Dissociative Disorder is a common mental disorder in our country. The word dissociative means dissociation. Dissociative Disorder means the emergence of consciousness-memory and identity problems (talking nonsense or as if you were a different person, not being able to speak, fainting, forgetfulness, not knowing who you are, etc.) in the individual due to various mental distress or traumatic (sad, frightening, embarrassing, anger-provoking) events.
What is Dissociative Disorder?
What are its symptoms?
What causes Dissociative Disorder?
What are the consequences?
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How is the treatment done?
What is Dissociative Disorder?
Despite all the tests and examinations performed in these patients, no brain disorder can be found that could cause these symptoms. There is a clear relationship between a history of childhood maltreatment-trauma and dissociative symptoms. It is seen in approximately 5-10% of psychiatric patients. 4 types are defined in the psychiatric classification system DSM IV: Dissociative amnesia, dissociative identity disorder, dissociative fugue, depersonalization disorder. Additionally, the ICD 10 diagnostic system also includes dissociative fainting and passing out.
What are the symptoms?
The most common symptom that causes medical attention is fainting. Symptoms may include fainting, epilepsy-like seizures, convulsions, and convulsions. Such symptoms usually occur when you are around other people; The patient falls to the ground slowly and is not injured. He can hear what is being said around him, but cannot respond, and fainting is usually long lasting. Some patients wake up by crying loudly after fainting. While he is coming to his senses, signs of exuberance such as aggressive behavior and tearing his hair or face may be observed. These seizures are also called conversion type fainting or pseudo-epileptic seizure. If the person does not remember what happened or did after this fainting, it can also be called a dissociative seizure. Other types of symptoms that can be seen in the disorder include the person suddenly remembering a certain period of time or important personal information and identity after a traumatic event. (dissociative amnesia), having personalities in which the person experiences himself as a different person with dissociative amnesia (dissociative identity disorder or multiple personality), the individual living in a different place with a different identity for a certain period of time and not remembering his old identity and information (dissociative fugue-escape).
What causes Dissociative Disorder?
The root of dissociative disorders is almost always bad events experienced in childhood. The child is very weak and helpless in the face of negative events and mistreatment by parents or older people who are much stronger than him. The only method to cope with these events is dissociation, that is, a mental state. It is a separation and separation from the environment and itself. Individuals who learn this method in childhood continue this style in adulthood. Dissociative Disorder is the way some individuals react to various psychological stresses, that is, traumas that the person cannot cope with (threat to physical integrity, beating, torture, exposure to violence, or witnessing such a situation, sexual assault and abuse, natural disasters and catastrophes, fights in interpersonal relationships). It is the way he reacts to a situation when he experiences other problems (such as an argument within the family, family problems, blaming himself or being blamed by others for an event that he does not attribute to himself, excessive fear, anxiety, regret).
Dissociative fainting. or ecstasy is a protection mechanism that allows the person to temporarily get away from intense negative emotions. Such blackouts are similar to the fuse that functions to protect electrical devices from high voltage, blowing when high voltage occurs, cutting off the electricity and shutting down the system. When the individual is exposed to intense negative emotions (anger, sadness, shame, fear, etc.) that he cannot bear while he is conscious, the person loses consciousness by "blowing a fuse" and is temporarily relieved of this intense psychological pain. Dissociative disorder is common in people who are calm, polite, do not want to upset people and cannot say no to them. Based on this, it is thought that people with dissociative disorder who cannot communicate verbally with their environment and share their problems express their problems through a change in consciousness. Symptoms of all kinds of psychological distress It may depend on the event that caused the conflict (mourning, death, argument, financial difficulty, family problems). Dissociative symptoms provide two psychological benefits: First, the person gets rid of the psychological distress that causes him problems, and indirectly, the attitude of those around him becomes more supportive and understanding is shown to him due to his illness, and the person can express some things that he cannot say in this situation. In some cases, the symptoms that occur may be related to the person's experiences, for example, a person who witnessed an event that he should not have seen may not remember this event.
What are the consequences?
