Pain-determined dissociation episodes

Objectives. Dissociation disorders are a group of conditions characterized by a disruption of integrated function of consciousness, memory, or percept ion. The purpose of this report is to describe the impact of increased pain levels on the genesis of two types of dissociation disorders, dissociative fugue (DF) and dissociative identity disorder (DID), in patients with chro nic pain (PWCP). Design/Patients/Inteiventions/Outcome Measures. From November 1992 to July 2000, 2 DID and 4 DF patients were identified from 2,544 consecutive PWCP e valuated and/or treated at the University of Miami Comprehensive Pain and R ehabilitation Center. The salient features of these six dissociation PWCP a re presented. All four DF PWCP completed a dissociation experience scale fi rst at the time of identification of the dissociation disorder (with chroni c pain) and one alleging their experiences with dissociation predevelopment of chronic pain. Results. Frequency percentage for dissociation for this population was 0.23 5%. For all four of the DF PWCP, dissociation episodes began after the onse t of chronic pain. All six (100%) PWCP described or associated their episod es of dissociation to times when their pain would increase. Mean dissociati on scale scores for the four DF PWCP were 1.4 +/- 1.11 pre-chronic pain and 20.53 +/- 16.82 at time of identification of the dissociative disorder (wi th chronic pain). Conclusions. The frequency percentage for dissociation within PWCP is small compared with psychiatric populations. There may be an etiological associa tion between the development of dissociation episodes and the development o f chronic pain and/or increases in chronic pain.