Dissociation is the splitting apart or compartmentalizing of the brain to separate mostly memories of traumatic events. This splitting is to protect the person from trauma that they are unable to deal with at the time. There are 4 main Dissociative disorders including; Dissociative Fugue, Dissociative Amnesia, Depersonalization Disorder, and Dissociative Identity Disorder (“The Cleveland Clinic”, 2005). There are many different treatments that are used for these disorders including; Psychotherapy, Psychopharmacology, Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing, Electroconvulsive Therapy, Family Therapy, Creative Therapy, and Hypnosis (“International Society, 2005).
The main goal for a person with any dissociative disorder is integration. Integration cannot always be completed, and even if it can be is not always the most desirable outcome (“International Society, 2005). However, in most cases, some integration is necessary. When a person hears the term integration, most often they associate it with integrating personalities that happens in therapy for patients with Dissociative Identity Disorder. However, integration is used in treating most dissociative disorders. Integration just means combining the separated parts of the memory.
Psychotherapy Methods
Psychotherapy is talk therapy it can include many different methods including Cognitive Behavioral Therapy. In patients with a dissociative disorder integration is usually the goal, this could happen in Psychotherapy. Integration is usually the goal after a couple of steps have been completed. These steps include; the patient achieving safety and security, decreasing symptoms, stabilizing the patient, and dealing with traumatic experiences (“International Society, 2005).
Integration is a long process that is not considered complete until the personalities have been merged and there has been no showing of them for 3 or more years. Comorbitidity is so frequent in patients with Dissociative Identity Disorder that often therapy is lengthy and requires many different approaches. Dissociative Identity Disorder is also often misdiagnosed causing the patient to sometimes be in therapy for many years. However, once diagnosed correctly, the average length of treatment is around 3-5 years and has a very positive outcome (“International Society, 2005).
Integration itself is very involved. The therapist uses techniques to integrate the compartmentalized parts of the memory. In Dissociative Fugue and Dissociative Amnesia this usually is done with Hypnotherapy and some Cognitive Therapy. In Depersonalization Disorder the outlook of therapy is not good, this may be due to lack of research in this area or also that there is not a treatment or therapy they have found that is successful with this disorder. In Dissociative Identity Disorder they use several different therapies however all are based around integration and what each personality needs to eventually integrate into one or more personalities. For Dissociative Identity Disorder, especially, the integration is meant just to get the person to a level at which they are functioning best, whether that is one or more personalities depends on the patient. It is a common misconception that the goal is to integrate into one personality(“International Society, 2005).
Integration in Dissociative Identity Disorder can be very tricky, besides aspects of comorbidity there may be certain personalities with a disorder that some of the others have or that is individual to that personality. This can make treating a patient with Dissociative Identity Disorder extremely complex, to the point that a Psychiatrist may choose to use a team of therapists specialized in different areas. For example, there might be on the team the Psychiatrist (for medication), a Cognitive Behavioral Therapist (for coping strategies, and dealing with the trauma, a Play or Creative Therapist (for either child personalities, or for art therapy), a Hypnotherapist (for hypnosis to bring forth memories of traumatic events), and even a Family Therapist (for helping the family learn about and deal with the disorder, and to help the patient learn about and deal with their past). There are many other doctors that can be brought in for different medical disorders or psychiatric disorders. The most important thing when working with a team is to make sure everyone is aware of what is going on in each aspect of therapy and treatment. Cooperation is essential to the proper treatment of Dissociative Identity Disorder.
Cognitive Therapy is mainly used to give patients, with a Dissociative Disorder, skills to cope with stress, skill building for coping with the trauma, a way to bring forth the trauma either slowly or all at once, and a way to deal with comorbid disorders. Giving patients with Dissociative Disorders coping skills for dealing with stress and trauma are important and in many cases essential to integration. This gives the patient a way to cope without blocking out memories, creating more personalities, or becoming detached from themselves emotionally and physically. There are all kinds of techniques that can be taught any physical exercise including walking and running, meditation, relaxation methods both physical and mental, reading, breathing techniques, autohypnosis, and even things like housework. Anyone of these methods can help with dealing with stress and there are several similar methods for dealing with traumatic events. Methods that are taught for dealing with traumatic events are things like grounding techniques, coping skills to help a patient stay in the present, breathing methods, and creating physical and cognitive boundaries (“Rape Crisis”).
Hypnosis Methods
Hypnosis is used for Dissociative Amnesia, Dissociative Fugue, and Dissociative Identity Disorder. The main purpose of hypnosis is to get the patient to recall memories that they have blocked. The person has to be ready for this, they have to have a lot of strength at the time hypnosis is used otherwise it can lead to recalling false memories or further dissociation because they cannot deal with the memories that are brought forth. Hypnosis takes a highly skilled therapist that is able to judge when a patient is ready to deal with these past traumas. Josef Breuer was the first one to think of using hypnosis to help a patient deal with traumatic memories. He found with his patient Anna O. that when she recalled memories of traumatic events the symptoms she had been experiencing vanished afterward (Alic,Margaret, 2007).
There is a lot of controversy over the use of hypnosis in Dissociative Identity Disorder patients. If a therapist asks leading questions, says something leading, or suggests anything whether the person is under hypnosis or not, they may have false memory syndrome. This has lead to many Psychiatrists and Psychologists disputing Dissociative Identity Disorder as a valid diagnosis. There was a surge of therapists in the 80’s that saw the success of hypnosis methods and immediately started to use the techniques without being aware of how highly suggestive the patients were under hypnosis.
