Dissociative Syndromes

  • Carsten SpitzerEmail author


Dissociation can likewise be conceived as state (of consciousness), as personality trait in terms of a disposition to dissociate, as collective name for a heterogeneous group of psychopathological features as well as psychophysiological response to traumatic experiences or as defence mechanism. A neuropsychodynamic model of dissociation could be conceptualized as follows: An external or internal stimulus leads to neuronal activation patterns that manifest on the level of subjective experience as highly adverse and intense emotions. Due to the negative valence and the (hyper-)arousal, these affective states impede upon an adequate integration with cognitive and self-referential information by a ‘bottom-up’ hyperactivation of prefrontal areas which, in turn, inhibit top-down cortical-subcortical networks which are essential for memory functioning, (self-)consciousness and agency as well as body control. Dissociation results from a cortical-subcortical inhibition and serves to cope with both external traumatic stress as well as interpersonal and intrapsychic conflicts by means of a subjective decontextualization.


  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  2. Aybek S, Nicholson TR, Zelaya F, et al. Neural correlates of recall of life events in conversion disorder. JAMA Psychiat. 2014;71:52–60.CrossRefGoogle Scholar
  3. Becker-Blease KA, Deater-Deckard K, Eley T, et al. A genetic analysis of individual differences in dissociative behaviors in childhood and adolescence. J Child Psychol Psychiatry. 2004;45:522–32.CrossRefGoogle Scholar
  4. van Beilen M, Vogt BA, Leenders KL. Increased activation in cingulate cortex in conversion disorder: what does it mean? J Neurol Sci. 2010;289:155–8.CrossRefGoogle Scholar
  5. Bell V, Oakley DA, Halligan PW, et al. Dissociation in hysteria and hypnosis: evidence from cognitive neuroscience. J Neurol Neurosurg Psychiatry. 2011;82:332–9.CrossRefGoogle Scholar
  6. Breuer J, Freud S. Studies on hysteria. In: Strachey J, editor. The standard edition of the complete psychological works of Sigmund Freud, vol. 2. London: Hogarth; 1955. p. 1–319.Google Scholar
  7. Bromberg PM. Mentalize THIS!: dissociation, enactment, and clinical process. In: Jurist E, Slade A, Bergner S, editors. Mind to mind: infant research, neuroscience, and psychoanalysis. New York: Other Press; 2008. p. 414–34.Google Scholar
  8. Brown RJ, Cardena E, Nijenhuis ERS, et al. Should conversion disorder be reclassified as dissociative disorder in DSM-V? Psychosomatics. 2007;48:369–78.CrossRefGoogle Scholar
  9. Browning M, Fletcher P, Sharpe M. Can neuroimaging help us to understand and classify somatoform disorders? A systematic and critical review. Psychosom Med. 2011;73:173–84.CrossRefGoogle Scholar
  10. Burke MJ, Ghaffar O, Staines WR, et al. Functional neuroimaging of conversion disorder: the role of ancillary activation. Neuroimage Clin. 2014;30:333–9.CrossRefGoogle Scholar
  11. Cardena E. The domain of dissociation. In: Lynn SJ, Rhue RW, editors. Dissociation: theoretical, clinical, and research perspectives. New York: Guilford Press; 1994. p. 365–94.Google Scholar
  12. Chen Y, Baram TZ. Toward understanding how early-life stress reprograms cognitive and emotional brain networks. Neuropsychopharmacology. 2016;41:197–206.CrossRefGoogle Scholar
  13. Dalenberg CJ, Brand BL, Gleaves DH, et al. Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychol Bull. 2012;138:550–88.CrossRefGoogle Scholar
  14. Dell PF, O’Neil JA, editors. Dissociation and dissociative disorders: DSM-V and beyond. New York: Routledge; 2009.Google Scholar
  15. Dorahy MJ, Brand BL, Sar V, et al. Dissociative identity disorder: an empirical overview. Aust N Z J Psychiatry. 2014;48:402–17.CrossRefGoogle Scholar
  16. Dutra L, Bureau JF, Holmes B, et al. Quality of early care and childhood trauma: a prospective study of developmental pathways to dissociation. J Nerv Ment Dis. 2009;197:383–90.CrossRefGoogle Scholar
  17. Ebner-Priemer UW, Mauchnik J, Kleindienst N, et al. Emotional learning during dissociative states in borderline personality disorder. J Psychiatry Neurosci. 2009;34:214–22.PubMedPubMedCentralGoogle Scholar
  18. Ellenberger HF. The discovery of the unconscious. The history and evolution of dynamic psychiatry. New York: Basic Books; 1970.Google Scholar
  19. Frankel AS. Dissociation and dissociative disorders: clinical and forensic assessment with adults. In: Dell PF, O’Neil JA, editors. Dissociation and dissociative disorders: DSM-V and beyond. New York: Routledge; 2009. p. 571–83.Google Scholar
  20. Guralnik O, Simeon D. Depersonalization: standing in the spaces between recognition and interpellation. Psychoanal Dialogues. 2010;20:400–16.CrossRefGoogle Scholar
  21. Holmes EA, Brown RJ, Mansell W, et al. Are there two qualitatively distinct forms of dissociation? A review and some clinical implications. Clin Psychol Rev. 2005;25:1–23.CrossRefGoogle Scholar
  22. Jang KL, Paris J, Zweig-Frank H, et al. Twin study of dissociative experience. J Nerv Ment Dis. 1998;186:345–51.CrossRefGoogle Scholar
