Dissociative dissociation and leakage

Kihlstrom, Tataryn and Hoyt, point out that dissociative disorders "peculiar" disorders, because the disorder's own label implies a specific mechanisms. Dissociation: "Structured separation of mental processes (thoughts, emotions, conction, memory and identity) that are normally integrated". The origins of the concept are found in the "first dynamic psychiatry" (1775-1900), although, their farthest background is found in mesmerism, animal magnetism or in hypnosis.

Dissociation concept

First described by Pierre Janet, that identified the mental structures of the mental system as "psychological automatisms": each automatism, I linked cognition, emotion and motivation with action. It would be similar to the "productions" or "productions" (cognition-action units that are executed in response to appropriate contextual indications). The repertoire of elementary psychological automatisms. Under certain circumstances, it might happen that one or more automatism Personality parts. This concept is different from that of "repression", maintained Pro Freud, because:

1. Janet's automatisms are "fixed ideas" that possessed some degree of autonomy with respect to their development and effects on action, experience and thought.
2. They are "subconscious" (outside the consciousness that could become conscious occasionally) as opposed to "unconscious".
3. Considered repression as one of the possible mechanisms of dissociation. The success of Freudian approaches, obscured Janet's work: the "second dynamic psychiatry" triumphed, with its emphasis on sex, aggression, dreams and repression.

Dissociation was considered, from the first moment, as one of the mechanisms of hysteria. Janet proposes 4 categories to describe the different ways in which they can manifest and subsequently collected by the DSM-III-R): Located amnesia: It is the most common type. I fail to remember facts that occurred for a specific period of time (first hours following trauma).

Current between survivors of natural catastrophes or violent crimes. Selective amnesia: similar to the previous one but there is a partial memory of the events that occurred in that period. Generalized amnesia: complete memory loss of the patient's past. It is usually present in multiple personality. Continuous amnesia: it extends from a specific point of the past, to the present including it. It is the only case in which amnesia exists Psychogen anterograde (In all others, amnesia is retrograde).

Nemiah, distinguishes 3 types of psychogenic amnesia:

• Located: It affects a variable period of time (from hours to weeks).
• Systematized: It affects only specific events and material related to them.
• Generalized: implies a transient memory loss of the individual's complete life.

Amnesia can be considered as reactions, uncommon but distinctive, to serious stressors, such as violations, catastrophic accidents, ... it is affirmed that this disorder has greater incidence in times of war or after natural disasters. That is, psychogenic amnesia can be a symptom of posttraumatic stress disorder (within anxiety disorders). On the other hand, although by definition it cannot be caused by cerebral damage or disease, we can find cases in which functional amnesia is associated with brain damage.

There are signs that help differentiate the psychogenic amnesia of organic:

• Loss of personal identity: Uncommon in organic.
• Affectation of new material learning: Uncing frequent in psychogenic.

Forgotten information can be remembered, in the case of psychogens, by barbiturates or hypnosis. Other more important problems of the diagnosis of psychogenic amnesia is to distinguish it from the simulated, perhaps the only help resides in the concept of unconscious motivation.

Criteria for the diagnosis of dissociative escape

The essential alteration of this disorder consists of sudden and unexpected trips away from home or job, with inability to remember the individual's past. Confusion about personal identity, or assumption of a new identity (partial or complete). The disorder does not appear exclusively in the course of a dissociative identity disorder and is not due to the physiological effects of a substance (P. eg., drugs or drugs) or medical disease (P. eg., temporal lobe epilepsy). Symptoms produce significant clinical discomfort or social, labor or other important areas of the individual's activity.

Fisher, distinguishes 3 types of leaks:

• Amnesia for personal history itself, accompanied by a change of identity and a new address.
• Amnesia accompanied by the loss (but not change) of personal identity.
• Regression to a previous period of life itself, with amnesia, but without change of identity. Difficult to distinguish it from psychogenic amnesia. The "escape recovery" usually occurs as a spontaneous awareness of the situation. When the situation is resolved, the patient suffers lacunar amnesia for the escape period.

Predisposing factors (Kopelman): Precipitating stressors, depressed mood, suicide attempts (never during escape -> The leak can be a substitute for suicide in depressive paintings)

Prior history of cranial trauma, epilepsy, previous history of alcohol abuse, tendency to lie.

Pratt points out that suicide has never occurred during the escape, but it can occur once the subject "has returned in itself".

It should be noted that the relationship between having previously suffered in amnesic syndrome and the probability of suffering in the future a psychogenic escape in the presence of depression or stressful factors, which indicates that the difficulty of separating the organic amnesias of the psychogenic.

The diagnosis of escape does not It entails great difficulties When all its elements are present. The state of escape from other states must be differentiated: epileptic leakage and poriomania (vagar because of an epilepsy).

The beginning of poriomania is usually preceded by an aura and its duration is only a few minutes. In both cases of epilepsy, patients behave as if they were intoxicated, with random movements and violent behaviors.

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