Understanding Dissociative Disorders

A guide for family physicians and health care professionals

By: Marlene E Hunter


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Size: 234 x 156mm
Pages : 208
ISBN : 9781845900502
Format: Paperback
Published: September 2009

Understanding Dissociative Disorders is for all physicians looking for ways to understand the idiosyncrasies of dissociative patients, their problematic ways of responding to medication, strange laboratory results and multitude of physical and emotional symptoms.

This book offers realistic, practical answers to questions you didn’t even think to ask. Carefully organised for easy reference, it discusses what you can do and what you can’t, where and how to ask for help, and what to say to your patient. More importantly, it explains what leads patients to solutions that seem utterly unrealistic.

Picture for author Marlene E Hunter

Marlene E Hunter

Marlene E. Hunter, MD is a family physician who began to work with highly dissociative patients in 1977. She is a Certificant and Fellow of the College of Family Physicians of Canada and a past Associate Clinical Professor at the University of British Columbia in the Department of Family Medicine. She is a past president of the American Society of Clinical Hypnosis, the Canadian Society of Clinical Hypnosis (B.C. Division) and the B.C. College of Family Physicians.


  1. Marlene Hunter's Understanding Dissociative Disorders is likely to become known as simply the best primer on this troublesome disorder.  The writing is exquisitely clear, concise, and enjoyable.  The bullet lists of clues to alert one that your confusing patient may be DID and case examples alone make this book a practical must for both family physicians and psychologists in practice. 

    Professor Areed Franz Barabasz, EdD, PhD, ABPP Washington State University USA, Editor, International Journal of Clinical and Experimental Hypnosis, President, American Psychological Association Div. 30 Society for Psychological Hypnosis
  2. For the physician or therapist who may feel confounded by the “thick file” patient/client, this book provides valuable and well-researched insights into dissociative disorders.

    Formerly know as Multiple Personality Disorder (MPD) Marlene E Hunter MD synthesises her wealth of clinical experience to assist with diagnosis, pharmacology and therapeutic intervention. Peppered with practical examples, this book may well answer the question of how to handle the “non-specific” patient complaint.
  3. This is a must-have for the bookshelf of primary care doctors and other healthcare workers and may also be a useful book to dip into for the service user as well. Although the focus is on the family physician, it embraces the challenges facing the health care professional in the diagnosis and treatment of a person with a Dissociative Disorder and Dissociative Identity Disorder in particular.
  4. Dissociative disorders can be bewildering and challenging to the unenlightened health care professional. Written in a jargon-free and easy-to-read style, Marlene Hunter offers a wealth of useful insights into the complexities of dissociation, as well as providing constructive guidelines for physicians and health care professionals who encounter dissociative patients in their practice. She addresses a wide range of issues, from dealing with crisis, to recognizing symptoms, to the right questions to ask, to medications found to be effective and ineffective. This highly readable and authoritative text deserves a place on the bookshelves of all professionals with a desire to understand and help patients who present with dissociative symptoms.
  5. Just reading the title of this book I was filled with hope " surely such a guide was long overdue. So many people I know (including myself) with dissociative experiences have been let down and badly re-traumatised because of the lack of knowledge about dissociative disorders among general practitioners and other general health care professionals working in primary & secondary care. I prayed that the book's contents wouldn't dash my hopes.

    In fact, I was so reluctant to have my hopes betrayed that I kept putting off reading the book. And one fine way I found to delay writing this review was to loan the book to my own GP (who though not very knowledgeable about dissociation has been willing to listen, believe and learn). I asked her if she could find the time in her busy schedule to read the book and let me know what she thought. After all wasn't she one of those for whom the book had been written " a family physician. She returned the book to me less than a week later with a brief note:-

    "I have read the whole book " very interesting " she seems to bring in most psychiatric problems. However, it does add to a GP's average level of knowledge about Dissociative Disorders and lots of other problems we see. Her positive attitude is helpful"

    That "most psychiatric problems' and "lots of other problems' really piqued my interest. I have long held the view that an understanding of dissociation would go a long way towards understanding, not just those disorders classified as dissociative, but most psychiatric and many physical problems too. It was looking like Marlene Hunter agreed with me so I began to read.

    I was not disappointed.

