What Are the Symptoms of Dissociative Disorder?

Separation disorder, also called separation (transition) disorder, was once called hysteria or hysterics. Dissociative disorder is a type of mental disorder caused by mental factors acting on susceptible individuals. Some patients show dissociative symptoms, and other patients show various forms of physical symptoms. Their symptoms and signs do not conform to the physiological and anatomical characteristics of the nervous system, and they lack the pathological basis of organic damage. These symptoms are considered to be a symbolic shift in internal conflicts and desires that patients cannot resolve.

Basic Information

nickname

Separation (transition) disorder, hysteria, hysterics

English name

Dissociative disorder

Visiting department

Clinical Psychology

Common causes

Suggestive, performative, self-centered, emotional, fantasy, etc. Closed homologous cultural environment, multi-factor inheritance

Common symptoms

Loss of recent stage memory, little or no response to external stimuli, after which the patient completely or partially forgets the process, etc.

Causes of dissociation disorder

Psychological factor

The individual's experience and response to stressful life events are important factors that trigger the disease. Traumatic experiences in childhood may also be an important cause of separation and transition disorders in adulthood. Patients with this disorder often have some common personality traits, including: suggestive, performative, self-centered, emotional, and fantasy.

2. Socio-cultural factors

Patients with this disease have a relatively low level of education and mostly live in a closed homologous cultural environment. Therefore, education, social culture, and living environment play an important role in the occurrence of separation and transformation obstacles.

3. Biological factors

The current genetics of segregation and conversion disorders are inconsistent. Some studies have found higher rates of first-degree relatives in patients with segregation and conversion disorders. But some studies have reached the opposite conclusion. Some scholars believe that this disease is a multifactorial genetic disease.

Clinical manifestations of separation disorder

1. Common clinical manifestations

(1) Dissociative forgetting Appears as the sudden appearance of being unable to recall important things, which is characterized by the loss of recent stage memory, which can be partial and selective, and generally surrounds traumatic events. This forgetting is not caused by organic causes, nor can it be explained by ordinary forgetfulness or fatigue.

(2) Separated roaming refers to the sudden departure of a patient from home or work place in an awake state, often leaving an intolerable environment for unplanned and purposeless roaming. At this time, the patient's scope of consciousness is reduced, but he can carry out basic daily life and simple social contact. Some patients forget their past experiences and appear in a new identity. Roaming can last from tens of minutes to days, and some can last longer. Sudden sudden onset of this attack, the patient can not fully recall the experience of the disease after awake.

(3) Separated wood stiffness The patient's behavior meets the criteria of wood stiffness, and no evidence of physical disease can be found on examination. Usually after a certain life event, the patient maintains a fixed posture for a long period of time, has little or no response to external stimuli, and has no or little speech and spontaneous purposeful movement. However, the patient's muscle tone and breathing movements are present, and sometimes there may be coordinated movements of eyes opening and eyeballs.

(4) Precariousness and Appendage Disorder This symptom manifests as a temporary loss of personal identity and complete awareness of the surrounding environment. The patient's range of consciousness is significantly reduced. Attention and consciousness are limited or focused on one or two aspects of the environment in close contact, and only respond to individual stimuli in the environment. There are often limited and repeated series of movements, postures, and pronunciations. If the patient's identity is replaced by a ghost, god, or dead person, it is called detached appendage disorder. After the episode, the patient forgot all or part of the procedure.

(5) Dissociated dyskinesias manifested as loss of all or part of the motor capacity of one or more limbs. Common forms include limb paralysis, limb tremor or myoclonus, inability to stand or walk, and aphonia. Paralysis can be partial, with reduced or slow movements; it can also be complete. Ataxia can be in various forms and to varying degrees, especially in the legs, which can cause bizarre postures or stand up without assistance. There may also be exaggerated tremor on one or more extremities or the whole body.

(6) Separation convulsions Separation convulsions (pseudoepileptic seizures) are a state similar to seizures, but without the clinical features and electrophysiological changes of the epilepsy. Tongue biting, severe falls, urinary incontinence, etc. are manifested in dissociation It is rare in convulsions, and there is no loss of consciousness, and it is replaced by rigidity or imagination.

(7) Separation sensory disorder can be manifested as physical numbness, loss, allergy or abnormality, or other special sensory disorders. The boundaries of the numb area of the skin indicate that it is closer to the patient's concept of physical function, and is incompatible with neuroanatomy. Sensory loss can be accompanied by complaints of paresthesia.

Visual impairment is often manifested as loss of visual acuity, blurred vision, or "tubular vision." It often occurs suddenly, but can also return to normal suddenly after treatment. Although the patient has the main complaint of vision loss, he still surprisingly retains his entire mobility and athletic performance intact. Hearing impairment is usually manifested as sudden hearing loss, and related hearing function tests are usually normal.

"Symptoms" are subjectively unclear things or clumps that cause discomfort such as fullness, compression or obstruction at the level of the circular cartilage at the base of the pharynx. TCM is called "mei qi". Relevant medical examinations cannot find organic abnormalities that match the symptoms.

