Significations et usages de Dissociative_disorder

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.
• Dissociative disorder not otherwise specified: used for forms of pathological dissociation that do not fully meet the criteria of the other 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. 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 can be understood by the historic context of hysteria. Even current systems used to diagnose DD such as the DSM-IV and ICD-10 differ in the way the classification is determined.^[5]

  Children and adolescents

Dissociative disorders (DD) are widely believed to have roots in traumatic childhood experience (abuse or loss), but symptomology often goes unrecognized or is 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 attempt 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 post a number of approaches to improve 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 (DA) in children can help alert clinicians to the possibility of dissociative disorders.^[7] Clinicians and researchers also stress the importance of using a developmental model to understand both symptoms and the future course of DD's.^[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 a young patient’s recovery will remain stable over time.^[9]

  Current debates and the DSM V

A number of controversies surround DD in adults as well as children. First, there is ongoing debate surrounding the etiology of dissociative identity disorder (DID). The crux of this debate is if DID is the result of childhood trauma and disorganized attachment.^[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

• Complex post-traumatic stress disorder
• Dissociative Experiences Scale
• Dissociative identity disorder in fiction
• Hysteria
• Structured Clinical Interview for DSM-IV

  References

  External links

Resources for parents, patients, and families:

• Mayo Clinic - http://www.mayoclinic.com/health/dissociative-disorders/DS00574/DSECTION=treatments-and-drugs
• Cleveland Clinic - http://my.clevelandclinic.org/disorders/dissociative_disorders/hic_depersonalization_disorder.aspx
• International Society for the Study of Trauma and Dissociation - http://www.isst-d.org/
• Child Welfare - http://www.childwelfare.gov/
• Sidran Institute - http://www.sidran.org/