Sažetak | Dissociation in the aftermath of psychotraumatization is a common disorder in psychiatric patients of any age. It may also accompany disorders and be masked by somatic symptoms with an underlying psychiatric etiology. During the early 20th century, first discussions about the etiology of dissociation in the context of hysteria were held amongst clinical figures such as Freud and Janet. Personal debates and clinical favoritism lead to a dismissal of Janets theories for many years, although nowadays, they are considered to be groundbreaking and more relevant than those of his counterpart Sigmund Freud.
Neurologically, dissociation is directly linked to a disturbance in the communication between the limbic system and the cortices of the brain, particularly the frontal and prefrontal cortex. This disturbance may lead to an overstimulation of the center for emotions as a response to a trigger, without the proper connection to the cognitive consciousness, which may lead to a hyper- or hypoarousal without proper awareness of the individual towards its triggers.
The DSM-5 classifies dissociative disorders into dissociative identity disorder, dissociative amnesia, depersonalization/derealization disorder and other specified or unspecified dissociative disorder. All of these disorders may have a traumatic experience as etiology or etiological factor and patients who have experienced trauma are at risk for developing these disorders. Additionally, the DSM-5 mentions posttraumatic stress disorder, acute stress disorder and borderline personality disorders as disorder with dissociative aspects. They too are based on traumatic events, in borderline personality disorder during childhood, that lead to a disruption of emotional and cognitive continuity.
The ICD-11 varies from the DSM-5 classification, as it lists neurological symptom disorder, trance disorder and trance possession disorder additionally to the disorders mentioned in the DSM-5. These disorders are also related to trauma, with trance and trance possession disorder being closely linked to cultural and religious experiences. Neurological symptom disorder may mask dissociative symptoms and dissociation with somatic symptoms, which can make a clinical diagnosis difficult. |