(8) Other disorders of separation and conversion Ganser syndrome is a special type of separation and conversion disorder, which is more common in detained prisoners. It is characterized by being able to understand questions, but often gives "approximate answers", often accompanied by several other dissociative symptoms, and the background of its occurrence suggests psychological reasons. Multiple personality disorder, also known as dissociative identity disorder, manifests as the same individual has two or more completely different personalities, but at one time, only one of them is obvious. Each personality is complete, has its own memory, behavior, and preferences, and can be completely opposed to a single pre-ill personality. The relatively common form is dual personality, usually one of which is dominant, but neither personality enters the memory of the other, and the existence of the other is almost unconscious. The transition from one personality to another is usually abrupt at the beginning and is closely related to traumatic events; thereafter, generally only when encountering large or stressful events, or receiving treatment such as relaxation, hypnosis or venting Before conversion occurs.

(9) Mixed type barriers to separation and conversion Refer to the mixed form of the above-mentioned various forms of barriers to separation and conversion.

2. Special manifestation

(1) Collective segregation disorder , which is a collective outbreak of segregation disorder , mostly occurs in areas with relatively backward economic culture and feudal superstition activities. At first, the onset was one person, and the surrounding people were exposed to symptoms similar to those of the first patient in a short period of time through self-suggestion and mutual suggestion. These patients often share common life backgrounds and cultural concepts, with the majority being women.

(2) Compensatory neurosis Refers to victims who show, exaggerate, or retain symptoms in compensation-related incidents such as work injuries, traffic accidents, and medical disputes. Symptoms can last for a long time. However, the persistence of this symptom may be caused by the patient's subconscious mechanism rather than the patient's intention.

(3) Occupational neurosis refers to the patient's symptoms that are closely related to his professional activities, mainly manifested as movement coordination disorders, such as writing cramps for writing workers, inability to perform lower limb movements before dancers perform, and teachers losing their voices before the podium.

(4) Dissociative disorder psychosis Suddenly onset after a stress event, manifested as blurred consciousness, roaming, behavioral disturbances, and recurring fantasy sexual life plots, which can be fragmented and delusional. Patients are generally indifferent or do not consider themselves ill. The course of the disease usually lasts for several weeks, often sudden abrupt, and easy to relapse.

Diagnosis of dissociative disorder

The following points must be confirmed:

1. The clinical characteristics of any type of separation disorder;

2. There is no evidence of a physical disorder that could explain the symptoms;

3. Evidence of mental illness, with a clear association in time with the relationship to a stressful event, problem, or disorder (even if the patient denies this).

Differential diagnosis of dissociative disorder

Acute stress disorder

The occurrence and development of this disease are closely related to mental stimuli, and they occur immediately after a strong stress event. The symptoms are related to the stress event and there is no history of recurrent attacks, so it can be identified.

2. Schizophrenia

The emotional outbreaks and behavioral disorders of dissociative disorders are easy to confuse with acute adolescent schizophrenia, but schizophrenia often manifests as uncoordinated affective disorders, sensory disturbances, and mental disorders, so they can be identified.

3. Seizures

Separation convulsions have similar aspects to the clinical manifestations of seizures, but seizures are consciously lost, often with falls, bites of the tongue, incontinence, and abnormal EEG.

4. Organic diseases

Organic diseases such as blindness, deafness, and sensory disorders can be found and explained according to relevant physical examinations and laboratory examinations in accordance with somatic anatomy.

5. Fraud

It means that in order to achieve a certain purpose, subjective deliberate "no illness pretending to be sick" or "exaggerating the original illness" often occurs suddenly, and subjective desire determines whether symptoms disappear or not. Once the symptoms of separation disorder occur, it is beyond the control of subjective will.

Dissociative Disorder Treatment

Patients with dissociative disorder should complete the relevant necessary examinations as soon as possible to determine that they have no organic damage, establish a good doctor-patient alliance in the treatment, and the treatment should be based on psychological treatment.

Psychotherapy

(1) Individual psychotherapy is applicable to almost all patients with separation disorder. On the basis of establishing a good doctor-patient alliance, understand and understand the patient's personal growth history, family relationships, personality characteristics, etc., empathize with the patient's emotions, give certain support, and explore the cause and process of the disease with the patient. Do not blindly excavate the childhood trauma of the patient without corresponding empathy and support, so as to cause secondary harm to the patient.

(2) Suggestive treatment can be used in patients with acute onset and high suggestiveness. Simply explain to the patient at the beginning of the treatment that the disease is a transient neurological dysfunction, which can be gradually recovered or even cured through the upcoming treatment. Patients with motor and sensory disorders can be treated with 10% calcium gluconate intravenously with verbal cues. Hypnotic therapy can also be used to put patients into a hypnotic state, combined with language cues to eliminate symptoms.

(3) Systematic desensitization treatment first allows the patient to talk about the mental factors related to the onset, and then relaxes the patient, gradually exposing the patient to the mental factors that induce symptoms, and the patient gradually experiences the ability to withstand the stress caused by these mental factors Anxiety does not occur, and then gradually increases the exposure dose.

2. Drug treatment

Clinically found that patients with separation and conversion disorder often have symptoms such as anxiety, depression, insomnia, and pain. Drug therapy can treat these symptoms, thereby improving the patient's mood and reducing the patient's physical discomfort. Selective serotonin reuptake inhibitors can be used to improve mood, and benzodiazepines can reduce anxiety and improve sleep.

Separation disorder prevention

Separation disorder is a disease that is prone to recurrence. Therefore, psychological education of the patient, timely elimination of the cause, improvement of the patient's interpersonal relationship, and change of some unfavorable personality characteristics can help prevent disease recurrence.