Abnormal Psychology

Dissociative and Somatoform Disorders 333

the person’s body. Later, the person has amnesia for the experience. At fi rst glance,

possession trance may seem to be a psychotic experience (delusions of spirits taking

over a body), but closer examination reveals that the “possessed” person doesn’t

exhibit any evidence of psychosis after the trance is over.

In some instances, dissociative experiences do indicate a disorder, but not nec-

essarily a dissociative disorder; other psychiatric disorders can involve dissociative

symptoms, such as when depersonalization or derealization occurs during a panic

attack. DSM-IV-TR reserves the category of dissociative disorders for cases in which

perception, consciousness, memory, or identity are dissociated to the point where

the symptoms are pervasive, cause signifi cant distress, and interfere with daily func-

tioning. Research fi ndings suggest that pathological dissociation is qualitatively dif-

ferent, not simply quantitatively different, from everyday types of dissociation, such

as “spacing out” (Seedat, Stein, & Forde, 2003).

Only about 2% of the U.S. population reports having experienced dissociation

to the extent that would be considered abnormal (Seedat, Stein, & Forde, 2003). Sur-

veys indicate that 4–29% of individuals who have some other type of DSM-IV-TR

diagnosis may also have a dissociative disorder (Coons, 1998; Foote et al., 2006;

Johnson et al., 2006; Maaranen et al., 2005).

Anna’s dissociative symptoms appear to have been abnormal; she had dissocia-

tions in perception, consciousness, memory, and identity:

Two entirely distinct states of consciousness were present which alternated very fre-

quently and without warning and which became more and more differentiated in the

course of the illness. In one of these states she recognized her surroundings; she was

melancholy and anxious, but relatively normal. In the other state she hallucinated and

was “naughty”—that is to say, she was abusive, used to throw the cushions at people,

... tore buttons off her bedclothes and linen with those of her fi ngers which she could
move, and so on. At this stage of her illness if something had been moved in the room
or someone had entered or left it [during her other state of consciousness] she would
complain of having “lost” some time and would remark upon the gap in her train of
conscious thoughts.
These “absences” had already been observed before she took to her bed; she [would]
stop in the middle of a sentence, repeat her last words and after a short pause go on
talking. These interruptions gradually increased till they reached the dimensions that
have just been described.... At the moments when her mind was quite clear she would
complain of the profound darkness in her head, of not being able to think,... of having
two selves, a real one and an evil one which forced her to behave badly, and so on.
(Breuer & Freud, 1895/1955, p. 24)

Anna’s dissociative experiences were clearly beyond normal ones—they were pervasive

and interfered with her daily functioning.

Cultural Variations in Pathological Dissociation

People in different cultures may express dissociative symptoms differently. For

example,latah, experienced by people—mostly women—in Indonesia and Malay-

sia (Bartholomew, 1994), involves fl eeting episodes in which the individual uses

profanity and experiences amnesia and trancelike states.

Dissociative experiences have also varied across eras. Symptoms of hysteria were

common among middle- and upper-class women of the Victorian era, the period in

which Anna O. lived. Women of that time and social class led severely limited lives:

They were expected to marry, have children, and run the home; they were allowed

to pursue only a restricted range of other activities. Some researchers hypothesize

that the hysterical symptoms of Victorian women like Anna who wanted a differ-

ent life were one of the few means of social protest they could employ (Kimball,

2000). As we consider each type of dissociative disorder listed in DSM-IV-TR, we’ll

consider whether Anna’s dissociative symptoms fi t the contemporary diagnoses.

Types of Dissociative Disorders

DSM-IV-TR defi nes four types of dissociative disorders, described in the follow-

ing sections: dissociative amnesia, dissociative fugue, depersonalization disorder,

Dissociative Disorders

A category of psychological disorders in

which perception, consciousness, memory,

or identity are dissociated to the point

where the symptoms are pervasive, cause

signifi cant distress, and interfere with daily

functioning.