtle or fleeting;[4] disturbances of memory, mood, or concentration associated with dissociation may be misinterpreted as symptoms of other disorders.[4]

In addition to developing diagnostic tests for children and adolescents (see above), researchers posit a number of approaches to improving recognition and understanding of dissociation in children. Recent research has focused on clarifying the neurological basis of symptoms associated with dissociation by studying neurochemical, functional and structural brain abnormalities that can result from childhood trauma.[6] Others in the field have argued that recognizing disorganized attachment styles in children can help alert clinicians to the possibility dissociative disorders.[7] Clinicians and researchers also stress the importance of using a developmental model to understand both the symptoms and future course of dissociative disorder.[4][6] In other words, symptoms of dissociation may manifest differently at different stages of child and adolescent development and individuals may be more or less susceptible to developing dissociative symptoms at different ages. Further research into the manifestation of dissociative symptoms and vulnerability throughout development is needed.[4][6] Related to this developmental approach, more research is required to establish whether young patient’s recovery will remain stable over time.[9]

Current debates and the DSM V

A number of controversies surround dissociative disorder in adults as well as children. First, there is ongoing debate surrounding the etiology of dissociative identity disorder (DID), commonly referred to as multiple personalities. The crux of this debate centers on whether or not DID is the result of childhood trauma or iatrogenesis.[6][10] A second area of controversy surrounds the question of whether or not dissociation as a defense versus pathological dissociation are qualitatively or quantitatively different. Experiences and symptoms of dissociation can range from the more mundane to those associated with posttraumatic stress disorder (PTSD) or acute stress disorder (ASD) to dissociative disorders.[4] Mirroring this complexity, it is still being decided whether the DSM V will group dissociative disorders with other trauma/stress disorders.[11]

See also

References

  1. ^ American Psychiatric Association (2000). DSM-IV-TR (4th ed.). American Psychiatric Press. p. 543. ISBN 0-89042-025-4.
  2. ^ International Statistical Classification of Diseases and Related Health Problems, 10th Revision. F44.9
  3. ^ Ross; et al. (2002). "Prevalence, Reliability and Validity of Dissociative Disorders in an Inpatient Setting". Journal of Trauma and Dissociation: pp.7–17. doi:10.1300/J229v03n01_02. {{cite journal}}: |pages= has extra text (help); Explicit use of et al. in: |last= (help)
  4. ^ a b c d e f g Steiner, H. (2002). "Dissociative symptoms in posttraumatic stress disorder: diagnosis and treatment". Child and Adolescent Psychiatric Clinics North America. 12: 231–249. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  5. ^ Splitzer, C (2007). "Dissoziative Störungen (Konversionsstörungen)". Psychotherapeut. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  6. ^ a b c d e Diseth, T. (2005). "Dissociation in children and adolescents as reaction to trauma - an overview of conceptual issues and neurobiological factors". Nordic Journal of Psychiatry. 59: 79–91.
  7. ^ a b Waters, F. (2005). "Recognizing dissociation in preschool children". The International Society for the Study of Dissociation News. 23 (4): 1–4. {{cite journal}}: Unknown parameter |month= ignored (help)
  8. ^ a b c James, B. (1992). "The dissociatively disordered child". Unpublished paper.
  9. ^ Jans, T. (23). "Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence". Child and Adolescent Psychiatry and Mental Health. 2. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)CS1 maint: extra punctuation (link)
  10. ^ Boysen, G. (2011). "The scientific status of childhood dissociative identity disorder: A review of published research". Psychotherapy and Psychosomatics. 80: 329–334. {{cite journal}}: Unknown parameter |month= ignored (help)
  11. ^ Brand, B. (2012). "Where are we going? An update on assessment, treatment, and neurobiological research in dissociative disorders as we move toward the DSM-5". Journal of Trauma and Dissociation. 13: 9–31. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

Resources for parents, patients, and families:

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