INTRODUCTON

Normally speaking, we know who we are. We may not be certain of ourselves in an existential,
philosophical sense, but we know our names, where we live, and what we do for a living. We also tend
to remember the salient events of our lives. We may not recall every detail, and we may confuse what
we had for dinner on Tuesday with what we had on Monday, but we generally know what we have been
doing for the past days,weeks, and years. Normally speaking, there is a unity to consciousness that
gives rise to a sense of self. We perceive ourselves as progressing through space and time. In people
with dissociative disorders, one or more of these aspects of daily living is disturbed sometimes
bizarrely.

To understand about the dissociation disorder it is foremost to learn about the continuum of self-
concept responses.

Self concept
A positive self-concept implies that the person expects to be successful in life. It includes acceptance of
the negative aspects of the self as part of one's personality. Such a person faces life openly and
realistically
.
Low self-esteem
Low self-esteem is a major problem for many people and can be expressed in moderate and severe
levels of anxiety. It involves negative self-evaluations and is associated with feelings of being weak,
helpless, hopeless, frightened, vulnerable, fragile, incomplete, worthless, and inadequate.
Low self-esteem is a major component of depression. It may indicate self-rejection and selfhate, which
may be a conscious or unconscious process expressed in direct or indirect ways.

Identity diffusion
Identity diffusion is the failure to integrate various childhood identifications into a harmonious adult
psychosocial identity. Important behaviors that relate to identity diffusion include disruptions in
relationships or problems of intimacy. The initial behavior may be withdrawal or distancing. A person
who is experiencing an undefined identity may wish to ignore or destroy threatening people. The
problem is one of gaining intimacy, but it is reflected in isolation, denial, and withdrawal from others.

Dissociation
A more maladaptive response to problems in identity is the withdrawal from reality that occurs when a
person experiences panic levels of anxiety. This panic state produces a blocking off of awareness, a
collapse in reality testing, and feelings of dissociation and depersonalization. Dissociation is a state of
acute mental decompensation in which certain thoughts, emotions, sensations, or memories are
compartmentalized because they are too overwhelming for the conscious mind to integrate (Weber,
2007). In severe forms of dissociation, disconnection occurs in the usually integrated functions of
consciousness, memory, identity, or perception.

Depersonalization
Depersonalization is the subjective experience of the partial or total disruption of one's ego andthe
disintegration and disorgani zation of one's self-concept. It is a feeling of unreality in which one is
unable to distinguish between inner and outer stimuli. In essence it is a true alienation from oneself.
The person has great difficulty distinguishing self from others, and one's body has an unreal or strange
quality.

TYPES OF DISSOCIATION
 Amnesia
 Derealisation
 Depersonalization
 Identity confusion
 Identity alteration

Amnesia
Amnesia derives from the Greek roots a-,mean-ing “not,” and mnasthai,meaning “to remember.
Amnesia refers to the inability to recall important personal information that is so extensive that it is not
due to ordinary forgetfulness, or when you can’t remember incidents or experiences that happened at a
particular time.        (Maldonado et al., 2002)     
      
Depersonalization: A feeling that your body is unreal, changing or dissolving. It also includes out-of-
body experiences,    such as seeing yourself as watching a movie.

Derealisation:
The world around you seems unreal. You may see objects changing in shape, size or colour, or you may
feel that other    people are robots.

Identity Confusion : Feeling uncertain about who you are. You may feel as if there is a struggle within
to define yourself.

Identity Alteration:      This is when there is a shift in your role or identity that changes your behaviour
in ways that others could    notice. For instance, you may be very different at work    from when you are
at home.

DISSOCIATIVE DISORDER

Dissociative disorders are condition that involve disruption or breakdown    of memory , awareness,
identity or perception. The essential features of dissociative disorders is a disruption in the usually
integrated functions of consciousness, memory, identity or perception. The disturbance may be sudden
or gradual, transient or chronic.
DSM IV CLASSIFIED DISSOCIATIVE DISORDERS AS-
 Dissociative amnesia
 Dissociative fugue
 Dissociative identity disorder
 Depersonalization disorder
 Dissociative disorder not otherwise specified

PREDISPOSING FACTORS

Genetics
The DSM-IV-TR suggests that DID is more common in first-degree relatives of people with the
disorder than in the general population. The disorder is often seen in more than one generation of a
family.

