Collected Works, Volume I, Diagnosis & Treatment of Dissociative Disorders

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However, the color of the hysterical symptoms, the terms used to signify mental suffering and the experience of conflict is guided by the reigning discourse. The appearance of alters also changed over time. Whereas it was very rare that more than two or eventually three personality states were described in the early 20th century Merskey, ; Baeten, , more recently an average of 13 alters is reported Putnam et al. Moreover, today alters seem to shift immediately and without warning, whereas in the 19th and early 20th century a transitional period e.

Also the secondary states were regularly not described as equaling the common conscious state of mind, yet rather appear as somnambular or hypnotic states. This is clear in descriptions of Azam , in Merskey, , who explained dual personality in terms of a doubling of consciousness connected to somnambulism. When considering the chameleon like nature of the hysterical subject Verhaeghe, , these observations are not so hard to understand.

As societies and cultural discourses change, so too do symptoms. The hysterical subject adapts to the discourses on mental and physical illness in the medical world and the broader society. Again, this in no way means we consider this to be a conscious process.

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Rather, these identificatory processes are dominant in the psychic make-up and proceed on an unconscious level, only surfacing in instances where the subject feels fake, not knowing who she is herself and sensing the major impact of the Other on her identity Fink, Not only does the hysterical subject identify with the reigning discourse, she actively turns toward the presumed master to signify her suffering. Doctors and therapists on account of their professional status easily occupy the position of the master who knows. In this respect, therapists and researchers stepping on the barricades as advocates of the veracity of the DID diagnosis and its traumatic origin preeminently incarnate such a position.

What is remarkable, and in line with our argument, is that most DID cases are reported in North America and center around a limited number of therapists and research groups. While Spanos for example notes that the majority of cases are reported by a small number of therapists, Gleaves argues that these research teams used data from a large number of clinicians.

As Lilienfeld et al. So it seems, therapists group around a fascination for these symptoms, form associations and communicate around this pathology. It is not so strange starting from the reasoning we are laying out here to understand why these therapists or groups of therapists find such high prevalence numbers, numbers that are not found anywhere else. This dimension of suggestion is further supported by the observation that in most cases alters only appear within the context of therapy and almost never as an admission complaint.

PTM proponents argue that DID is mostly hidden and that patients are unwilling to show their symptoms because of shame, for example. They claim that it requires a skillful therapist to notice the signs of DID. Descriptions of both diagnostic and therapeutic procedures show that they actively probe for alters, for example by asking if someone is else speaking when a patient reacts or talks a bit differently than usual e. Starting from their fundamental psychic make-up, the hysterical subject hears this as a suggestion and rightly so to which they consent by identifying with the suggested symptom.

Surely, this gives form to an existing problematic founded on the essential dividedness from which they are suffering. In that sense, the suggestive nature of questions actively addressing different personalities or alters within a patient does not create something ex nihilo. But we might wonder whether this division is not intensified and pathologized further by substantiating alter identities this way. We could say that it is strange that such spectacular symptoms like DID go unnoticed by relatives and other clinicians across the world, clinicians with years of experience working with complex pathology and traumatic experiences.

On the other hand, as these symptoms find their basis in conflicting desires and identifications, dissociative tendencies are not unexpected in the hysteric and serve the function of appropriating the desire of the Other. Again, the question is whether therapists should further consolidate these tendencies.


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Actually, such a practice boils down to what Lacan e. In the first phase of the therapy, Lasky describes the focus of the therapy as rather concrete, discussing domestic problems and her history as one of ten children in a religious family. By around the 50th session, the strong ambivalence toward her mother because of an extramarital affair gradually came to the fore. Re-experiencing feelings of rage started to give rise to another way of appearing in the sessions. Where Lasky, as therapist, is able to reflect on his own desire to see her as a strong woman who functions well, given the difficult circumstances, he allows her to find words for the aggressive desires and the splitting disappears.

In sum, I think that in order to achieve memory integration it is crucial to create space for the full spectrum of subjectivity rather than focusing on alter identities directly. Indeed, we believe that the latter approach simply strengthens the dissociative process and prompts new alters to appear during the therapeutic process e. Oddly enough, it seems that in the literature on treatment for DID e.

Considering both the PTM and the SCM in detail, I actually argued that both models hint at important mechanisms to understand DID: the role of trauma on the one hand and the role of the underlying subjective structure on the other. However, while both models are busy arguing against each other, they miss the opportunity to elaborate this fully. From a psychoanalytic point of view we could say they are talking about two sides of the same coin, i.

