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Reconnaître, diagnostiquer et surmonter les troubles dissociatifs : le difficile chemin vers l’intégration pour les patients et les cliniciens

Abstract : This thesis addresses dissociative disorders as described by the international classification systems DSM and CIM, through ten articles. In this field, a clear definition of dissociation is needed, and for this purpose we follow the theory of the structural dissociation of the personality. This theory proposes that, in the aftermath of a traumatic situation and by a lack of integration, the personality of a subject can divide (dissociate) itself into several dissociative parts: a part called 'apparently normal part' continues to engage in actions of daily life and avoids one or more dissociative parts called 'emotional parts' which remain fixated on the traumatic situation and engage in actions resembling animal defenses in the face of a threat. The first part of this thesis focuses on the recognition of these disorders, in particular the dissociative identity disorder, which is probably the most controversial psychiatric disorder. Then, we describe the conceptualization of dissociative disorders according to the theory of the structural dissociation of the personality. The second part of the thesis focuses on the diagnostic procedure of dissociative disorders. An article presents the validity and reliability study of the SCID-D, a semi-structured interview for the diagnosis of dissociative symptoms and disorders according to DSM-5 and ICD-11. We also discuss diagnostic procedures more adapted to cases of dissociative disorder requiring an approach as close as possible to the patient's singularity. The third part focuses on the therapeutic principles and means useful to overcome these severe disorders. Several articles are presented, in particular on the theme of the integration of traumatic memories and dissociative parts. Therapeutic interventions are described in detail. We also take into account the complex relational aspects of these clinical situations, in particular the counter-transferential issues. Acknowledging, diagnosing and overcoming dissociative disorders is a major challenge for patients but also for professionals who often have to go beyond their theoretical fundamentals to meet the patients in their unexpected singularity. It is also a challenge in terms of public health policy and professional training, since dissociative disorders are frequent and highly disabling.
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Submitted on : Wednesday, July 7, 2021 - 10:03:54 AM
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  • HAL Id : tel-03280131, version 1

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Olivier Piedfort-Marin. Reconnaître, diagnostiquer et surmonter les troubles dissociatifs : le difficile chemin vers l’intégration pour les patients et les cliniciens. Psychologie. Université de Lorraine, 2021. Français. ⟨NNT : 2021LORR0075⟩. ⟨tel-03280131⟩

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