Neurobiological
Some clinicians have suggested a possible correlation between neurological alterations and dissociative
disorders. Although available information is inadequate, it is possible that dissociative amnesia and
dissociative fugue may be related to neurophysiological dysfunction. Areas of the brain that have been
associated with memory include the hippocampus, amydala, fornix, mammillary bodies, thalamus, and
frontal cortex.
Such findings suggest a role for the locus ceruleus/noradrenergic system, which is implicated in fear
and arousal regulation and influence a number of cortical structures such as the prefrontal, sensory and
parietal cortex, the hippocampus, the hypothalamus, the amygdala, and the spinal cord. Still the
relationship between trauma exposure, cortisol, hippocampus damage, memory, and dissociation is
tentative at best, and remains to be thoroughly investigated.
Some studies have suggested a possible link between DID and certain neurological conditions, such as
temporal lobe epilepsy and severe migraine headaches. Electroencephalographic abnormalities have
been observed in some clients with DID.

Psychodynamic Theory
Freud (1962) believed that dissociative behaviors occurred when individuals repressed distressing
mental contents from conscious awareness. He believed that the unconscious was a dynamic entity in
which repressed mental contents were stored and unavailable to conscious recall. Current
psychodynamic explanations of dissociation are based on Freud’s concepts. The repression of mental
contents is perceived as a coping mechanism for protecting the client from emotional pain that has
arisen from either disturbing external circumstances or anxiety-provoking internal urges and feelings
(Maldonado & Spiegel, 2003). In the case of depersonalization, the pain and anxiety are expressed as
feelings of unreality or detachment from the environment of the painful situation.

Psychological Trauma
A growing body of evidence points to the etiology of DID as a set of traumatic experiences that
overwhelms the individual’s capacity to cope by any means other than dissociation. These experiences
usually take the form of severe physical, sexual, or psychological abuse by a parent or significant other
in the child’s life. The most widely accepted explanation for DID is that it begins as a survival strategy
that serves to help children cope with the horrifying sexual, physical, or psychological abuse. In this
traumatic environment, the child uses dissociation to become a passive victim of the cruel and
unwanted experience. He or she creates a new being who is able to endure the overwhelming pain of
the cruel reality, while the primary self can then escape awareness of the pain. Each new personality
has as its nucleus a means of responding without anxiety and distress to various painful or dangerous
stimuli.

DISSOCIATIVE AMNESIA (PSYCHOGENIC AMNESIA)

It is characterized by an inability to recall important personal information, usually of a traumatic or
stressful nature, that is too extensive to be explained by ordinary forgetfulness. Nor can the memory
loss be attributed to a particular organic cause, such as a blow to the head or a particular    medical
condition, or to the direct effects of drugs or alcohol. Unlike some progressive forms of memory
impairment (such as dementia associated with Alzheimer’s disease; see Chapter 15),the memory loss in
dissociative amnesia is reversible, although it may last for days, weeks, or even years. Recall of
dissociated memories may happen gradually but often occurs suddenly and spontaneously, as when the
soldier who has no recall of a battle for several days afterward suddenly remembers being transported
to a hospital away from the battlefield.
Amnesia is not ordinary forgetfulness, such as forgetting someone’s name or where you left your car
keys.
Memory loss in amnesia is more profound or wide ranging. Dissociative amnesia is divided into five
distinct types of memory problems.

1.Localized amnesia.
Most cases take the form of localized amnesia in which events occurring during a specific time period
are lost to memory. For example, the person cannot recall events for a number of hours or days after a
stressful or traumatic incident, such as a battle or car accident.
2.Selective amnesia.
In selective amnesia, people forget only the disturbing particulars that take place during a certain period
of time. A person may recall the period of life during which he conducted an extramarital affair, but not
the guilt arousing affair itself. A soldier may recall most of the battle, but not the death of
his buddy.
3. Generalized amnesia.
In generalized amnesia, people forget their entire lives—who they are, what they do, where they live,
whom they live with. This form of amnesia is very rare, although you wouldn’t think so if you watch
daytime soap operas. Persons with generalized amnesia cannot recall personal information, but they
tend to retain their habits, tastes, and skills. If you had generalized amnesia, you would still know how
to read, although you would not recall your elementary school teachers. You would still prefer French
fries to baked potatoes—or vice versa.
4. Continuous amnesia.
In this form of amnesia, the person forgets everything that occurred from a particular point in time up
to and including the present.
5. Systematized amnesia.
In systematized amnesia, the memory loss is specific to a particular category of information, such as
memory about one’s family or particular people in one’s life.