Due to these symptoms, the patient may not remember the event. Although some of their problems may decrease, problems may arise in their work and family lives and their productivity may decrease. If it occurs after a difficult situation that started suddenly and temporarily, and if the person does not have another psychiatric or physical illness, the outcome is generally good. In patients who do not have any additional disease or who become dissociative due to temporary stress, if the problem disappears, the symptoms disappear on their own over time. Since people with this disorder are susceptible to suggestion, most of the disorders that are said to be cured immediately by some folk doctors or non-medical methods constitute dissociative disorders. Since these patients are susceptible to suggestion, they may respond well to hypnosis or other non-medical suggestion methods and their symptoms may disappear suddenly, but this is not permanent, and after a while the symptoms reappear due to the difficulties they experience. Symptoms may continue despite treatment in people who have been experiencing negative living conditions and difficult events for many years.
How is the treatment performed?
Those who have been thoroughly examined physically and psychologically and no neurological disease has been detected. Treatment is started after patients are diagnosed with dissociative disorder through psychiatric examination. Since the person does not have a structural disease related to the brain, its treatment is not urgent and psychiatric treatments cannot be provided in emergency room conditions. It is appropriate for these patients to be brought to the psychiatrist for treatment when they are suitable for psychiatric examination, that is, when they can express themselves by talking.
Family and close circle should only care about these people when they have dissociative symptoms. i (i.e. only when fainting, talking nonsense, becoming speechless, etc.) causes the problem to continue. For this reason, it would be beneficial for the family to show an appropriate and supportive approach to this person in general and not to show a specific change in attitude when there are dissociative symptoms.
The cooperation of the family with the doctor in the treatment is of great importance for the success of the treatment. Some people may have additional mental disorders, which must then be treated. When a person faints after a sad or distressing event and whose fainting is confirmed by doctors to be of psychological origin, faints in a family environment, it would be better for the patient to take him/her to a quiet room and leave him/her alone. Applying procedures such as making such patients smell onions, putting them in a cold shower, rubbing their hands and face with cologne, and having everyone around them gather around them will only increase their stress instead of helping them. In chronic and difficult cases, treatment focuses on two points: firstly, solving the problems that cause difficulties for the patient, and secondly, ensuring that more mature reactions are developed instead of dissociative reactions to problems. This is sometimes possible with psychotherapies that will last for years and aim at partial change in personality.
Dissociation in young people and children
Dissociative disorders are very common among young people. It is also seen in children. It is easier to treat at a young age. The most common symptoms are especially outbursts of anger, using violence at home or among friends, not remembering some of your words or behaviors and therefore appearing to lie, unexplained fluctuations in academic success, sometimes appearing to be in a good mood but sometimes getting angry and sad moods.
Behaviors such as reckless behavior in sexual matters, drug use, suicide attempt, and harming one's own body may occur. Deviation in such directions is more common, especially in cases that remain untreated. The presence of a child or young person with a dissociative condition at home is a very difficult situation for the parents and the whole family, and many parents' marriages are shaken for this reason. encountered life experiences r. These are sometimes obvious traumatic events such as being frequently beaten, being subjected to excessive criticism, sexual harassment, or being neglected. However, in most of the cases, although such events are not seen at first glance ('Apparently Normal Family'), some characteristics that create dissociative disorder are encountered in parental attitudes. Even if there are no apparent traumatic experiences, factors such as excessive pressure to be a model ('nice') child or excessive pampering can create similar negative results.
Frequent excessive arguments between parents when the child is young. There are traumatic factors that do not attract attention at first glance, but can be understood by getting to know them closely, such as the mother or father using double (contradictory) messages without realizing it in their relations with the child, secret confrontation within the family, false harmony within the family.
Dissociative Family
Some families have secrets, big or small. Some events that happen in the family are ignored. Some family members, especially parents, do not want to perceive their responsibilities in some events, because this creates a feeling of guilt. On the other hand, people hiding some facts even from themselves sometimes turns one person in the family into a scapegoat, and he/she experiences many emotions on behalf of others. For this reason, in dissociative families, one person (sometimes a child or a young person in the house) ) have mental problems while others appear normal. The psychiatrist's duty in such cases is to take the whole family into consideration and bring the individual who has to carry the patient position to a healthy state. This approach is often beneficial to both that individual and the family as a whole. Such situations are encountered more frequently, especially in child and youth psychiatry.
Psychological trauma occurs when the stress created by the events a person has been through exceeds his or her ability to withstand. Therefore, the same event may or may not have a traumatic effect on different people. In psychiatry, all mental disorders can be divided into those that are trauma-related and those that are not. While there are some known mental disorders that are largely caused by trauma, trauma may also play a secondary role in disorders that are predominantly caused by constitutional (biological-genetic) factors.<
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