You want to know about dissociative disorders for your exam. So, let’s do an overview here.
Consider this case example throughout our discussion of dissociative disorders. “A 28-year-old
woman was brought to the emergency department for an evaluation after police found her at a
local clothing store selecting outfits for customers. The woman said she worked there but the
store manager denied this. The woman was not able to tell officers her name, date of birth, or
address. They gleaned some information only after looking through her wallet and finding her
driver’s license. The woman, who is apparently named Alice, had a home address that was over
300 miles away from the store. The police brought her to the emergency department sensing
something was wrong and in the hospital Alice would only talk about her nephew’s 10th birthday
party that had been months before.” So what would you do next in the emergency department to
assess Alice? Well, first and foremost you want to create a comfortable atmosphere where she
feels safe and start to develop that ever important therapeutic alliance. Explore her history
further by gathering as much information from her as possible. Consider calling someone she
knows for collateral information. Ask for her permission to reach out to someone and ask her
for a phone number of a close family member or friend. Also complete a physical exam along
with cognitive screening, a mental status exam and also a mini-mental status exam. Rule out
any general medical problems that could potentially be happening here. Do this through your
physical exam obtaining baseline blood work and consider head imaging as well and do a neurological
exam to see if there is any reason why she is not recalling important information about herself.
Consider getting a neurology consult involved. This can help to tease out exactly whether or
not the root cause of what’s happening with her memory disturbance is in fact a brain or
neurological problem. So, what is dissociation? This is defined as loss of memory, identity, or
one’s sense of self. But what is the self? Well, it’s a unique identity that we all have: one that
is comprised of our individual thoughts, behaviors, feelings and memories. There are different
types of dissociative disorders. There’s dissociative amnesia, dissociative fugue, dissociative
identity disorder and also depersonalization/derealization disorder. Dissociative disorders are
primary disorders. Unlike amnestic disorders, important to know they are never due to an
underlying general medical condition or substance abuse so you must rule those out before
diagnosing someone with a dissociative disorder. The onset of a dissociative episode is usually
precipitated by a very stressful life event or significant personal problem. Dissociative disorders
are frequently associated with a history of childhood abuse, adult trauma, substance abuse
and also major mood disorders. That’s an overview about dissociation and we’re going to review
some of the types and a lot more detail. So keep in mind that sense of self and also what it
means to dissociate as we move forward.