SPECIFIC AGE FEATURES

Difficult to assess in preadolescent children because it may be confused with inattention, anxiety,
oppositional behavior and developmentally appropriate childhood amnesia.
PREVALENCE
In recent years there has been an increase in reported cases of dissociative amnesia.

COURSE
It can be present in any age group. Individuals who have had single episode of amnesia may be
predisposed to develop amnesia for subsequent traumatic circumstances. Acute amnesia may resolve
spontaneously after the individual is removed from the traumatic circumstances with which amnesia
was associated. Some individuals with chronic amnesia may gradually begin to recall dissociated
memories. Other may form a chronic form of amnesia.

DIFFERENTIAL DIAGNOSIS

 Amnestic disorder due to general medical condition

Amnesia is direct result of a specific neurological or other general medical conditions.
 Dissociative fugue and dissociative identity disorder
Dissociative amnesia is symptom for both the disorders hence if amnesia occurs exclusively during
the course of fugue and identity disorder it cannot be diagnosed as dissociative amnesia.
 Post traumatic stress and acute stress disorder
Amnesia is symptom for both the disorders hence if amnesia occurs exclusively during the course
of these disorders then    it cannot be diagnosed as dissociative amnesia.
 Substance related amnesia
A variety of substances and intoxicants have been implicated in production of amnesia.
 Delirium, dementia and other amnestic disorder
In patients with organic disorder the loss for personal information is embedded in a far more
extensive set of cognitive impairments.

TREATMENT
Cognitive therapy
Helps in identifying the specific cognitive distortions that are based    in the trauma may provide an
entrée into autobiographical memory for which the patient experiences amnesia. As the patient
becomes able to correct cognitive distortions, particularly about the meaning of prior trauma, more
derailed recall of traumatic events may occur.
Hypnosis
It is used to contain, modulate and titrate the intensity of symptoms; to facilitate controlled recall of
dissociated memories; to provide support and ego strengthening for the patient; and finally to promote
working through and integration of dissociated material.
Somatic therapies
Pharmacologically facilitated    interviews are used in somatic therapies a variety of drugs can be used
for this purpose like thiopental and amphetamines.   
Group psychotherapy
Time limited and longer term group therapist have been reported to be helpful for survivors of
childhood abuse. During group sessions patients may recover memories for which they have had
amnesia. Supportive interventions by the group members and the therapist or both may facilitate
integration and mastery of the dissociated material.
 DISSOCIATIVE FUGUE (PSYCHOGENIC FUGUE)
Fugue derives from the Latin    fugere, meaning “flight.” The word    fugitive has the same origin.
Fugue is like amnesia “on the run.” dissociative fugue is characterized by sudden, unexpected travel
away from home or customary place of daily activities, with inability to recall some or all of one's past.
An individual in fugue state cannot recall personal identity and often assumes a new identity. The
person may not think about the past, or may report a past filled with false memories without
recognizing them as false. Whereas people with amnesia appear to wander aimlessly, people in a fugue
state act more purposefully. Some stick close to home. They spend the afternoon in the park or in a
theater, or they spend the night at a hotel under another name, usually avoiding contact with others. But
the new identity is incomplete and fleeting, and the individual’s former sense of self returns in a matter
of hours or a few days.
The assumed identity    may be simple and incomplete or complex. If a complex identity is assumed the
individual may intricate interpersonal and occupational activities. They may establish new families and
successful businesses. Although these events sound rather bizarre, the fugue state is not considered
psychotic because people with the disorder can think and behave quite normally—in their new lives,
that is. Then one day, quite suddenly,    awareness of their past identity returns to them, and they are
flooded with old memories. Now they typically do not recall the events that occurred during the fugue
state. The new identity, the new life—including all its involvements and responsibilities—vanish from
memory.

SPECIFIC CULTURE FEATURES

Individuals with various culturally defined running syndromes (eg: navajo “frenzy” witchcraft in
western pacific cultures) may have symptoms that diagnostic criteria of dissociative fugue.

PREVALENCE
A prevalence rate of 0.2% is reported in general population. The prevalence may increase during times
of extremely stressful events such as wartime or natural disaster.

COURSE
the onset of this disorder is usually related to traumatic events. Single episodes are more commonly
repeated. Recovery is usually rapid but refractory amnesia may persist.

