Approche thérapeutique des troubles dissociatifs

Beyond the individuality inherent in psychotherapeutic counseling, the therapeutical approach varies depending on the clinical type of dissociation and above all on the psychiatric comorbidities. The most commonly used psychotherapeutic techniques are psychoanalytical (free associations, or from dissociative experiences), hypnosis (work on modified states of consciousness) and more recently cognitive-behavioral techniques. Group psychotherapy has also been used. Several points were made in the attempt to formulate a specific psychotherapy for patients suffering from dissociative disorders: the necessity of informing the patient on the nature and the extent of the treatment; identification of the different “states” of personality and their functions; exploration, assimilation and integration of traumatic reminiscences; renunciation of dissociation as the sole “strategy of survival”; progressive integration of the different dissociated states of personality into one stable personality. There is no consensus on the treatment of dissociative disorders. Sketches of guidelines are presently being elaborated, notably on the impulse of the ISSD (International Society for the Study of Dissociation) and the APA (American Psychiatric Association). After the confirmation of the diagnosis (excluding in particular psychotic disorders), the proposed psychotherapeutic treatment is frequently associated with pharmacotherapy essentially suited to the existing comorbidities (anxiety and depressive disorders, etc.), since several pharmacological studies have not demonstrated the specificity of certain molecules for the dissociative disorders. A precocious diagnose allows the optimization of the management of the patients while cutting down the risk for developing comorbidities.