    The book is less than 200 pages long and written in a readable style with short paragraphs, many references to real life situations and advice on how to respond. This all contributes to making it accessible and useful. This is very important, because, with the many conflicting demands in the busy life of the average health care professional, ignorance about dissociative disorders will continue to flourish if basic, immediately practical information to counter that ignorance isn't easily and quickly digestible.
    And Dr Anne was right. The book does cover many problems which wouldn't traditionally be thought of as dissociative.

    The author includes chronic pain syndromes such as fibromyalgia; other syndromes such as chronic fatigue syndrome, somatisation, irritable bowel, urinary problems. She advises understanding and treating all of these within a dissociative disorder framework. This is a welcome view as so often trauma survivors with inconsistent and confusing physical and neurological symptoms are dismissed as attention-seeking and manipulative.

    Appropriately, a whole chapter is devoted to PTSD but also included are very readable sections on depression, borderline personality disorder, suicide & self-harm, alcohol abuse, body-image distortions, eating disorders, sleep disturbances " all of which are commonly found alongside (or misdiagnosed instead of) the traditional dissociative disorders. 

    Final chapters include information on sexual dysfunction and relationships. A chapter headed "For Children with Dissociative Parents" addresses the vulnerability of children in the care of people who are dissociative. While welcoming the responsible advice given for the protection of children I was disappointed that the author countered her own message that not all dissociative parents are bad parents with an ambiguous anecdote.

    Traditional dissociative disorders are covered in early chapters which regrettably stereotype dissociative patients as "thick chart' patients. I can see that such stereotyping serves to get the target audience interested " GPs, particularly, want answers about patients who attend frequently but can't be firmly diagnosed" but its regrettable that the author panders to some professionals' prejudices with the use of such pejorative terms as "thick chart' and "difficult'. Other early chapters look at specific contexts of working with the dissociative patient " accident & emergency, obstetrics, surgery, even at the dentist. Brief though these sections are they show much needed recognition of how re-traumatising such experiences can be for the abuse survivor who dissociates.

    There are useful chapters on how misleading the results of lab investigations can be when the patient is dissociative and about the special considerations needed when medicating people who dissociate. 

    But the basic definitions and explanations of the traditional dissociative disorders " particularly DID - are covered in an Introduction which is at risk of being skipped because of it's subtitles "How Did I Get Into This" or "What's a Nice Girl Like You Doing in Such a Psychotherapeutic Minefield". Don't skip it. The introduction is very informative and isn't as ego-centric as those subtitles suggest.

    Throughout the book there is an oft repeated heading "What can you do?" which provides sensible and practical advice on how to respond to particular problems. And each chapter ends with a bullet point summary which is very useful.

    Overall, I can recommend this book " not just for GPs and other general health care workers. It's a valuable primer on the wide ranging effects of dissociation for front line staff in mental health too " for psychiatric nurses, social workers, support workers, housing workers etc. As it is so accessible the interested lay reader may also find it useful. " family, friends, survivors themselves.
  6. This most informative resource, backed up by neurophysiological evidence, offers immediate insight into dissociative disorders with its practical, down-to-earth approach, wisdom and humour. The large print and easy to read format makes this very clear and concise book a manual on how to proceed when the patient's presentation offers no obvious or easy path to take. 

    This essential primer is must-have reading for all medical professionals looking for understanding of the complexities of dissociative patients " their idiosyncratic ways of responding to medication, inconclusive laboratory results, and a multitude of chronic physical and emotional symptoms that appear to defy diagnosis. Hunter invites us to look for inconsistencies in presentation, to be aware of counter-transference, and to find a balance between referral lab tests, prescribing and the quagmires of hypnosis, tranquillisers and anti-psychotics. She urges ways to maximise on time spent and procedures implemented, and to use diagnostic questionnaires to look beyond the medical implications of presentation for possible dissociative inclination. 

    Offering realistic, practical answers to questions you hadn't thought to ask, and carefully organised for easy reference, this book discusses what you can and cannot do, where and how to ask for help, and what to say to your patient. And vitally, she explains why patients may cope and react in apparently abnormal ways to urge us all to avoid a pre- or proscriptive approach, and to treat each patient as an individual.

