Introduction
Dissociation, or splitting, is a mechanism that allows the mind to separate or subdivide specific memories or thoughts of ordinary consciousness. These forked subconscious thoughts are not erased. They can re-emerge spontaneously in consciousness. They are enlivened by so-called triggers, which can be objects and events surrounding a person during a traumatic event (Ganslev et al., 2020). Dissociative identity disorder is believed to be caused by a combination of several factors: intolerable stress, the ability to dissociate, the manifestation of defense mechanisms in ontogenesis, and – during childhood – a lack of care and participation concerning the child in a traumatic experience or lack of protection from subsequent unwanted experiences. Children are not born with a unified identity; the latter develops based on multiple sources and experiences. In critical situations, child development is hindered, and many parts of what should have been integrated into a relatively unified identity remain segregated.
This paper deals with a patient with a dissociative fugue. He complains that he may end up in a completely unfamiliar place and not remember how he got there. In this case, a person may forget some vital information about himself and not even remember his name. At the same time, the memory for some information, such as literature, science, and other things, can be preserved. In a fugue state, a person assumes a different personality and identity with a different character, manners, and behavior. While in this identity, a person can lead an outwardly everyday life. A dissociative fugue can last for several hours or several years.
Etiological Causes
Scientists have not yet found the genetic causes of dissociative personality disorder. A moderate degree of dissociation can occur due to stress; in people who have been awake for a long time, during a dental operation, or have had a minor accident. Complex forms of dissociation are observed in persons with the traumatic experience of abuse in childhood, participants in hostilities, robberies, torture, or when suffering a natural disaster or car accident. Dissociative symptoms can develop in patients with pronounced manifestations of post-traumatic stress disorder or disorders formed during somatization.
Consequently, the main etiological reasons can be identified as stressful situations that affect a person to varying degrees. The most common are childhood violence or the aftermath of war. North American studies show that 95-96% of adults with dissociative identity disorder describe childhood abuse situations and that abuse can be documented in more than 80% of adults and 94% of children and adolescents with multiple personality disorder and other similar forms of dissociative disorder (Ganslev et al., 2020). These data indicate that childhood abuse is the leading cause of the disorder in North American patients, while the effects of war or natural disasters may play a significant role in other cultures. Some patients may not have experienced violence but may have experienced early loss, serious illness, or another extremely stressful event.
Symptoms
The patient immediately confirmed one of the main symptoms – the inability to periodically remember how and why someone got to a particular place. Therefore, one of the first signs of this disease is memory impairment. Moreover, the patients may suddenly speak in a completely different voice; they may have different handwriting. For example, a child’s personality may suddenly start writing in childish handwriting.
Loss of personal identity is a direct symptom of dissociative disorder. Violation of self-perception, a feeling of detachment from oneself and one’s emotions, begins to manifest itself as other personalities develop. A person who has a dissociative disorder suffers greatly from their condition. At the moment of a dissociative state, the patient does not have the opportunity to critically look at himself and his behavior (Sun et al., 2019). In fact, in a situation where one of the alternative personalities appears, he is in an inadequate state.
Stress in this situation can lead to a decrease in motor functions, up to paralysis. These disorders result in tremors, walking disorders, loss of balance, and dysphagia. Numbness of body parts, slurred speech, decreased vision or even hearing, often associated with psychogenic conditions, including self-harm, suicidal ideation, and substance use, make life and treatment difficult for the patient (Sun et al., 2019). Given that these actions are uncontrollable by the patient himself, it is necessary to monitor their condition and actions.
Treatment
Treatment of a diagnosed dissociative disorder must be started immediately; this is the key to complete recovery. It first focuses on relieving symptoms, then reducing and eliminating stressors and preventing relapse. Treatment varies according to the type of dissociative disorder but usually includes only proven psychotherapy with a psychotherapist. There is no cure for a dissociative disorder; therefore, pharmacotherapy in these cases aims only to eliminate the symptoms of concomitant conditions, such as anxiety, depression, and panic attacks (Swart et al., 2020). Cognitive-behavioral therapy and dialectical behavioral therapy are two of the most effective psychotherapy methods for dissociative or conversion disorders.
If a child suffers from this disease, then specialists carry out separate work with his parents and provide them with methods of proper communication to improve the results of his treatment. If one does not treat dissociative personality disorder but lets the disease take its course, then in the case of multiple personalities, a person in an inadequate state may commit some extremely negative actions concerning others, for example, violent ones. In the case of a dissociative fugue, patients may get lost and never return home – it will simply be impossible to find them.
References
Ganslev, C. A., Storebø, O. J., Callesen, H. E., Ruddy, R., & Søgaard, U. (2020). Psychosocial interventions for conversion and dissociative disorders in adults. Cochrane Database of Systematic Reviews, (7). Web.
Sun, P., AlvarezâJimenez, M., Lawrence, K., Simpson, K., Peach, N., & Bendall, S. (2019). Investigating the prevalence of dissociative disorders and severe dissociative symptoms in first episode psychosis. Early Intervention in Psychiatry, 13(6), 1366-1372. Web.
Swart, S., Wildschut, M., Draijer, N., Langeland, W., & Smit, J. H. (2020). Dissociative subtype of posttraumatic stress disorder or PTSD with comorbid dissociative disorders: Comparative evaluation of clinical profiles. Psychological Trauma: Theory, Research, Practice, and Policy, 12(1), 38. Web.