Chapter 4. Why does Dissociation Occur ? (3)

Does dissociation really serve as a defence? – issue of acute stress disorder (ASD)
What needs to be asked here is how much it is relevant to consider dissociation as a defence from our vantage point of modern psychiatry. Many clinicians agree that although dissociation can work as a defense, it is just temporary, and it can leave some deleterious effect as it postpones our chance to process the traumatic memory（Candel, 2004）. It is worth examining the validity of the theory.
If we only focus on dissociation experienced around the traumatic event, its effectiveness is obvious. Trauma can amount to a psychological death, and with the help of dissociation we can numb up ourselves and bypass its direct experience. However, it is possible that dissociative response itself can be maladaptive in our daily life. In current psychiatry, we acknowledge this maladaptive dissociation in the form of a diagnostic condition called acute stress disorder (ASD)
ASD appeared in DSM-IV in 1992, as s trauma-related disorder diagnosed within 4 weeks after trauma. It also appeared in ICD-10 in 1994. There was a reason why the diagnostic category of ASD should be created. By then clinicians found some inconvenience with PTSD which, accoding to DSM, could not be diagnosed until 4weeks after the traumatic event. Many people experience flashbacks, emotional numbness and hyperalertness as a normal response to the trauma, but most of them recover within a month. They thought that the clinicians need to wait for a month to diagnose PTSD to avoid unnecessary overdiagnosis. Obviously this left many patients with serious symptoms undiagnosed soon after the trauma until 4 weeks have passed. Thus the introduction of ASD had a purpose of filling this diagnostic vacuum.
The main symtoms of ASD in the DSM is dissociative in nature. There are five dissociative symtoms that a patient could have.
In the B criteria, DSM states that a patient “(E)ither while experiencing or after experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms:
1. a subjective sense of numbing, detachment, or absence of emotional responsiveness
2. a reduction in awareness of his or her surroundings (e.g., “being in a daze”)
3. derealization
4. depersonalization
5. dissociative amnesia (i.e., inability to recall an important aspect of the trauma)