The construct
Dissociation = disruption of the normal integration of consciousness, memory, identity, perception, emotion, and body representation — strongly linked to trauma.
- Dissociative amnesia — inability to recall important autobiographical (usually traumatic) information, beyond ordinary forgetting; localised/selective/generalised; ± dissociative fugue (purposeful travel + identity disturbance).
- Depersonalisation/derealisation disorder — persistent detachment from self/surroundings with intact reality testing (they know it's a subjective experience — the key separator from psychosis).
- Dissociative identity disorder — discontinuity of identity/agency with recurrent amnesia; near‑universal severe early trauma.
Discriminators (high‑yield)
- Dissociative vs organic amnesia: dissociative amnesia is typically retrograde, autobiographical, trauma‑linked, with preserved new learning; organic (e.g., Wernicke–Korsakoff, TBI, TGA) shows anterograde deficits and a medical cause — image and screen first.
- Dissociation vs psychosis: dissociation disturbs integration with preserved reality testing; psychosis disturbs reality testing. (They can co‑occur, e.g., in complex PTSD.)
- Non‑epileptic (dissociative) seizures vs epilepsy: a functional/dissociative phenomenon — confirm with video‑EEG; both are real and neither is "faking."
The clinical stance
Functional/dissociative symptoms are genuinely experienced, not feigned. Exclude organic disease properly (never a lazy label), then treat with trauma‑focused psychotherapy and psychoeducation; "nothing is wrong" is both false and harmful.
Pitfalls
- Labelling "conversion/dissociation" without excluding organic disease (missed encephalitis, stroke, TGA).
- Conflating dissociation with psychosis.
Pearls
- 🎯 Preserved reality testing distinguishes dissociation from psychosis.
- 🩺 Dissociative amnesia spares new learning; anterograde failure = look for an organic cause.
Next → The high‑volume, high‑stakes domains — addictions, child psychiatry, eating, and sleep (Part 4).