This is the 2007 version. Click here for the 2017 chapter 12 table of contents.

Dissociative Disorders

Dissociative states involve a dis-association or split in awareness between the normal conscious mind and other thought processes. Dissociative states range from mild to extreme, from normal to seriously disruptive.

What are examples of "normal" dissociative states?

An example of a normal dissociative state is carrying out a simple motor task absent-mindedly. The task can be anything from knitting to picking peas to driving. Most people have experienced the phenomenon of "driving on autopilot" for a period of time. When you "snap out of it," you realize you do not remember the preceding miles. Typically a driver will snap to awareness if anything unusual happens. For example, if you glimpsed a flashing light by the side of the road, your attention would immediately return to driving.

Automatic actions such as driving on autopilot are common when highly practiced motor skills are involved. For example, people who work on an assembly line can let the mind wander while performing a routine task. For similar reasons, you can walk into a room, then snap out of it and wonder why you went there. As discussed in Chapter 7 (Cognition), the act of walking is so well practiced (overlearned) that you can do it without thinking. You program yourself to walk to another room, then your mind wanders, and when you get there you no longer remember why you started the motor program.

"Letting your mind wander" is fine if you are performing a routine task. But if your mind wanders when you need to be oriented to reality, or if your body wanders when you are asleep, there is a category for you in DSM-IV.

Perhaps the most common dissociative state listed in DSM-IV is sleepwalking Ironically, it is not even categorized as a dissociative state in DSM-IV; it is listed under a separate section for Sleep Disorders. However, sleepwalking meets three criteria of a dissociative state: (1) It is intelligent activity (sleepwalkers avoid obstacles, walk up and down stairs, open doors) (2) The person's normal awareness is absent or distracted (in fact, sleepwalkers are usually dreaming about something unrelated to the sleepwalk) (3) The individual has amnesia for the event later (sleepwalkers seldom remember the sleepwalk).

What are characteristics of dissociative fugue states?

More rare than sleepwalking is the dissociative fugue state—a temporary episode of automatic action followed by complete amnesia for the time of the activity. It is often associated with epilepsy and may be set off by seizure activity. Like seizures themselves, fugue states are triggered by stress.

What fugue state did Rice and Fisher report?

Rice and Fisher (1976) reported a case in which a young man had fugue states lasting from minutes to hours that occurred every day. He also had a history of seizures.

The patient remembers walking down the stairway of his residence... and the next thing he knew he was on the eighth floor of a hospital about 5 miles from his home. He must have walked the entire distance as he had no money with him. By coincidence, an acquaintance saw him there and asked him whom he was visiting. The patient suddenly emerged from his fugue, felt very embarrassed, made up some trivial excuse for being there, and walked back home. The father had been a patient in this hospital and on that floor at the time of his death. (p.165)

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