The Trauma-Stressor and Dissociative Disorders Project

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Hello and welcome to the Trauma and Dissociation Project. Here we do our best to present the most accurate information on the Dissociative Disorders and the Trauma and Stressor-Related Disorders. You can find old information just about anywhere, but few projects will strive to read and understand massive amounts of information and stay abreast of the most current research in the world of neurology, biology, psychology and other related sciences. This project will focus on quality, rather than quantity. We have a narrow focus here and the idea is to use this space to explain our topic well, rather than to include pages that are not highly relevant to the Trauma-Stressor Related Disorders and the Dissociative Disorders. We invite you to contribute your knowledge. Thank you

Dissociative Disorders

The Dissociative Disorders (DD) in the DSM-5 include 300.14 dissociative identity disorder (DID), 300.12 dissociative amnesia (DA), 300.6 depersonalization disorder (including derealization) (DPD), 300.15 other specified dissociative disorder (OSDD), 300.15 and unspecified dissociative disorder (UDD).

Trauma and Stressor-Related Disorders

The Trauma and Stressor-Related Disorders in the DSM-5 include 313.89 reactive attachment disorder (RAD), 313.89 disinhibited social engagement disorder, 309.81 posttraumatic stress disorder (PTSD), 308.3 acute stress disorder (ASD). The adjustment disorders include 309.89 other specified trauma and stressor-related disorder and 309.9 unspecified trauma and stressor-related disorder.

Structural Dissociation of the Personality

Structural Dissociation of the Personality occurs at the point when an individual is overwhelmed due to unprocessed trauma that has not been fully integrated into narrative memory. The following are disorders that fall within the boundaries of Structural Dissociation of the Personality: acute stress disorder (ASD), posttraumatic stress disorder (PTSD) with, and without the dissociative aspects of depersonalization and derealization. The authors of the theory use the term complex-posttraumatic stress disorder (C-PTSD) for PTSD with two or more less than distinct states making up the personality. Also included within the scope of Structural Dissociation are the complex Dissociative Disorders: other specified dissociative disorder (OSDD) and dissociative identity disorder (DID). All of these disorders: acute stress disorder (ASD), posttraumatic stress disorder (PTSD), other specified dissociative disorder OSDD), and dissociative identity disorder (DID) are caused by Structural Dissociation of the Personality. Borderline personality disorder (BPD) is not, but after the condition already exists then Structural Dissociation can take place adding dissociative symptoms to the disorder.

See the page on Structural Dissociation for referenced and more detailed information.

What you are looking at in the left image is a minute section of a fMRI scan showing activity as a switch results in one distinct state (ANP) switching with another distinct state (ANP). The images catches the leaving distinct state (ANP) before it fully exits consciousness, which is a process that is only possible in dissociative identity disorder (DID). In other specified dissociative disorder (OSDD) only one distinct state exists, and so obviously a switching of distinct states will never be seen on an fMRI. In both dissociative identity disorder (DID) and other specified dissociative disorder (OSDD) there will be at least two, and usually several - less than distinct states (EP) switching with each other. In posttraumatic stress disorder (PTSD) there is only one less than distinct state (EP) and only one distinct state (ANP), and both states will remain lit up until something triggers the less than distinct state (EP), and then the distinct state (ANP) is no longer visible. That trigger resulted in some sort of reaction (flashback for example) to their unprocessed memories. When an individual has posttraumatic stress disorder (PTSD), with the dissociative symptoms of depersonalization and derealization, then there is always two less than distinct states (EP), which can be identified on an fMRI scan, but both will not always be visible together. The authors of the theory of Structural Dissociation call this form of PTSD, complex-posttraumatic stress disorder (C-PTSD). Borderline personality disorder is an odd ball in this bunch because the disorder is not caused by Structural Dissociation, but after the disorder already exists, the individual with BPD can be overwhelmed by trauma memories resulting in Structural Dissociation and then they will have dissociative symptoms. On their fMRI scans we see one distinct state (ANP) and one less than distinct state (EP), but the distinct state (ANP) is the only part visible until the individual is in distress, and then the less than distinct state (EP) shows up. This state will not take over as is seen in posttraumatic stress disorder (PTSD) and so there are no flashbacks or similar symptoms, but instead are the dissociative symptoms of derealization and depersonalization. Go to links for the referenced information.

