The human mind works in a coordinated and holistic way. The mind, which works systematically, may need to relax and protect itself by losing its level of conscious awareness in the face of traumatic life events (Öztürk, 2017; Öztürk, 2020; Şar, 2013). In such cases, the mind may begin to function abnormally, developing dissociation, which literally means dissociation or dissociation. It can be said that a mind with the mentioned working style suffers from dissociative disorder (Balcıoğlu & Balcıoğlu, 2018; Butcher, Mineka & Hooley, 2013).
In dissociative disorders, the individual’s mind experiences a loss in memory, consciousness, identity information and perception of the environment. Although there is no physical brain damage, the main reason for the loss is psychological (Özden, 2018). For example, an individual who has experienced a severe traumatic event recently or in childhood (harassment, rape, war, earthquake, sudden death, etc.) may experience dissociative disorder (Öztürk, 2017).
According to The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), the dissociative disorders that the individual may experience are discussed under five headings. These; Dissociative Amnesia (in Dissociative Fugue), Dissociative Identity Disorder, Depersonalization/Derealization, Another Specified Dissolution Disorder, and Unspecified Dissolution Disorder.
1. Dissociative Amnesia
In this disorder, important personal information (name, parent’s name, job, residence, etc.) that can have a traumatic effect on the individual is not remembered at a level that cannot be explained by ordinary forgetfulness. The information in question is not completely lost, only remembered during amnesia. On the other hand, no impairment is observed in the individual’s skills such as reading, writing and speaking (Butcher, Mineka, & Hooley, 2013).
Dissociative Amnesia is closely related to childhood traumas, as well as to a recent traumatic life event. Sexual abuse, war and natural disasters that an individual is exposed to are among the most common causes. Apart from these traumatic experiences, dissociative amnesia can be frequently encountered in individuals with stressful occupations (Öztürk, 2020).
The prevalence of Dissociative Amnesia was found to be 7% in the general population. Recovery in the treatment of dissociative amnesia is closely related to the stress factor causing the amnesia and secondary traumas. In most cases, immediate improvement can be seen with supportive approaches. Hypnosis and amobarbital interviews (medical psychotherapy) have been used successfully (Sar 2013).
2. Dissociative Fugue
Dissociative Fugue is located under the title of Dissociative Amnesia in the DSM-5 book. In Dissociative Fugue disorder, the individual forgets his past and identity and leaves his home and job in an abnormal way and travels far from where he lives. Here he attempts to establish a new life by acquiring a new identity for himself. When the individual returns to his pre-fugue life, he may not remember his life during the fugue. Individuals with Dissociative Fugue frequently encounter situations such as depression, anxiety, shame, guilt, suicide, and aggression (Butcher, Mineka, & Hooley, 2013).
Dissociative Fugue; It occurs as a result of trauma experienced by the individual as a result of natural disasters, war, family problems, personal rejection, failure, financial problems, sudden death and abuse. In addition, alcohol or substance use, epilepsy and depression are some of the factors that trigger dissociative fugue. Personality disorders such as borderline, schizoid, and histrionic also predispose to fugue (Şar, 2013).
The prevalence of Dissociative Fugue was found to be 0.2% (Sar 2009). Recovery in the treatment of dissociative fugue is closely related to the stress factor causing the fugue and secondary traumas. In most cases, immediate improvement can be seen with supportive approaches. Hypnosis and amobarbital interviews (medical psychotherapy) have been used successfully (Butcher, Mineka, & Hooley, 2013).
3. Dissociative Identity Disorder
It is the most severe and chronic disorder among dissociative disorders. In Dissociative Identity Disorder (DID), there is at least 2 personalities or different identities (Steinberg, 1994, cited in Butcher, Mineka, & Hooley, 2013). Here, each identity is called “alter”. The life story, personal characteristics, way of thinking, and behavioral characteristics of each identity differ from each other. When there is a transition between alters, personal information about the previous personality is not remembered (Şar, 1998).
DID is associated with childhood psychological traumas. Today, DID is accepted as a chronic and complex post-traumatic dissociative psychopathology related to childhood abuse (Şar, 2010).
The prevalence of Dissociative Identity disorder was found to be 1% in the general population (Şar 2013). Although general psychotherapy rules and interventions are valid for ICD treatment, there are also ICD-specific techniques. The 5 most commonly used ones are; talking with alters, mapping, orientation to reality, round table technique, and unification rituals. In the treatment of DID, there is no drug that treats the psychopathology of the disorder. In addition, Eye Movement Desensitization and Reprocessing (EMDR) and hypnosis can be used for traumatic memories. Treatment in DID consists of 3 stages:
1. In the first stage, the diagnosis is made. It consists of educating the person about the disease, recognizing the alter system and providing stabilization.
2. In the second stage, the traumatic memories that caused the split are studied.
3. The third stage consists of integration and non-dividing work, which means combining the alters (Yanık, 2017).
4. Depersonalization(Self Alienation) / Derealization(Unrealism)
In depersonalization disorder, the individual feels as if he is separated from his body and looking at himself from the outside. In depersonalization disorder, the individual’s ability to evaluate the truth about himself is atrophied. On the other hand, in Derealization disorder, the individual’s ability to evaluate the reality of the environment is atrophied. Depersonalization and derealization can sometimes be seen individually or both together (Butcher, Mineka, & Hooley, 2013).
It usually occurs after traumatic or stressful life events. In addition, depersonalization disorder may occur in cases of electrical stimulation of the temporal lobe cortex and brain tumors or epilepsy (Butcher, Mineka, & Hooley, 2013).
The prevalence of depersonalization was found to be 2.4% (Sar 2013). Although no drug is known that is effective in the treatment of depersonalization, the use of drugs in the treatment is aimed at other symptoms. In addition, there is not enough information in the context of psychotherapy. However, emphasis is placed on dynamic psychotherapy, hypnosis, and behavioral therapy. Overflow and systematic desensitization are recommended for traumatic situations. If it occurs due to diseases such as depersonalization, panic attacks, depression, and schizophrenia, it is beneficial to treat these diseases first (Öztürk, 2020).