Note: this is only a brief excerpt from the above manuscript to give the reader an overview of dissociative symptoms.
Many patients with dissociative disorders need to express the "memories and feelings connected to their traumas, but are afraid to, because of the fear, pain, anger, and shame connected to them, of which they may not even be conscious" (Franklin, 1988, p.29). Franklin suggests that this leads to a conflict between expression and hiding which often leads to a compromise where the memories and feelings escape through subtle signs of dissociation. In relation to models of suppression and repression, Franklin states that the subtle signs are returns of the dissociated rather than a return of the repressed and that internal or external stressors may serve as triggers which activate these memories.
Loewenstein (1991) in his interview model created to diagnosis MPD through dissociative signs grouped many of these subtle signs or symptoms into a matrix of outlining symptom clusters:
(1) Process (MPD) symptoms:
- Alter attributes
- Passive influence symptoms/interference phenomena
- Linguistic usage
(2) Amnesia Symptoms
- Blackouts/time loss
- Disremembered behavior
- Unexplained possessions
- Inexplicable changes in relationships
- Fluctuations in skills/habits/knowledge
- Fragmentary recall of entire life history
- Chronic mistaken identity experiences
(3) Autohypnosis Symptoms (Manifest by High Hypnotizability)
- Spontaneous trances
- Spontaneous age regression
- Negative hallucinations
- Voluntary anesthesia
- Out-of-body experiences
- Trance logic
- Eye roll and switching
- Psychological trauma
- Reactivity to triggers/panic/anxiety
- Hyperarousal/startle response
(5) Somatoform Symptoms
- Conversion symptoms
- Somatoform pain symptoms
- Somatization disorder/Briquet's syndrome
- Somatic memory
(6) Affective Symptoms
- Depressed mood
- Mood swings
- Vegetative symptoms
- Suicidal thoughts or attempts/self-mutilation
- Helpless/hopeless" (p. 569)
Loewenstien states that many patients show subtle signs of dissociation as expression of the conflict between expression (of memories and feelings connected to their traumas) and hiding. He also states that child abuse, trauma, and family violence is the single largest preventable cause of mental illnes and that it is in this light that dissociative symptoms should be routinely and persistently looked for and inquired after to insure proper mental health care delivery.
Franklin, J. (1988) Diagnosis of covert and subtle forms of multiple personality disorder. Dissociation Vol. 1,No. 2, pp 27-32.
Kluft, R.P. (1985) Making the diagnosis of multiple personality disorder (MPD). In F.F. Flach (Ed.), Directions in Psychiatry (Vol. 5, Lesson 23). New York: Haterleigh.
Loewenstein, R.J. (1991) An office mental status examination for complex chronic dissociative symptoms and multiple personality disorder. Psychiatric Clinics of North America, Vol. 14, No. 3, pp 567-604.
Putnam, F.W. (1985) Dissociation as a response to extreme trauma. In R.P. Kluft (Ed.), Childhood antecedents of multiple personality. Washington, DC: American Psychiatric Press.