However, in line with the argument on structural trauma at the core of identity formation, we do not deny the real basis for this pathology, as the symptoms seem to present an enlargement of the structural division of human psychic functioning. Different identificatory layers of human identity often depict contradictory desires where conflicts inevitably arise.

Such conflicts are difficult to experience by the subject and fall prey to repression. Traumatic contexts can induce painful identifications: in such situations the subject tries to understand the desire of the Other in an attempt to meet expectations and thus identifies with desires that are often more disruptive when the other is abusive, aggressive, transgressive… Conflicting desires exist for every neurotic subject, but the extent to which they derail the subject will always differ. To avoid these disruptive desires and thus fail to appreciate the fundamental division between opposing desires will intensify and fixate conflict rather than help the subject come to terms with them.

This will create a space for the subject to give words to these experiences and assume them, rather than push the subject to act these tendencies out. Rather than focusing on and being fascinated by the symptom itself, we must allow the subject to speak freely and not recoil from the darker side of his unconscious desire.

This will help the patient put it into words and will have a therapeutic effect on symptoms, such that they dissipate. As history shows, to focus solely on the symptom of DID leads to the invention of all kinds of techniques e. A clinical vignette from a larger study is briefly discussed. All patients receive oral and written information on the study and provide written informed consent. The author is responsible for the entire manuscript. Other contributions are mentioned in the acknowledgements.

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. I want to thank Mattias Desmet Ghent University for being an inspiring and driving force in our single case research project and for having the courage to open his own clinical work for scientific study.

I want to thank both him and Ruth Inslegers Ghent University for their support in the study of the patient presented in the clinical vignette included in this paper. American Psychiatric Association Google Scholar. Baeten, S.

Where can I go for help with dissociation and dissociative identity disorder? | PODS

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What is DISSOCIATIVE FUGUE? What does DISSOCIATIVE FUGUE mean? DISSOCIATIVE FUGUE meaning

A Clinical Introduction to Lacanian Psychoanalysis. Theory and Technique. Cambridge: Harvard University Press. Freud, S. Strachey, Vol. Gleaves, D. The sociocognitive model of dissociative identity disorder: a reexamination of the evidence. Hacking, I. Double consciousness in Britain Dissociation 4, — London: Sage, 3— Herman, J. Guidelines for treating dissociative identity disorder in adults, third revision. Trauma Dissociation 12, — Janet, P. Marseille: Lafitte reprints. Kluft, R. The phenomenology and treatment of extremely complex multiple personality disorder.

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Dissociative identity disorder and schizophrenia: Differential diagnosis and theoretical issues

Libbrecht, K. De kliniek van de meervoudige persoonlijkheid.


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Perspectieven 26, 45— Lilienfeld, S. Dissociative identity disorder and the sociocognitive model: recalling the lessons of the past. Lynn, S. Disocciation and dissociative disorders: challenging conventional wisdom. The trauma model of dissociation: inconvenient truths and stubborn fictions. McHugh, P. Multiple personality disorder. Health Newletter 10, 4—6. Merskey, H. The Analysis of Hysteria. Understanding Conversion and Dissociation. Mulhern, S. Satanism, ritual abuse, and multiple personality disorder: a sociohistorical perspective.

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Multiple personality disorder: fact or artifact? Psychiatry 10, — Schimmenti, A. Linking the overwhelming with the unbearable: developmental trauma, dissociation, and the disconnected self. Spanos, N. Multiple identity enactments and multiple personality disorder: a sociocognitive perspective. Spiegel, D.

Dissociative disorders in DSM Anxiety 28, — Vanheule, S. London: Palgrave Macmillan. Identity through a psychoanalytic looking glass. Theory Psychol. Verhaeghe, P. Keywords : dissociative identity disorder, etiology, Freudian—Lacanian psychoanalysis, hysteria, treatment. The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice.

No use, distribution or reproduction is permitted which does not comply with these terms. Children who are physically, emotionally or sexually abused are at increased risk of developing mental health disorders, such as dissociative disorders. If stress or other personal issues are affecting the way you treat your child, seek help. If your child has been abused or has experienced another traumatic event, see a doctor immediately.

Your doctor can refer you to a mental health professional who can help your child recover and adopt healthy coping skills.

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Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective

Overview Dissociative disorders are mental disorders that involve experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. References Dissociative disorders.

Arlington, Va. Accessed Oct. Dissociative disorders. National Alliance on Mental Illness. American Psychiatric Association. Merck Manuals Professional Version. Palmer BA expert opinion. Mayo Clinic, Rochester, Minn.



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