Dr.Hussein Psychology

تصدع الوعي
- dissociative symptoms seemed to have remove clusters of mental elements
fr om their conscious , awareness and willful control تحكم عنيد .

- Freud's early th eories of unconscious were base dlargely on work with

patient who appear to have ( splitting of unconsciousness ) that could be
integrated via hypnosis or psychoanalysis of the rest of the mind
in dissociative disorder the following are dissociated from rest of the mind
 memory ,
 personal identify ,
 consciousness
So that patient experience amnesia , fugue state هيام , altered personality state ,
episodes of depersonalization , these lost cluster of mental events can be
recovered quiet suddenly .

- dissociative disorder are dramatics مستمدة من االعمال الدرامية and have
received much publicity in literature , in film and on television , but mild
dissociative phenomena are normal feature of everyday life .
- for Ex, people commonly become so absorbed in reading a book that they l oss
awareness of what is happening in the environment or become lost in thought
and fail to get off bus at proper stop .
- other ex. Hypnotic trance غيبوبة ----- certain type and religious experience (
e.g speaking )


1- dissociative amnesia( sudden inability to recall important person al
inform ation ) . فقدان الذاكرة التصدعي
2- dissociative fugue ( amnesia combined with sudden travel away from
home ) التصدعي السير الغير مالوف
3- dissociative identity disorder : the presence of two or more distinct
personality withinindividual , each of which is dominant at spp time . أضطراب
الهوية التصدعية
4- depolarization disease : feeling of self -estrangement جفاء للذات or unreality
that impair social or oc cupational functionأضطراب الذات التصدعي

Dr.Hussein Psychology



 sudden inability to recall important personal
information ( eg . Name , occupation , fairly ).
 This might be amnesia for one entire life up until
moment of onset or it is amnesia for
circumscribed period of time e.g for event
surrounding car crash.
 amnesia may be selective , some events during
specific time are forgotten , whereas others are subjected to recall .
 onset of dissociative amnesia is often abrupt and follow stressful or traumatic events .
 people with diss. Amnesia usually first enter into an altered state of co nsciousness in
which they perform complex activities , may wander يتجول around and are often
confused and dissociative .
 This phase last from minute to hours followed by the awareness that they don’t
remember what has transp ir ed الذي ظهر او حصل over period of time and some time they
don’t -------

Etiology of dissociative amnesia

1- several type of traumatic like
a- life threating situation e.g war , physical abuse , sexual abuse
b- actual loss of an important person.
c-involvement in ego – dystonic - homicidal
e- suicide
f - sexual imp ulsive are all a ssociation with onset of disorder .
2- uses of repression القمع defense to banish أبعاد unacceptable or unbearable thought and
feeling from conscious

D ifferential diagnosis :

Dr.Hussein Psychology

1- Dissociative amnesia usually occur in people 30 to 40 yearsunlikeamnesia that is due to
organic mental disorder like dementia which occur later in life ( above 65 s )( gradually
growing )
2- post head injury amnesia is retrograde ( amnesia for event before trauma ) where are in
dissociative amnesia is usually anterograde for event after traumatic events .
3- diss ociative Identify disease >>> prolong and recurrent alteration of conscious
whilediss. Amnesia is single episode .


- high percentage of diss. Amnesia resolve spontaneously and no. specific treatment is
-hypnosis ----- has been useful for patient to recover lost information .
- gentle exploration will often help patient to recall diss ociative material
- psych oth erap y is impor tant to understand conflict .


 it involve amnesia combined with physical flight
usually from an intolerable situation .
 the indiv idual travelled away from home and is
unable to recall his or her previous identity .
 the phenomenon generally is short lived and
involve minimal amount of travel
 however sometime it is quite prolong and may in
the assumption of an entirely new life in another
location ( e.g amen may leave his family , move to another city , get new job , and make a
new set of friends ) .
 more often no clear identi ty replace old one .
 little known about prevalence of diss ociative Fugue but it is thought to be uncommon .
 more common among people who were exposed to major trauma such as natural
disaster or war .
 some clinician report preexisting psychopathology and history of growing up in family
may predispose to fugue .

Dr.Hussein Psychology

 many patient has separation anxiety and suicidal , homosexual impulses
 response to stressful event ---- several hours ----- several days .
 Temporal lobe epilepsy can involve diss. Experience including amnesia and travel ,
but doesn’t involve identity conf usion .
 recovery usually occur as abrupt as the onset and recurrence are rare .
 patient seldom remain in fugue state by time come to attention of physician
psychodynamics therapy may be needed to help person under of intra suicidal
dissoci ative identity disorder of formerly multiple
identity disorder
 it involve the presence within the indiv idual of two or more distinct identities , each with
its Owen unique set of memorie s , attributes and social relationship .
 each personality dominant and determines the indiv idual Behavior's at different time ,
 transmission from one person to another is often abrupt .
 e.g ----- an indiv idual m ay have one shy and inhibited personality , another that gregarious
اجتماعي and promiscuous مختلط , and the third that hostile and suspicious ,
 the personality may call themselves by different names , the personality has different
voice , mannerism تصنع وتشكيل , facial expression and handedness , they may have
different allergic and response , allergy to medication different pyscho. Test
 increase number of diagnosis of diss ociative Identity disorder due to heightened متصاعد
awareness of the disorder .
Similarity to PSTD
1. high incidence of childhood sexual and physical abuse
2. wax and wane over time .
3. 3\4 are female at middle age .
4. some are fu nction well. Other are severely impaired
- complication : including suicidal, self -mutilation تشويه ذاتي literature ( the three
faces of evil and devil )

Etiology of multiple personality disease :

Dr.Hussein Psychology

- 98% have history of childhood sexual and physical abuse
-familial association.
-trauma is transmitted from one generation to another .
-unimpaired parents are unable to protect children from abuse by others .
- many children mention abuse by their paren t >
DDX : -
1. dissociative amnesia
2. TLE ,
3. schizophrenia ,
4. malingering
- diagnosis of identity is difficult .
- patient May have var iety of somatic symptoms but not give history of multiple personality
disease .
- Rorsach test ( projective test ) is important in certain behavior or time , discovery of
objective or handwriting in patients possession .
- many patient hear voice that realize coming from their own head but that are perceived alien
غريب.hearing voice might be confused with auditory hal lucination and in DD x of
a- Temporal Lobe Epilepsy .
b- dissociative identity ------- repeated slight in indentity , but single diss. Episode .
c- malingering ------ information of friend rela tio nship are helpful .
d- PTS .
e- borderline personality disorder


psychodynamic psychotherapy is treatment of choice for different personality to ---------
 involve recurrent or persistent episode of depolarization , during which people feel
that they are detached observer of their own mental process or bodies that are
automation or they are in dream .
 patient feel that they are not in control of their action and feel ing of losing their society .
 however reality test of them remain intact e.g know ing that one is no t literally an
automation )
 the diso rder often chronic , commonly wa xing and waning according to severity of
anxiety and depression .
 episode of depolarization occur in 30% – 70 % of healthy young adult
particularly during time of stress MCQ .
-it may associat e with other disorder like schizo. , anxiety , B.P.D , TLE , DEP

Dr.Hussein Psychology

-Depersonalization is diagnosed by exclusion , screening of toxin and EEG

Treatment :

1. hypnosis ( self - hypnosis and chemical hypnosis ) .
may learnpat ient Who to def le ct يحرف او يسيطر على dep ersonalization Symptom's and
relapsing them by pleasant imaging .
2. other relaxation technique ( biological back )
3. Drugs like anti anxiety , antide pressant and ………

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