Dissociative, Trauma & Stressor-Related Disorders (College Board AP® Psychology): Study Guide

Symptoms & causes of dissociative disorders

• Dissociative disorders involve a disruption in the integration of:

  • consciousness

  • memory

  • identity

  • perception

• Dissociation is a disconnection from one's thoughts, feelings, memories, or sense of identity

  • In mild forms, dissociation is normal, e.g. daydreaming or "spacing out" are minor dissociative experiences

  • In dissociative disorders, dissociation is severe, persistent, and disruptive to daily functioning

• Two dissociative disorders include:

  • dissociative amnesia (with and without fugue)

  • dissociative identity disorder

Dissociative amnesia

Symptoms

• Dissociative amnesia is characterized by an inability to recall important autobiographical information, usually traumatic or stressful in nature

  • The amnesia is psychologically caused - there is no neurological basis (e.g. brain injury)

• The person may be unable to recall significant periods of their life, specific traumatic events, or even their entire personal identity

  • E.g. a person who cannot recall several years of their life following a period of severe abuse

• Dissociative amnesia with fugue:

  • A fugue state involves the person not only losing memory but also leaving their normal life

  • The person may travel far from home, establish a new life and identity, and have no recollection of their previous life

  • Fugue states typically resolve and the person returns to their former identity, though the period of the fugue may remain amnesic

Dissociative identity disorder (DID)

Symptoms

• Dissociative identity disorder (DID) is characterized by the presence of two or more distinct personality states that take control of the person's behavior

  • These personality states are also called alters

• Each alter may have its own name, age, gender, memories, and behavioral patterns

  • These behaviors are sometimes very different from each other and from the host identity

    • E.g. an adult with DID may have one identity who is a child, one who is aggressive, one who is highly competent. They take control at different times and the person has significant memory gaps between these states

• DID is rare and controversial:

  • Some researchers argue that DID cases increased dramatically in the 20th century as it became more publicized

    • This suggests that DID is influenced by the media

  • Critics suggest that some cases may be iatrogenic

    • This means that DID has been created by therapy rather than representing a genuine underlying dissociation

Causes of dissociative disorders

The following causal explanations apply across dissociative disorders, though each has specific relevance to individual conditions

Psychodynamic causes

• In dissociative amnesia: the memory is actively kept out of consciousness (repressed) and the person has no access to specific traumatic events or periods of their life

  • E.g. a person who experienced prolonged childhood abuse has no memory of those years. The memories exist at an unconscious level but cannot be retrieved because they are too threatening to the person's psychological stability

• In DID: when childhood trauma is extreme and prolonged, the mind protects itself by splitting consciousness entirely rather than simply repressing individual memories

  • Different identity states develop to manage different traumatic experiences and emotions, as the person cannot integrate these into a single coherent sense of self

Behavioral causes

• The avoidance of traumatic memories removes the intense distress associated with them, making dissociation more likely to be repeated over time

  • The dissociative response is maintained because it successfully reduces psychological pain

• In dissociative amnesia: not accessing the traumatic memory produces relief

  • This reinforces the pattern of memory avoidance

• In DID: switching between identity states removes the person from overwhelming experiences

  • Each alter may carry only a portion of the traumatic experience, distributing the distress across states rather than concentrating it in one identity

Trauma

• High levels of stress hormones (particularly cortisol) can disrupt the normal functioning of the hippocampus, which is critical for encoding and retrieving explicit autobiographical memories

  • The memory may be fragmented or stored in ways that make retrieval difficult or impossible under normal circumstances

• In dissociative amnesia: this neurobiological disruption explains why specific traumatic memories or entire periods of life are inaccessible

  • The trauma has disrupted the normal storage and retrieval of those memories

• In DID: when trauma occurs in early childhood before a stable, integrated sense of identity has formed, the developing self cannot assimilate the experience

  • Separate identity states emerge as the child's way of managing experiences

Cultural context

• The rates of DID diagnosis vary significantly across cultures and historical periods

  • This suggests sociocultural factors shape the prevalence and expression of the disorder

• In some cultures, dissociative experiences are understood as valued spiritual states rather than symptoms of disorder

  • They are therefore not pathologized

• This cultural variation raises questions about the extent to which DID is a universal response to trauma versus a culturally shaped expression of distress

Symptoms and causes of trauma & stressor-related disorders

• Trauma and stressor-related disorders are characterized by exposure to a traumatic or stressful event

Post-traumatic stress disorder (PTSD)

Symptoms

• PTSD develops in some people following exposure to a traumatic event either directly or indirectly, such as:

  • combat,

  • sexual assault

  • natural disaster

  • witnessing death

• Not everyone who experiences trauma develops PTSD

  • Individual vulnerability and the nature of the trauma all influence whether PTSD develops

• Symptoms of PTSD fall into four clusters:

• Re-experiencing (intrusion) symptoms

  • Flashbacks: vivid, involuntary reliving of the traumatic event as if it is happening again in the present

  • Recurrent, intrusive memories of the trauma

  • Distressing dreams or nightmares related to the trauma

  • Intense psychological distress when reminded of the trauma

• Avoidance symptoms

  • Avoiding thoughts, feelings, or reminders associated with the trauma

  • Avoiding people, places, activities, or situations that trigger memories of the trauma

• Negative alterations in cognition and mood

  • Emotional detachment: feeling cut off from others and the inability to experience positive emotions

  • Persistent negative beliefs about oneself, others, or the world, e.g."I am damaged"

  • Persistent negative emotional states, e.g. fear, horror, anger, guilt, shame

  • Loss of interest in previously valued activities

• Alterations in arousal and reactivity

  • Hypervigilance: being constantly on alert for danger

  • Persistent heightened state of anxiety

  • Sleep disturbances

  • Hostility and irritable or aggressive behavior

  • Difficulty concentrating

Causes

• The possible causes of PTSD involve the interaction between the traumatic event and individual vulnerability factors:

  • Severity and nature of the trauma:

    • more severe, prolonged, or interpersonal traumas (e.g. sexual assault, combat) are more likely to produce PTSD than brief, accidental traumas

  • Biological factors:

    • genetic predisposition to anxiety and stress reactivity

    • differences in the stress response system (HPA axis)

    • structural differences in the amygdala and hippocampus

  • Psychological factors:

    • pre-existing depression or anxiety increases vulnerability

    • cognitive appraisal of the event (perceiving it as catastrophic and uncontrollable) influences whether PTSD develops

  • Social factors:

    • lack of social support after trauma is one of the strongest predictors of PTSD development, whereas having a strong support network is protective

  • Cultural factors:

    • cultural norms influence what is considered traumatic, how trauma is expressed, and whether help-seeking is acceptable