Dissociation Across Psychiatric Disorders: A Confounding Factor or An Opportunity for Research and Innovation
The clinical heterogeneity of dissociation constitutes a challenge to the clinician and researchers. Variability in experiencing dissociation, the interplay between acute and chronic, and predominance of a nosologically interface type of clinical surface conceal core dissociative symptoms. While the latter (amnesia, depersonalization, derealization, identity confusion and identity alteration) usually remain underreported, the clinical surface may be dominated by acute (functional neurological symptoms, brief psychosis, an experience of possession, acute dissociative reaction to a stressful event) or chronic (mood and personality disorders) secondary syndromes. However, these syndromes also constitute gateways in pursuing the clues of core dissociation. Given that culture influences communication between clinician and patient, accurate expression of mental content requires the idiomatic armamentarium describing the experience. The latter is problematic in dealing with phenomena of core dissociation while the secondary representations have relatively universal character for both clinicians and patients. Nevertheless, this approach requires a transdiagnostic understanding in conceiving this clinical interface. This interface reflects, in fact, complications of dissociative disorders which require to be addressed in the first line. This is either due to the medical and psychiatric urgency (e.g. functional neurological symptoms, brief psychosis) or due to resistance to treatment (e.g. antidepressant pharmacotherapy) which seem to be indicated for the particular condition. This transdiagnostic schema is based on a combined utilization of etic and emic principles in cultural understanding of psychiatric disorders. Namely, universal medical-psychiatric categories are conceived as tools of communication and mutual understanding rather than being mere appearances or primary disturbances. On the other hand, not only clinical studies, research on neurobiology of dissociation as well as other psychiatric disorders are also heavily affected by the parallel-distinct presence of psychopathological constructs. Nevertheless, consideration of this natural phenomenon would serve as a new avenue for psychiatry in general which is hoped to lead discoveries improving prevention and treatment of the affected population.
Potential to Distress
This presentation was originally presented as a live webinar in May 2022.
At the conclusion of this webinar participants will be able to:
- List three acute or chronic secondary syndromes
- Discuss the influences of dissociation on other psychiatric disorders
- Describe the cultural aspects of the interaction between clinical surface and core psychopathology in dissociative disorders
- Identify potential areas of innovation in psychiatry through the comorbidity problem related to dissociation
Presenter: Vedat Sar
Presenter Bio: Vedat Sar, MD is a psychiatrist and professor/chair in the Department of Psychiatry, Koc University School of Medicine, Istanbul, Turkey. He has been studying and teaching dissociative disorders and complex trauma since early 90’ies in various general psychiatric settings including inpatient, outpatient, and emergency units of academic hospitals as well as in a solo private practice. Main focus of his research has been epidemiology, diagnosis, and comorbidity issues on the spectrum of trauma-related disorders. He has published peer-reviewed papers and book chapters on the subject alongside two co-edited books. He is a Fellow and Past President of the International Society for the Study of Trauma and Dissociation (ISSTD) and Past President of the European Society for Traumatic Stress Studies (ESTSS). He has been honored by ISSTD with a Lifetime Achievement Award.
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