Des états dissociatifs vers une clinique des troubles dissociatifs

Dissociation can be defined as a dysfunction of the normally integrated functions like memory, consciousness and perception of environment. The history of dissociative disorders rejoins the history of hysteria with the work of Charcot, Janet and Freud at the end of the 19^th century and the beginning of the 20^th century. The concept of hysteria disappeared from the international classifications of mental disorders (DSM-III and DSM-IV, ICD-10) which stimulate a regain of interest in the past 20 years for the field of somatoform and dissociative disorders. After discussing the clinical and etiological issues of the concept of dissociation, we emphasize the interest for the clinician to recognize dissociative states and dissociative disorders, while insisting on the differential diagnosis and the psychiatric comorbidities. Dissociation is now considered as a trans-nosographical entity that can be observed in many psychiatric disorders, such as anxiety and mood disorders, personality disorders, substance-related disorders and even some organic disorders. Substantial progress has been recently made in diagnosing and treating these disorders, allowing the development of sensitive (DES - Dissociative Experience Scale, DQ - Dissociation Questionnaire) and specific (DDIS - Dissociative Disorder Interview Schedule, SCID-D-R - The Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised) diagnostic tools. Despite important differences found in the epidemiological studies, the prevalence of the dissociative disorders being around 10 % in the general population, there is a consensus in the literature concerning the importance of precocious detection of these disorders, in order to improve the management of the patients.