    Hunter urges us to remember that the slower we go, the faster we get there, all the while offering easy to implement methods to facilitate those patients who are especially difficult to identify and treat because their histories offer a confusing, often contradictory scenario. She reminds us to see each patient as unique and well worth the respect and time it can take to offer an appropriate diagnosis, all the while prompting professionals to remember the benefits of taking time to care for your self as well as your patient " after all, our own emotional health is essential before we can help others. She is an advocate of ongoing education and continuous professional development, of knowing your own limits, and maximising on the benefits to all concerned of referring to appropriate professionals, usually psychotherapists.
  7. Dissociative disorders really interest me. After all I specialise in treating eating disorders which have an element of dissociation. But there are many other dissociative disorders, some of which can be hard to spot initially.

    This book clarifies and details the differences between "normal" so-called ego states (or what I would call our many different conscious states) and "abnormal" dissociative disorders. The first chapter also lists clues and indicators for dissociative disorders to help therapists and medical professionals identify patients quickly.

    It is methodically organised for easy reference and has separate chapters on the main dissociative disorders. Even more helpful is the way it helps the therapist understand how far they can go and where to find external assistance when it is needed. Also, the book gives explanations and guidelines to help therapists to assist their clients to find their own solutions to what can be a lonely and isolating disorder.

    Furthermore, there is a whole chapter dedicated to research and reference material for he therapist who want to know more about the subject.

    This is a valuable book for any therapist who treats clients with DD's or even for someone who just wants to know more about the subject. It is clear, concise and interesting. I would certainly recommend it.
  8. Although written primarily for Doctors and Health Care Professionals, this is a book which will also be of tremendous help to therapists, in that it is a fascinating account of the number of presenting problems, most of which you have probably come across, which may have their origins in dissociation. 

    Originally termed as having "Multiple Personality Disorder', wrongly, as the author remarks, those suffering from Dissociative Disorders have an incredible ability to compartmentalise different aspects of their personality. Some know all about their alter egos, while others can switch from one to another with no knowledge at all of becoming, to all intents and purposes, someone totally different. This could explain why it is possible for someone who was witnessed performing some act or other to categorically deny having done any such thing. They will have switched to another personality so quickly that they truly believe that it wasn't them!

    The author freely admits that, during the early days of her work with such patients, she had to feel her way to effective treatments using trial and error as there were very few studies into the disorder and fewer still ways of dealing with it, other than medication. One of the effective ways of working with Dissociative patients was the use of Ego State therapy, which, in many cases, she found to be very beneficial.

    You may feel that working with clients suffering from this disorder is not for you but even if that is the case, this book is still a riveting read and a real eye-opener.
  9. Dissociative personality disorders have been difficult to recognise, comprehend and treat for generations. Understanding Dissociative Disorders provides a revealing insight into the possible cause of confusing and contradictory patient histories. It explores clearly how dissociative disorders can influence the progress of a variety of somatic and psychological conditions. Conversely it is also shown how these can be symptomatic of a dissociated mind. Marlene Hunter has written a valuable and informative resource, backed up by neurophysiological evidence, for all those working at the frontline of healthcare provision that effectively demystifies dissociative disorders with its clear and concise approach.
  10. Marlene Hunter has planted her flag in the still fertile soil once cultivated by Charcot, Freud, Bernheim, and Janet, some hundred years ago in their investigations of "difficult patients." Understanding Dissociative Disorders: A guide for physicians and health care workers, will take its place amongst your other valued reference books, and come off the shelf frequently to inform one of the most difficult challenges faced by clinicians: the medically ill and/or undiagnosed patient with a dissociative disorder. In a day and time where neuroscientists have worked out enough kinks from new theory to teach us that differences between Mind and Body are not so distinct, Dr. Hunter's work provides an unusually practical guide to these "grey areas' of diagnostic inquiry. Each area of inquiry is capped by a clinically astute section: "What can you do?" With a mingling of wisdom and candor, you will enjoy her writing voice in this exposition of thirty years of clinical effort to understand that which is on the edge of understanding. Her respect for her patients, and her ingenious approaches to medical care, will delight you and keep you reading long after you have found that for which you were looking!
  11. Involuntary and debilitating "dissociation-of-mind" is perhaps the most important and yet most profoundly misunderstood malady of our age. The provision of reliable, accurate information regarding the diagnosis and treatment of this disorder is therefore essential. Such information is particularly important to family physicians and health care professionals who invariably hold roles of "sentinel-like' responsibility. In this regard "Understanding Dissociative Disorders" by Marlene Hunter is a key text which should be required reading for medical students and GP's alike. The book is well annotated and represents an extremely welcome contribution to the burgeoning literature on dissociative disorders. Extremely useful and practical bullet-point summaries appear at the end of each chapter.
  12. My initial impression of this book was "attractive'; to the eye " clear print and colourful cover; to the hand " physically small and light; and to the mind " the large print with bite sized sections (bullet points are excellent) persuade one immediately that this book is comfortably readable.

