Dissociative Disorders - Clinical Manifestation and Management

Abstract

Dissociative disorders are heterogeneous group of mental disorders with dissociation as dominant symptoms. Dissociation is often defined as partial or total disconnection between memories of the past, awareness of identity and of immediate sensations, and control of bodily movements, often resulting from traumatic experiences, intolerable problems, or disturbed relationships. Etiopatogenezis of dissociative disorders have not exactly known yet. The process of dissociation is independently associated with several distressing conditions such as psychiatric diagnoses, somatization, current psychological distress, and past sexual and physical victimization. The disturbance may have a sudden or gradual onset and may be temporary or chronic in its course. Dissociation has a negative impact on treatment oucome. Additionaly, dissociative patients may have an insecure attachment pattern negatively affecting the therapeutic relationship. Conceptually, the course of treatment is to improve coping, maintain reality, and establish normal integrative functions. Goals:

1. 1. improve thought processes;

2. 2. maintain a sense of reality;

3. 3. improve coping skills;

4. 4. develop stress management abilities;

5. 5. increase identity integration.

The treatment is possible with psychotherapy or pharmacotherapy or both. We will introduce the CBT approach. Participants will learn:

• • pharmacological possibilities in the treatment of dissociative disorders;

• • CBT model of dissociative disorders;

• • motivational interviewing with dissociative patient;

• • how to develope therapeutic relationship with dissociative patient;

• • conceptualization of dissociative disorder with the patient;

• • Socratic questioning;

• • working with cognitive, emotional and behavioral avoidance;

• • exposure technique with dissociative problems;

• • problem solving.

Supported by the research project IGA NR 9323-3.