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DISSOCIATIVE DISORDERS DSM-IV 300.12 Dissociative amnesia 300.13 Dissociative fugue 300.14 Dissociative identity disorder 300.15 Dissociative disorder NOS 300.6 Depersonalization disorder In these disorders a disturbance or alteration exists in the normally integrative functions of identity,  memory, or consciousness. The individual blocks off part of his or her life from consciousness during  periods of intolerable stress. The stressful emotion becomes a separate entity, as the individual “splits”  from it and mentally drifts into a fantasy state. ETIOLOGICAL THEORIES Psychodynamics Selective repression of distressing mental contents from conscious awareness is used as a mechanism  for protecting the individual from emotional pain or expressing self in dangerous ways. The stressor(s) may  arise from external circumstances or internal sources with onset of symptoms sudden or gradual and of  transient or chronic nature. Intrapsychic conflict thus uses denial and “ego splitting” to decrease anxiety. Physical sensations seen in these disorders may represent forbidden wishes that have been somatized.  The use of the defense mechanism of displacement allows the feeling(s) to be directed away from the ego- threatening object toward one less threatening. In psychoanalytic terms, dissociation is a form of denial in  which the object denied is part of the self or ego. Biological Research on the biological basis of these disorders is increasing as more recognition of the mind-body  connection   is   accepted.   It   is   difficult   to   determine   whether   the   biological   changes   (fight-or-flight  mechanism)  that  accompany   severe  anxiety   precede  or precipitate   the emotional  state.   Biochemical,  physiological, and endocrine systems have an intimate connection with actual physical changes occurring  in all body systems via the autonomic nervous system. Some studies have shown EEG abnormalities  associated with cerebral mechanisms in the temporal and limbic regions of the brain, which mediate  identity   formation   and   a   sense   of   personal   boundaries   and   may   affect   development   of   gender   and  generation boundaries. Organic causes of pathological dissociative experiences that are known or suspected include temporal  lobe epilepsy, sensory deprivation, sleep loss, strokes, encephalitis, and Alzheimer’s disease. Drugs may  also   induce   amnesia   or   depersonalization   directly   or   indirectly   in   some   incidences.   However,   most  dissociative states are not associated with any obvious organic conditions and the diagnosis of dissociative 
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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