10/24 Dissociative Disorders - Palmeri Flashcards
dissociation
complex psychobiological process that exists as a continuum ranging from:
- daydreaming, transient lapses in attention
to
- pathological failure to integrate thoughts, feelings, memories, and actions into a coherent and unified sense of consciousness
disruption or discontinuity in integration of consciousnes, memory, identity, emotion, perception, body representation, motor control, behavior
dissociative sx
- unbidden intrusions into awareness and behavior with accompanying losses of continuity in subjective experiences
- while dissociating, inability to access info or control normal behavior or mental fx
usually occur in context of traumatic stressors as an attempt to maintain emotional equilibrium but end up in distress and dysfx
dissociative disorders
- dissociative amnesia
- depersonalization/derealization disorder
- dissociative identity disorder
- other specified dissociative disorder
- chronic and recurrent syndromes of mixed sx
- identity disturbance due to prolonged and intense coercive persuasion (i.e. brainwashing)
- acute dissociative rxn due to stress
- dissociative trance
recall: dissociation involves disturbances in…
- memory
- perception
- sense of self
- consciousness
- emotion
- motor control/behavior
what fails to integrate in each dissociative disorder?
- dissociative amnesia : memory
- depersonalization/derealization : perception and motor control
- dissociative identity disorder : identity, sense of self, and consciousness
neurobio of dissociation
- NMDA, 5HT, and endogenous opiod dysregulation
- autonomic blunting
- HPA baseline with incr tone AND blunted reactivity to stress
- disruptions in sensory cortex (somatosensory, auditory, visual)
DID : decr hippocampal and amygdala volume
memory suppression : PFC, paralimbic, subcortical, and parietal involvement in memory suppression
hypoemotionality : frontal inhibition of limbic structures
psych disorders that commonly have dissociative sx
medical conditions related to dissociation
PTSD
psychosis
panic disorder
somatization or pain disorders
substance abuse
OCD
borderline personality disorder
- partial complex seizures*
- temporal lobe disease*
- migraine*
- delirium*
- Alzheimer’s endocrine disorders*
- sleep disorders*
- sensory deprivation*
- substance intox/withdrawals*
common comorbidities with dissociative disorders
MDD
persistent depressive disorder
substance abuse/dependence
GAD
eating disorders
borderline personality disorder, OCD personality disorder, avoidant personality disorder
what might you pick up in diagnostic interview for dissociative disorders?
- blackouts/time loss
- disremembered behavior
- fugues
- unexplained possessions
- changes in relationships (instability)
- fluctuations in skills/habits/knowledge
- fragmentary recall of personal history
- passive influence (feeling that thoughts are not your own - are being influenced by someone else)
- negative hallucinations (not seeing or hearing what people around you see/hear)
- analgesia
- depersonalization/derealization (not feeling like ‘self’/environment distorted)
dissociative amnesia
what is it?
“with dissoc fugue”
levels of severity
- inability to recall important autobio info - NOT FORGETTING
- usually related to a trauma (repeated or severe trauma is a risk factor)
- recurrent
- comorbidities: borderline personality disorder, affective disorders, substance abuse, conversion
with dissociative fugue: apparently purposeful travel or bewindered wandering for ID/autobio info
- memory changes may be more permanent
as a disorder, levels of severity:
- localized: failure to recall events during a circumscribed time
- selective: recall of some but not all of events in a circumscribed time
- generalized: complete loss of memory for one’s personal identity; can occur as semantic loss (facts/environment) or procedural (skills)
- systemized: loss of memory for one category of knowledge (ex. family)
- continuous: loss of memories as each new even occurs
depersonalization/derealization disorder
depersonalization: lasting or recurring feeling of being detached from one’s body, observer to ones thoughts/feelings/sensations
- perceptual alterations
- distorted sense of personal time
- unreal/absent self
- emotional/physical numbing
derealization: experiences of unreality or detachment is respect to surrounding environment
- people/objects experienced as unreal, dreamlike, foggy, lifeless, visually distorted
- macropsia/micropsia
high levels of distress (feel like going crazy)
often history of emotional abuse/neglect
onset: sudden, mean age 16 (only 5% after 25), sudden or gradual
course: can last days-years, can often be persistent (not remitting)
- discrete/continuous/discrete→continuous
dissociative identity disorder
disruption of identity caused by two or more distinct personality states (sometimes described as possession)
- marked discont in sense of self
- alterations in affect, behavior, consciousness, memory, perception, cognition, motor fx
- recurrent gaps in memory/recall (not forgetting)
chronic, and most severe dissoc disorder
involves overwhelming trauma (physical/sexual abuse)
usually young women
multifactorial in devpt (OFC, hipocampus/parahippocampal gyrus, amygdala)
avg = 5-10 personalities
70% atttempt suicide
related to ongoing stressors
marked by
- sudden alteration in sense of self and agency
AND
- recurrent dissociative amnesia (gaps in remote memory of personal nature, lapses in dependable memory, discovery of evidence) w mixed awareness of lapses
identity disturbance due to prolonged an intense coercive persuasion
brainwashing/thought reform
acute dissociative disorders
occur less than a month after a trauma
resolve after 1 month mark
dissociative trance
- not culturally acceptable
- complete loss of awareness of environment with stereotyped behavior and LOC
- look like awake
treatment for dissociative disorders
no controlled studies
most SYMPTOMS remit quickly (not disorders)
if remission does not occur…
- behavioral (flooding, positive reward)
- cognitive tx
- psychodynamic psychotherapy
- psycho education
- psychopharmacology
- stress management
- hypnosis