  23. Koenen KC, Saxe G, Purcell S, et al. Polymorphisms in FKBP5 are associated with peritraumatic dissociation in medically injured children. Mol Psychiatry. 2005;10:1058–9.CrossRefGoogle Scholar
  24. Kopelman MD. Disorders of memory. Brain. 2002;125:2152–90.CrossRefGoogle Scholar
  25. Lanius RA, Vermetten E, Loewenstein RJ, et al. Emotion modulation in PTSD: clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry. 2010;167:640–7.CrossRefGoogle Scholar
  26. Lochner C, Seedat S, Hemmings SM, et al. Investigating the possible effects of trauma experiences and 5-HTT on the dissociative experiences of patients with OCD using path analysis and multiple regression. Neuropsychobiology. 2007;56:6–13.CrossRefGoogle Scholar
  27. Markowitsch HJ, Calabrese P, Fink GR, et al. Impaired episodic memory retrieval in a case of probable psychogenic amnesia. Psychiatry Res. 1997;74:119.e26.CrossRefGoogle Scholar
  28. McLean SA, Diatchenko L, Lee YM, et al. Catechol O-methyltransferase haplotype predicts immediate musculoskeletal neck pain and psychological symptoms after motor vehicle collision. J Pain. 2011;12:101–7.CrossRefGoogle Scholar
  29. Musholt K. A philosophical perspective on the relation between cortical midline structures and the self. Front Hum Neurosci. 2013;7:536. Scholar
  30. Nijenhuis ER, van der Hart O. Dissociation in trauma: a new definition and comparison with previous formulations. J Trauma Dissociation. 2011;12:416–45.CrossRefGoogle Scholar
  31. Nijenhuis ER, Spinhoven P, Vanderlinden J, et al. Somatoform dissociative symptoms as related to animal defensive reactions to predatory imminence and injury. J Abnorm Psychol. 1998;107:63–73.CrossRefGoogle Scholar
  32. Northoff G, Bermpohl F. Cortical midline structures and the self. Trends Cogn Sci. 2004;8:102–7.CrossRefGoogle Scholar
  33. Ogawa JR, Sroufe LA, Weinfield NS, et al. Development and the fragmented self: longitudinal study of dissociative symptomatology in a nonclinical sample. Dev Psychopathol. 1997;9:855–79.CrossRefGoogle Scholar
  34. Perez DL, Dworetzky BA, Dickerson BC, et al. An integrative neurocircuit perspective on psychogenic nonepileptic seizures and functional movement disorders: neural functional unawareness. Clin EEG Neurosci. 2015;46:4–15.CrossRefGoogle Scholar
  35. Pieper S, Out D, Bakermans-Kranenburg MJ, et al. Behavioral and molecular genetics of dissociation: the role of the serotonin transporter gene promoter polymorphism (5-HTTLPR). J Trauma Stress. 2011;24:373–80.CrossRefGoogle Scholar
  36. Putnam FW, Carlson EB, Ross CA, et al. Patterns of dissociation in clinical and nonclinical samples. J Nerv Ment Dis. 1996;184:673–9.CrossRefGoogle Scholar
  37. Reinders AA, Nijenhuis ER, Paans AM, et al. One brain, two selves. NeuroImage. 2003;20:2119–25.CrossRefGoogle Scholar
  38. Reinders AA, Willemsen A, den Boer JA, et al. Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: a PET study and neurobiological model. Psychiatry Res. 2014;223:236–43.CrossRefGoogle Scholar
  39. Sartory G, Cwik J, Knuppertz H, et al. In search of the trauma memory: a meta-analysis of functional neuroimaging studies of symptom provocation in posttraumatic stress disorder (PTSD). PLoS ONE. 2013;8(3):e58150.CrossRefGoogle Scholar
  40. Savitz JB, van der Merwe L, Newman TK, et al. The relationship between childhood abuse and dissociation. Is it influenced by catechol-O-methyltransferase (COMT) activity? Int J Neuropsychopharmacol. 2008;11:149–61.CrossRefGoogle Scholar
  41. Schilder P. Depersonalization. Introduction to psychoanalytic psychiatry. Nerv Ment Dis. 1928;50:120.Google Scholar
  42. Schore AN. Advances in neuropsychoanalysis, attachment theory, and trauma research: implications for self psychology. Psychoanal Inq. 2002;22:433–84.CrossRefGoogle Scholar
  43. Sierra M, Berrios GE. Depersonalization: neurobiological perspectives. Biol Psychiatry. 1998;44:898–908.CrossRefGoogle Scholar
  44. Sierra M, David AS. Depersonalization: a selective impairment of self-awareness. Conscious Cogn. 2011;20:99–108.CrossRefGoogle Scholar
  45. Simeon D, Guralnik O, Hazlett EA, et al. Feeling unreal: a PET study of depersonalization disorder. Am J Psychiatry. 2000;157:1782–8.CrossRefGoogle Scholar
  46. Spitzer C, Spelsberg B, Grabe HJ, Mundt B, Freyberger HJ. Dissociative experiences and psychopathology in conversion disorders. J Psychosom Res. 1999;46:291–4.CrossRefGoogle Scholar
  47. Spitzer C, Barnow S, Freyberger HJ, Grabe HJ. Dissociation predicts symptom-related treatment outcome in short-term inpatient psychotherapy. Aust N Z J. 2007;41:682–7.CrossRefGoogle Scholar
  48. Staniloiu A, Markowitsch HJ. Towards solving the riddle of forgetting in functional amnesia: recent advances and current opinions. Front Psychol. 2012;3:403. Scholar
  49. Staniloiu A, Markowitsch HJ. Dissociative amnesia. Lancet Psychiatry. 2014;1:226–41.CrossRefGoogle Scholar
  50. Van der Hart O, Dorahy MJ (2009) History of the concept of dissociation. In: Dell PF, O’Neil JA (eds) Dissociation and dissociative disorders: DSM-V and beyond. Routledge, New York, pp 3-26Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Asklepios Fachklinikum TiefenbrunnRosdorfGermany

Personalised recommendations