    The back cover reviews inform a comprehensive selection of professional views although, for the UK market, I felt that there was an over emphasis on Hypnotherapy. I would suggest some validation from a specialist in Attachment Theory, might be useful as an alternative.

    The other point that I felt would have been better made on the flyleaf is the very definite role of family practitioners and health care workers in this field " this is, in fact, not made until page XV of the introduction.

    I felt that the subtitle "A Guide for Family Physicians and Health Care Professionals' was vitally important. My experience, as a counsellor, of trying to "educate' the medics involved in my clients' care about dissociation has often been met with resistance. It must be so much more appealing to the ego to have a book written by a medic especially for a medic than to have someone of a different professional discipline possibly make you feel more uncomfortable about a patient you were already feeling uncomfortable about, (although of course you would not admit it)! 

    Marlene offers an understanding of the psychosomatic presentations of the patient in a manner acceptable to both physician and patient. In fact this was something I really valued throughout the book " I felt the patient was represented as a unique person of worth rather than "a difficult patient' or "a nuisance' as is so often the case. 

    Particularly for those who are responsible for the prescribing of medication, the information Marlene offers regarding appropriate drugs/dosages must be a godsend. The neurophysiological material offered is welcome "evidence'- science agreeing with what we, as practitioners, have long since "known'. Indeed this book marries comfortably together psyche and soma, therapy and science, left and right brain and counsellers and physicians. 

    Certainly Marlene makes many pertinent points through the pages of her book and I felt that her coverage of the multiple issues related to Dissociative was given comprehensive and concise coverage. I also appreciated her use of "common language' (although some of the brand names of medicines need to be modified for the UK). Too often writer's fail in conveying their learning to their audience through the use of complex language understood only by the minority. 

    One negative observation - in my experience issues of transference and counter transference are enormous with this client group and the appropriate understanding/management or lack of such can be a great help or a great hindrance to the client work. I did not feel that this issue was covered in anything like enough detail. Although Marlene does talk about her responses to the patient she does not explain it in terms of the process of transference. 

    I felt that the writer rather "meandered' through her own personal journey to the hard core factual text " but then perhaps all of us have become interested/active in this area of work via our own personal journey? In a world where the expectation is that the "Doctor always knows' Marlenes candour and willingness to share her personal learning process has an appealing honesty. I would hope that this would give other medics the courage to confront their own discomfiture and confusion. Certainly Marlene succeeds well in normalizing DID for the family physician "you have a dissociative patient on your caseload, open your eyes!'

    Finally, I would judge this an excellent little book that fills a gap in the UK medical market and I would hope that in the current climate of the rewriting of the NHS Mental Health guidelines and policies it could make some impact. Surely every practitioner cannot fail to immediately recognise themselves/their dissociative patients on reading it? I sincerely hope so.
  13. Beautifully written with a complete absence of jargon to allow a complete understanding of an often misunderstood and misdiagnosed class of patient. Extremely wide ranging in its overview it is nonetheless a concise and practical guide to recognising and treating dissociative disorders.
  14. For general practitioners, social workers, therapists and family members alike, trying to understand and deal with the emotional turmoil and behavioural consequences of dissociation it like trying to navigate uncharted waters without a map or a compass.

    As a pioneer of these uncharted waters, Marlene Hunter has provided an essential map and compass in her work, "Understanding Dissociative Disorders.'

    Marlene has approached her work with both sensitivity and scientific objectivity to give a rounded and comprehensive guide to identifying and understanding this baffling array of problems. I recommend the book as an essential tool in the armoury of every family doctor, social worker and therapist, whatever their discipline or conceptual framework for therapy may be. It should also be required reading for all students of mental health and should be in the library of every school, college, university and teaching hospital.
  15. I found the book eminently readable as it is written in a conversational style.

    I thought that it provides a very good overview of the many different ways in which dissociative disorders may present themselves to health care professionals.