DIFFERENTIAL DIAGNOSIS
Mania
Wandering and purposeful travel that occur during manic phase is distinguished from fugue
Schizophrenia
Person with fugue don't demonstrate any of the psychopathology involved with schizophrenia like
delusions and negative symptoms.

TREATMENT
 Dissociative fugue is usually treated    with an eclectic, psychodyanamically oriented psychotherapy
that focuses on helping the patient recover memory for identity and    recent experience.
 Hypnotherapy
 Pharmacologically facilitated interviews.
 Clinician should be prepared for the emergence of suicidal ideation or self-destructive ideas and
impulses as the traumatic or stressful prefugue circumstances are revealed.
 DISSOCIATIVE IDENTITY DISORDER:(MULTIPLE PERSONALITY
DISORDER)
In dissociative identity disorder, two or more personalities—each with well-defined traits and
memories—“occupy” one person. They may or may not be aware of one another. In some isolated
cases, alternate personalities (also called alter personalities) may even show different EEG records,
allergic reactions, responses to medication, and even different eyeglass prescriptions (Birnbaum,
Martin, &T homann, 1996; S. D. Miller et al., 1991; S. D. Miller & Triggiano, 1991). Or one
personality may be color blind, whereas others are not (Braun, 1986). These findings are    based on
isolated case reports.
Only one of the personality is evident at any given moment and one of them is    dominant most    of the
time over the course of the disorder. Each personality is unique and composed of a complex set of
memories, behaviour patterns and social relationships that surface during the dominant interval. The
transition from one personality to another is sudden, often dramatic and usually precipitated by
stress.The time required to switch from one identity to another is usually a matter of seconds but less
frequently may be gradual.
While the different personality states influence the person’s behaviour, the person is usually not aware
of these personality states and experiences them as memory lapses. Before therapy the original
personality is usually unaware of the    other subpersonalities, but when there are two or more than two
subpersonalities, they are usually aware of each other's existence. Most often the various
subpersonalities have different names, may be different gender, race and age.
Generally there is amnesia for events that took place when another personality was in the dominant
position, and the clients reports gaps in the autobiographical histories. Sometimes however one
personality does not experience such amnesia and retains complete awareness of the existence, qualities
and activities of the other personalities. Subpersonalites that are amnestic for the other subpersonalities
experience the periods when others are dominant as “lost time” or blackouts.

CASE EXAMPLE
In year 1977 the Ohio State campus dwelled in terror as four college women were seized, coerced to
cash checks or get money from automatic teller machines, then raped. A cryptic phone call led to the
capture of Billy Milligan, a 23-year-old drifter who had been dishonorably discharged from the Navy.
Billy wasn’t quite the boy next door. He tried twice to commit suicide while he was awaiting trial, so
his lawyers requested a psychiatric evaluation. The psychologists and psychiatrists who examined
Billy deduced that ten personalities dwelled inside of him. Eight were male and two were female.
Billy’s personality had been fractured by a brutal childhood. The personalities displayed diverse facial
expressions, memories, and vocal patterns. They performed in dissimilar ways on personality and
intelligence tests. Arthur, a sensible but phlegmatic personality, conversed with a British accent. Danny,
14, was a painter of still lifes. Christopher, 13, was normal enough, but somewhat anxious. A 3-year-old
English girl went by the name of Christine. Tommy, a 16-year-old, was an antisocial personality and
escape artist. It was Tommy who had enlisted in the Navy. Allen was an 18-year-old con artist. Allen
also smoked. Adelena was a 19-year-old introverted lesbian. It was she who had committed the rapes. It
was probably David who had made the mysterious phone call. David was an anxious 9-year-old who
wore the anguish of early childhood. trauma on his sleeve. After his second suicide attempt, Billy had
been placed in a straitjacket. When the guards checked his cell, however, he was sleeping with the
straitjacket as a pillow. Tommy later explained that he was responsible for Billy’s escape.The defense
argued that Billy was afflicted with multiple personality disorder. Several alternate personalities resided
within him. The alternate personalities knew about Billy, but Billy was unaware of them. Billy, the core
or dominant personality, had learned as a child that he could sleep as a way of avoiding the sexual and
physical abuse of his father. A psychiatrist claimed that Billy had likewise been “asleep”—in a sort of
“psychological coma”—when the crimes were committed. Therefore, Billy should be judged innocent
by reason of insanity. Billy was decreed not guilty by reason of insanity. He was committed to a mental
institution. In the institution, 14 additional personalities emerged. Thirteen were rebellious and labeled
“undesirables” by Arthur. The fourteenth was the “Teacher,” who was competent and supposedly
represented the integra- tion of all the other personalities. Billy was released six years later.