Due to this surge in hypnosis without proper technique, a lot of Dissociative Identity Disorder patients had false memories. Many therapists concluded that since the patients had false memories that their personalities may have been false or fake as well. Dissociative Identity Disorder is not very prevalent, which has not helped the feeling among therapists that this disorder is invalid. If a therapist never has a patient that has Dissociative Identity Disorder it would be very easy to discount it as a valid disorder between some of the mistakes made and Hollywood dramatizing accounts of it. It is a double edged sword, on one hand if Hollywood makes a movie on something it at least gets publicized, but on the other hand the account of the disorder may not be completely accurate.
There are not any medications that have been found to work for dissociative disorders. They can use Pentothal for recalling memories either if hypnosis doesn’t work or in place of hypnosis (“International Society, 2005). Also there are many medications for the comorbid disorders that can accompany the Dissociative Disorders, such as medications for disorders like anxiety, depression, and bipolar. There may be more research in this area that uncovers medications that help, but so far there is nothing that helps with this disorder specifically.
Family Therapy Methods
Family therapy can be very important in working through Dissociative Disorders (Pais, Shobha, 2002). It is helpful for a strong support system, which is very important for people that have dealt with a traumatic experience. It can help both the patient and their family deal with and learn about the disorder and also give them coping strategies and teach them how to support each other. Family Therapy can also help the therapist and patient get another view on the patient’s past and also find out about past traumas that may have happened.
Creative Therapy Methods
Creative Therapy can be really helpful for patients that are better at expressing themselves through art rather than words. It would also help in the case of patients with Dissociative Identity Disorder that have personalities that are children. Art can help them better express themselves.
Electroconvulsive Therapy
The Mental Health field tried to use Electroconvulsive Therapy to treat patients with Dissociative Identity Disorder, however the results of this were not positive. The treatment helps with extreme depression but is used as a last resort. They found in patients with Dissociative Disorders that it may help treat the patients that also had depression however it did not help with the Dissociative Disorders and in some cases even hurt (“International Society, 2005). Electroconvulsive Therapy can cause memory loss as a side effect and with Dissociative Disorders, that have memory loss in some form as one of the major symptoms, it would just complicate these disorders.
Eye Movement Desensitization and Reprocessing
Dissociative Disorders are very linked to Post Traumatic Stress Disorder because both Disorders usually stem from a traumatic event. Eye Movement Desensitization and Reprocessing or EMDR is very successful in the treatment of Post Traumatic Stress Disorder or PTSD and because PTSD is linked to Dissociative Disorders it follows that EMDR may be successful in treating Dissociative Disorders. Researchers found that it did help with the PTSD in patients with Dissociative Disorders however ultimately without modification EMDR was detrimental to patients specifically with Dissociative Identity Disorder (“International Society, 2005). The treatment was found to cause, in some cases, more personalities to emerge, the traumatic events to be too much for the patients to handle, and even in some cases caused the patient such emotional stress that they wound up having to be hospitalized. There is research that suggests with some modification EMDR could be used successfully with Dissociative Identity Disorder, though right now there is not enough research to say for sure.
Group Therapy can be both beneficial and detrimental to patients with Dissociative Disorders. Therapists say that as long as the group is specifically the same diagnosis that the group can be helpful, however other peoples traumatic memories can be more of a detriment to the others health if they are not far enough along in recovery.
Conclusion
There is no concrete research on the success rates or outcome of patients with Dissociative Disorders. There are too few cases to be able to gather enough information. Hopefully over time researchers will be able to observe enough cases to gather information. It appears when Integration is done right and given enough time the rate of success is very high, again though with so few cases it is hard to tell. With Dissociative Amnesia and Dissociative Fugue in many cases they find that all of a sudden they spontaneously regain memory. In these cases the prognosis is extremely high. The worst outcome seems to be for patients with Depersonalization Disorder. There is not a lot of research in the area nor is there a tremendous amount of cases, hopefully with time more research will be collected.
There is much room for advancement in the field of Dissociative Disorders. With a little more of a spotlight shown on these disorders and a little more research there are huge advancments that could be made. If Hollywood and Psychologists could work together to create accurate films of Dissociative Disorders it would help in gaining publicity and creedence among the public and therefore the field of Psychology.
Integration techniques that we have today are very innovative and successful in most Dissociative Disorders. More research could still vastly improve upon these techniques and possibly add a few more therapies to use. There are great possiblities for research in the EMDR field and other fields as well. The prognosis overall for Dissociative Disorders are better than many other Psychological Disorders but there is improvement to be made in the length of therapy and other options if Integration is not successful. Every person has dissociative tendencies so shouldn’t we all be helping to find answers?
References
Alic, Margaret. (2007). Josef Breuer – Studies physiological processes, The story of Anna O. Retrieved October 20, 2007, from http://psychology.jrank.org/pages/95/Josef-Breuer.html.
International Society for Study of Dissociation. (2005). Guidelines for Treating Dissociative Identity Disorder in Adults. Retrieved October 20, 2007, from http://www.isst-d.org/education/treatmentguidelines-index.htm.
Pais, Shobha. (2002). AAMFT Consumer Update Dissociative Identity Disorder. Retrieved October 20, 2007, from http://www.aamft.org/families/Consumer_Updates/Dissociative%20Identity%20Disorder.asp.
Rape Crisis Information Pathfinder. Coping Skills for Trauma. Retrieved October 29, 2007, from http://www.ibiblio.org/rcip/copingskills.html#ground.
The Cleveland Clinic Health Information Center. (May 11, 2005). Dissociative Fugue. Retrieved October 20, 2007, from http://www.clevelandclinic.org/health/health-info/docs/3800/3825.asp?index=9790.
