[Dissociative Disorders]

DR. AMY WENZEL: A dissociative disorderis a disorder [Amy Wenzel, PhD, ABPP, Clinical AssistantProfessor of Psychiatry, Perelman School of Medicine,University of Pennsylvania] in which the person loses touchwith or escapes from reality.Examples would be dissociative amnesia,when a person might forget who he or she isor forget where he or she is from for a period of time.Another example is dissociative identity disorder,or what used to be called multiple personality disorder.

DR. AMY WENZEL [continued]: The causes are not entirely clear.There are a couple of things that we oftentimessee associated with dissociative disorder.One is a history of very, very severe trauma.So an experience like repeated childhood sexual abuseis something we often see people whoclaim to be suffering with dissociative identity disorder.

DR. AMY WENZEL [continued]: And the idea there was that the personis experiencing such pain, such trauma that the only escapefrom that is to retreat within the selfin order to avoid that or not fully experience it.I could give one particular examplethat diagnosis of dissociative identity disorderis actually quite controversial.

DR. AMY WENZEL [continued]: I did see one patient in my time whosaid that she was experiencing multiple personalities.This was actually somebody I saw in graduate school,so I certainly was not savvy in terms of the diagnosisor the treatment of this particular condition.She had told me that she had 42 personalitiesand that there is a 43rd that had been being integrated

DR. AMY WENZEL [continued]: with a previous therapist.I do have to say that my supervisor wasvery skeptical that this was the casewith this particular patient.The lore out there is that when people change personalities,it can seem pretty distinct, wherethey take on different tones of voiceor different manners of speaking.That wasn't the case with my particular patient.

DR. AMY WENZEL [continued]: In fact, she actually indicated that shewas switching all the time, but it certainlywasn't visible to me.What that did bring up in this particular clinical case--and there's certainly been scholarly discourse about thisas well-- is that there are other factors thatare important to consider in a diagnosisof dissociative identity disorder.One, certainly, would be the secondary gainthat a person would get from carrying

DR. AMY WENZEL [continued]: such a severe diagnosis.That might then give them, say, disability or relieve themfrom certain responsibilities in their lives.Our hypothesis about this patientwas that either she truly had dissociative identity disorder,or she perceived that she did and that these were just

DR. AMY WENZEL [continued]: aspects of her personality that she was experiencing,but she was labeling them as distinct individuals.Unfortunately, I only worked with her for a few sessionsbefore she actually had left townand sought treatment from another therapist.But it just goes to show that they are very few and farbetween, but there are a lot of factorsto consider when a person presents with a dissociation.

DR. AMY WENZEL [continued]: The other thing I should say is that there is a scale outthere called the Dissociative Experiences Scale, whichlooks at people's tendencies to experiencedissociation-like phenomenon.And my sense of the research with the use of that scaleis that dissociation is really on a continuum.And so it's not like a person either has a disorderor doesn't have a disorder.

DR. AMY WENZEL [continued]: But dissociation is something that some people do experienceat various points in their lives, another illustrationthat mental health disorders are not necessarilyjust pigeonholed into a category of having itor not, but that we all experiencesome degree of the symptoms or experiences on occasionin our lives.