Chapter 20: Dissociative Disorders

The chapter presents the diagnostic frameworks established in DSM-5-TR, which categorizes dissociative identity disorder, dissociative amnesia, depersonalization and derealization disorder, and other specified and unspecified dissociative disorders, while also reviewing how ICD-11 extends classification to include trance and possession experiences. The historical foundation of dissociation scholarship is traced through pivotal figures including Jean-Martin Charcot, Pierre Janet, and Sigmund Freud, whose observations of dissociative phenomena in the late nineteenth and early twentieth centuries shaped contemporary understanding. The chapter emphasizes trauma as a central etiological factor, illustrating this connection through clinical presentations such as wartime dissociation, dissociative fugue states, and the hysterical manifestations documented at La Salpêtrière hospital. Modern conceptualizations have evolved from psychoanalytic models toward contemporary trauma-informed and neuobiological frameworks that integrate cognitive, biological, and cultural perspectives on dissociation. The chapter addresses significant controversies that have influenced psychiatric understanding, including debates surrounding false memory formation, allegations of ritual abuse, and sociocognitive critiques of dissociative identity disorder diagnosis. Additionally, the chapter explores institutional and cultural dimensions of dissociative pathology, including betrayal trauma within organizational contexts, the intersection of systemic racism with trauma responses, and implications of high-profile abuse scandals. Throughout, the chapter discusses ongoing refinements in nosological classification and the need to balance empirical evidence with cultural sensitivity in understanding dissociative experiences across diverse populations and contexts.