TREATMENT

 Cognitive therapy
 Hypnosis
Hypnotherapeutic interventions can often alleviate self destructive impulses or reduce symptoms, such
as flashbacks, dissociative hallucinations and passive influence experiences. Teaching the patient self
hypnosis may help with crises outside of sessions. Hypnosis can be used to access specific alter
personality states and their sequestered affects and memories.
 Pharmacology
Clinicians report some success with SSRI, TCA and MAO antidepressants, beta blocekers, clonidine
and anticonvulsants and benzodiazepines in reducing intrusive symptoms, hyperarousal, and anxiety in
patients with DID.
 Electroconvulsive Therapy
For some patients the ECT is helpful in ameliorating refractory mood disorders and does not worsen
dissociative memory problems.
 Group therapy
The group formed by the dissociative identity disorder patients is proved to be more successful but the
groups must be selected and formed carefully and firm limit should be provided and should focus only
on    coping and adaptation.
 Family therapy
It helps the family members to cope effectively with the condition of the patient.
 Expressive and occupational therapy
Art and movement therapy helps in containtment and structuring of severe dissociative identity
disorder. Movement therapy may facilitate normalization of body sense and body image for these
severely traumatized patients.

DEPERSONALIZATION DISORDER
Depersonalisation disorder is characterised by a temporary change in the quality of self awareness,
which oftenn takes the form of feelings of unreality, changes in the body image, feelings of detachment
from the environment, or a sense of observing oneself from outside the body. In severe cases, the
person cannot recognize themselves in a mirror.
Depersonalisation is differentiated from derealisation, which describes an alteration in the perception of
the    external environment.
It is estimated that approximately half of the adults experience transient episodes of depersonalisation.
The diagnosis of depersonalisation disorder is made only if the symptoms causes a significant distress
or impairment in functioning.
The DSM IV described this disorder as the recurrence or persistence of    experiences of
depersonalization, which are characterized by feelings of detachment from one’s mental processes or
body, as if one were an outside observer of oneself. The experience may have a dreamlike quality.
These altered perceptions are experienced as disturbing, and are often accompanied by anxiety,
depression, fear of going insane, obsessive thoughts, somatic complaints, and a disturbance in the
subjective sense of time (APA, 2000). The disorder occurs at least twice as often in women as in men,
and is a disorder of younger people, rarely occurring in individuals older than 40 years of age
(Andreasen & Black, 2006).

DISSOCIATIVE DISORDER NOS (NOT OTHERWISE SPECIFIED)

 Clinical presentations similar to Dissociative Identity Disorder that fail to meet full criteria for this
disorder. Examples include presentations in which a) there are not two or more distinct personality
states, or b) amnesia for important personal information does not occur.
 Derealisation unaccompanied by depersonalization in adults.
 States of dissociation that occur in individuals who have been subjected to periods of prolonged and
intense coercive persuasion (e.g., brainwashing, thought reform, or indoctrination while captive).
 Loss of consciousness, stupor, or coma not attributable to a general medical condition.

DISSOCIATIVE TRANCE DISORDER

It is manifested by a temporary marked alterations in the state of consciousness or by loss of the
customary sense of personal identity without the replacement by an alternate sense of identity.

POSSESSION TRANCE
It is a variant of dissociative trance and involves single or episodic alterations in the state of
consciousness, characterised by the exchange of persons identity with new identiy usually attributed to
a spirit or divine power.

BRAINWASHING
In DSM V this dissociative disorder is described as identity disturbances due to prolonged and intense
coercive persuasion. It implies that under conditions of adequate stress and duress individuals can be
made to comply with the demands of those in power, thereby undergoing major changes.

RECOVERED MEMORY SYNDROME

Under hypnosis or during psychotherapy a patient may recover a memory or a painful experience or
conflict- particularly of sexual or physical abuse- that is etiologically significant. If the event recalled
never really happened but the person believes it to be true and reacts accordingly, it is known as false
memory syndrome.

GANSER SYNDROME (HYSTERICAL PSEUDO DEMENTIA)

Giving approximate answer to question or providing
nonsensical or wrong answers to questions. The answers given, usually so close to the question as to
reveal that the patient has understood the question.    Also called - nonsense syndrome , balderdash
syndrome, syndrome of approximate .