    I think that the main strength of the book is its clear approach in enabling professionals to identify or recognise features of dissociative disorder and to try to improve the understanding of these clinical and personal issues, rather than consciously or unconsciously rejecting or avoiding them.
  16. This book provides a useful and vivid collation and presentation of presenting factors and characteristics in dissociative patients. Those grappling with understanding memory, neurophysiology and co morbidity in dissociative clients will find the clear explanations very helpful indeed. I am sure the book will assist in diagnosing, supporting and referring patients appropriately, and will also support health professionals in coping with feelings and situations that arise whilst fulfilling and maintaining their roles.

    More importantly, this book will increase the likelihood of patients and clients receiving compassionate, informed and appropriate support from those charged with their care, for what can be a very distressing and painful condition.
  17. The information contained in this excellent book will be of great value to any therapist or physician as we all find ourselves confronted by dissociative disorders among our patients. Marlene Hunter's practical information and advice is presented in an extremely 'readable' style, unlike many other reference books. It really encourages you to read on, rather than stopping when you have found the help you need to deal with a particular aspect of the problem. The care and respect Dr. Hunter has for her patients is obvious from the very beginning. I have already added this book to the list of required reading for our students.
  18. This timely book manages to educate both the experienced and inexperienced family doctor or health worker in the complex and controversial subject of Dissociative Identity Disorder. It is written in a clear and personal style that allows the author's long knowledge of the subject to be transmitted comfortably.

    Dr Hunter focuses provides us with a formidably titled sequence of chapters but it is important to note that the way these subjects are explored makes it accessible for the professional new to this work. We are taken through the important areas of physical pain, medication, other organ systems, neurophysiology,, research and references, relationship and sexual problems, children with DID parents, eating disorders, posttraumatic stress disorder and co-morbidity with dissociation. These problem areas are explored with concern and respect for the client.

    GPs are often the first port of call for people with dissociative disorders. They often present with ranges of mental and physical pain. The more they meet health care workers with an understanding of their predicament, the more there is hope for a health service that lessens rather than adds to the dissociative client's pain. This book should be on nursing and medical students' essential textbooks.
  19. Dissociation in Psychological terms is the separation of a belief, attitude or a group of related psychological activities from the rest of the personality so that they function independently. 

    Understanding Dissociative Disorder written by Marlene E Hunter, M.D. is a very valuable book which will enable Physicians to understand the idiosyncrasies of emotional symptoms which dissociative patients present with, and provides practical guidance regarding resolution of their psychological dilemmas.
  20. Marlene Hunter, M.D., is a highly distinguished teacher, practitioner, and author in the fields of hypnosis and dissociative disorders. She is a family physician who has worked with dissociative patients since 1977. Past president of both the American and Canadian Societies of Clinical Hypnosis, she has given numerous lectures and workshops on topics related to dissociation and hypnosis.

    The stated purpose of the book is to educate family practitioners and other health workers about the relationship between child abuse, dissociation, and a host of psychosomatic and psychiatric conditions commonly seen by physicians and psychotherapists. These include fibromyaglia, irritable bowel syndrome, certain urinogenital conditions, post-traumatic stress disorder, substance abuse, eating disorders and chronic pain syndromes. This concise, cogent, friendly, and well-structured book presents the new paradigm of understanding many physical and mental conditions on the basis of early trauma effects and mind-body unity.

    Each medical condition listed above rates a separate chapter, each with very pertinent and up-to-date references. These references in turn are followed by a brief descriptive and explanatory comment by the author.

    Hunter has produced a landmark text filled with practical suggestions to physicians about how best to relate to and treat patients with psychosomatic conditions, many of whom have trauma histories and related dissociative disorders. She cogently explains somatoform dissociation and its relevance to the disorders listed above. Neurophysiological under pinnings and torrelations are clearly illustrated. The seminal research and writing of Van der Kilk, Meltack, Rossi and Nijenhhuis are presented to clarify her points.

    The reviewer's only criticism concerns her chapter on psychiatric medications, which is not as clear or we"developed as the rest of the book. While I agree with her statement about minimizing medication and maximizing non-pharmacological treatments, such as hypnosis, yoga, meditation, massage, etc, many dissociative patients will also need a combination of medications to control extreme depression, agitation, and switching of ego-states/alters. However, hunter skilfully explains and illustrates the important role of hypnosis for calming, grounding, ego-strengthening, reframing and visualization of success.

    In summary, Marlene Hunter has presented a highly scientific, useful and clearly written work which every health practitioner should read. Her kindness, patience and understanding permeate the text and humanize her astute presentation of clinical information and treatment guidance.

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