Dissociation -: therapeutic and phormacologic interventions

Dissociation is a response to trauma which interrupts integrative functions of the brain, biographic memory, development of an integrated identity and/or adequate apperceptions. Trauma will be memorized as an affective state (memory function of the amygdala) but not as a structured personalized autobiographic event with a time-line to it (memory function of the hippocampus). Afterwards trauma-related dissociation will be maintained by integrative deficits and phobic avoidance. It occurs automated any time the patient faces a trigger of an emotional scheme associated with traumatic material. Psychotherapeutic interventions should aim to access primary emotions to the dissociative patient in a stable therapeutic relationship. Thereby dysfunctional emotional schemes can be discovered, reframed and new affective functional schemes be experienced, formed and integrated into the patients' identity. Alternative solutions/reactions to trauma-triggers can be found and memorized. Pharmacologic treatment options for dissociative disorders are limited. Up till now the following agents have been investigated for the treatment of dissociative patients: antidepressants, benzodiazepines, opiate antagonists as well as antiadrenergic substances. However none of the agents has proven as a gold standard. To the contrary, the effects were limited, so that psychopharmacological treatment can only he adjuvant in the treatment of dissociative disorders.