NURSING MANAGEMENT

NURSING DIAGNOSIS: DISTURBED THOUGHT PROCESSES

RELATED TO: Severe psychological stress and repression of anxiety
EVIDENCED BY: Loss of Memory
OUTCOME CRITERIA
Client will recover deficits in memory and develop more adaptive coping mechanisms to deal with
stress.

NURSING INTERVENTIONS
1. Obtain as much information as possible about the client from family and significant others if
possible. Consider likes, dislikes, important people, activities, music, and pets.
2. Do not flood client with data regarding his or her past life.
3. Instead, expose client to stimuli that represent pleasant experiences from the past such as smells
associated with enjoyable activities, beloved pets, and music known to have been pleasurable to the
client. As memory begins to return, engage client in activities that may provide additional stimulation.
4. Encourage client to discuss situations that have been especially stressful and to explore the feelings
associated with those times.
5. Identify specific conflicts that remain unresolved, and assist client to identify possible solutions.
Provide instruction regarding more adaptive ways to respond to anxiety

NURSING DIAGNOSIS: INEFFECTIVE COPING

RELATED TO: Severe psychosocial stressor or substance abuse and repressed severe anxiety
EVIDENCED BY: Sudden travel away from home with inability to recall previous identity
OUTCOME CRITERIA
Client will demonstrate more adaptive ways of coping in stressful situations than resorting to
dissociation.

NURSING INTERVENTION
1. Reassure client of safety and security through your presence. Dissociative behaviors may be
frightening to the client.
2. Identify stressor that precipitated severe anxiety.
3. Explore feelings that client experienced in response to the stressor. Help client understand that the
disequilibrium felt is acceptable in times of severe stress.
4. As anxiety level decreases and memory returns, use exploration and an accepting, nonthreatening
environment to encourage client to identify repressed traumatic experiences that contribute to chronic
anxiety.
5. Have client identify methods of coping with stress in the past and determine whether the response
was adaptive or maladaptive.
6. Help client define more adaptive coping strategies. Make suggestions of alternatives that might be
tried. Examine benefits and consequences of each alternative. Assist client in the selection of those that
are most appropriate for him or her.
7. Provide positive reinforcement for client’s attempts to change.
8. Identify community resources to which the individual may go for support if past maladaptive coping
patterns return.

NURSING DIAGNOSIS: DISTURBED PERSONAL IDENTITY

RELATED TO: Childhood trauma/abuse
EVIDENCED BY: The presence of more than one personality within the individual
OUTCOME CRITERIA
Client will verbalize understanding about the existence of multiple personalities in the self, the reason
for their existence, and the importance of eventual integration of the personalities into one.

NURSING INTERVENTION
1. The nurse must develop a trusting relationship with the original personality and with each of the
subpersonalities.
2. Help client understand the existence of the subpersonalities and the need each serves in the personal
identity of the individual.
3. Help client identify stressful situations that precipitate transition from one personality to another.
Carefully observe and record these transitions.
4. Use nursing interventions necessary to deal with maladaptive behaviors associated with individual
subpersonalities. For example, if one personality is suicidal, precautions must be taken to guard against
client’s self-harm. If another personality has a tendency toward physical hostility, precautions must be
taken to protect others.
5. Help subpersonalities to understand that their “being” will not be destroyed but rather integrated into
a unified identity within the individual.
6. Provide support during disclosure of painful experiences and reassurance when client becomes
discouraged with lengthy treatment.

SUMMARY
A dissociative response has been described as a defense mechanism to protect the ego in the face of
overwhelming anxiety. Dissociative responses result in an alteration in the normally integrative
functions of identity, memory, or consciousness. Classification of dissociative disorders includes
dissociative amnesia, dissociative fugue, dissociative identity disorder, and depersonalization disorder.
The individual with dissociative amnesia is unable to recall important personal information that is too
extensive to be explained by ordinary forgetfulness. Dissociative fugue is characterized by a sudden,
unexpected travel away from home with an inability to recall the past, including personal identity.
Duration of the fugue is usually brief, and once it is over the individual recovers memory of the past
life but is amnestic for the time period covered by the fugue. The prominent feature of DID is the
existence of two or more personalities within a single individual. An individual may have many
personalities, each of which serves a purpose for that individual of enduring painful stimuli that the
original personality is too weak to face. Depersonalization disorder is characterized by an alteration in
the perception of oneself (sometimes described as a feeling of having separated from the body and
watching the activities of the self from a distance).

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