Differences between DID, OSDD, C-PTSD, PTSD, BPD and between MPD and DID and DDNOS and OSDD

Other specified dissociative disorder (OSDD) is not the same thing as the now defunct description of dissociative disorder not otherwise specified (DDNOS), a category which was in the DSM-IV. The DSM-5, published late in 2013, offers criteria that finally simplify the diagnosis of other specified dissociative disorder and dissociative identity disorder, but to understand how clear the new criteria make diagnosis, one must understand what a distinct state and a less than distinct state ("discontinuities in sense of self and agency") are. In dissociative identity disorder, distinct states switch with one another, so anyone with only one distinct state does not meet the criteria for dissociative identity disorder. The other disorders that fall under the umbrella of Structural Dissociation will have one distinct state and a varied number of less than distinct states. The less than distinct states are "discontinuities in sense of self and agency." Dissociative identity disorder has two more less than distinct states in addition to two or more distinct states. Other specified dissociative disorder has one distinct state and two or more less than distinct states. Posttraumatic stress disorder has one distinct state and one less than distinct state. Complex-posttraumatic stress disorder (in the DSM-5, it's most similar to PTSD with derealization and depersonalization), has one distinct state and two less than distinct states. Borderline personality disorder, if it has resulted in Structural Dissociation (which would mean the person was overwhelmed due to unprocessed trauma memories after already having the disorder) will have one distinct state and one less than distinct state.

See the categories on Structural Dissociation, dissociative identity disorder, other specified dissociative disorder and the DSM for referenced and more detailed information.

Dissociative boundariesA dissociative boundary separates dissociated states. <ref name=Spiegel2011/> <ref name=DSMIV/> <ref name=DSM5Deskref/> {{See also | Amnesia}}

All Dissociative Disorders have dissociative boundaries associated with the states, and those boundaries are highly responsible for how states act and react. The boundaries associated with the distinct states in dissociative identity disorder are highly complex including the chemical, neurological and the physical makeup of them. They contain, replicate, and isolate most things including memory. They are unyielding in their phobia of each other until a great deal of therapeutic work has been done. This also occurs, but to a lesser extent in other disorders than result from Structural Dissociation. Overtime many individuals with Dissociative Disorders process their trauma memories and break down the dissociative boundaries, and increase communication between states. This is called the integration process. When all states can freely communicate with each other then the term unification is more appropriate. This process of integration is what all the Dissociative Disorders have in common. It is what they have yet been unable to complete in their life-time. The dissociative boundaries of the less than distinct states in other specified dissociative disorder and dissociative identity disorder, and all other disorders that have them, differ from each other in their chemistry, neuronal and physical makeup.

See the categories on Structural Dissociation, dissociative identity disorder, other specified dissociative disorder and the DSM for referenced and more detailed information.

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DSM-5 Category: Dissociative Disorders

The DSM-5, was released May, 2013 and the DSM-5 committees have settled on the following categories:

  • Dissociative identity disorder (DID)
  • Dissociative amnesia (DA), with or without dissociative fuguepsychogenic fugueA temporary loss of personal identity due to trauma, reclassified as dissociative amnesia within the DSM-5. Dissociative amnesia includes dissociative fugue as a subtype, since fugue is a rare disorder that always involves amnesia, but does not always include confused wandering or loss of personality identity. <ref name=DSMIV/> <ref name=DSM5Deskref/> <ref name=Spiegel2013/>Dissociative amnesia (DA) was previously called psychogenic amnesia is a form of temporary amnesia that presents often in traumatic situations; for example in car accidents or victim or witness of a violent crime. Dissociative Amnesia is described in the DSM as a disorder that causes significant distress or impairment in functioning, such as when a person cannot remember significant events that happened to them. <ref name=ISSTD.org/> (DF)
  • Depersonalization/derealization disorder
  • Other specified dissociative disorder (OSDD)
  • Unspecified dissociative disorder (UDD)

DSM-5 Category: Trauma and Stressor-Related Disorders

The Trauma and Stressor-Related Disorders are:

Note: Complex posttraumatic stress disorder is a term not included in the DSM-5, but the DSM-5 PTSD category does have a couple of "dissociative" specifiers. The term complex-PTSD implies an etiology of childhood trauma and is being considered for inclusion in the ICD-11 manual.

Table of contents

The Masks of DID represents the normal face presented to the world; behind the mask are the states who struggle in many ways. This is how DID is. The distinct states face normal life tasks, while the less than distinct states live in a world of trauma memories. The demons represent the shame and other issues felt by the individual; the lightning strikes attacks the personality. The train carries normal people toward paradise while the mentally ill person looks on, stuck in a nightmare. By Jeffsong

Child abuse and the Trauma and Dissociation Project

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Child abusers can go to great length to hide emotional, physical and sexual abuse which they enact upon the young and innocent, which along with the mental disorders the victims endure cause them to question their own history, but the fact remains that child abuse is common, and is a hidden epidemic. In addition, abused individuals suffer shame, and often blame themselves for the acts perpetuated upon them.

This page is an introduction, see the following pages for more information: Structural Dissociation, other specified dissociative disorder, and dissociative identity disorder.

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Dissociative Identity Disorder.org is a multi-authored peer written site, reviewed by a health care professional.

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Transitory has donated the time and knowledge to create this work space. Thank you Transitory!

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