Dissociative alterations of the consciousness: A preliminary study

Aim: Over the last few years much discussion has taken place as to whether dissociation can be considered a transnosological phenomenon associated to other important psychiatric problems or whether it should be classified as an individual nosological category. In fact, dissociative phenomena are not infrequent in a number of psychiatric illnesses, which has led some authors to hypothesize the apparent lack of specificity in the spectrum of dissociative symptoms. Methods. Our study examines patients observed during the year 2004 at UOP 2 directed by the University at A.O. Ospedale di Circolo e Fondazione Macchi in Varese, where dissociative alterations of the consciousness were found to be present, which, according to a primary distinction (Janet) were of a non psychotic nature. Having confirmed the real manifestation of dissociative states using the Dissociative Experience Scale II (DES II) together with clinical diagnosis, made with the DSM-W-TR and the ICD-10, extraneous to psychosis groupings, the study likewise underlines the fact that dissociative alterations of the consciousness are also to be seen in numerous diagnostic categories. Results. The aim of this paper is to search for significant pathogenic events of both a traumatic nature (bereavement, childhood abuse, adoption, war) and also an anthropological-cultural nature (migration from foreign countries) which could possibly correlate to the alterations in consciousness observed. Conclusion. In order to have a clearer phenomenologlcal understanding of dissociative states, three levels of increasing gravity relative to the alterations of the state of consciousness were arbitrarily introduced: fluctuating, altered, and dissociated. These levels were verified by a rising score on the DES II scale.