13. Dissociative Disorders

Question 1

Define: Dissociative Disorders (2)

Answer 1

• severe dissociation resulting in breakdown of integrated functions of consciousness and perception of self
• differential diagnosis: PTSD, acute stress disorder, borderline personality disorder, somatic symptom disorder, substance abuse, GMC (various neurologic disorders including complex/partial seizures, migraine, Cotard syndrome)

Question 2

Define: Dissociative Identity Disorder (3)

Answer 2

• disruption of identity characterized by ≥2 distinct personality states or an experience of possession
• can manifest as sudden alterations in sense of self and agency (ego-dystonic emotions, behaviours, speech)
• features recurrent episodes of amnesia (declarative or procedural)

Question 3

Define: Dissociative Amnesia (3)

Answer 3

• inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with normal forgetting and not attributable to a psychiatric disorder or medical illness
• localized/selective amnesia: failure to recall all/some events during a prescribed period of time
• generalized amnesia: (more rare) complete loss of memory for one’s life history, ± procedural knowledge, ± semantic knowledge; usually sudden onset; often presents with perplexity, disorientation, and aimless wandering

Question 4

Describe: Depersonalization/Derealization Disorder (3)

Answer 4

• persistent or recurrent episodes of one or both of:
  
  • depersonalization
  • derealization
• transient (s-h) experiences of this nature are quite common in the general population
• episodes can range from h-yr, patients are often quite distressed and verbalize concern of “going crazy”

Question 5

Describe: Depersonalization (1)

Answer 5

• experiences of detachment from oneself, feelings of unreality, or being an outside observer to one’s thoughts, feelings, speech, and actions (can feature distortions in perception including time, as well as emotional and physical numbing)

Question 6

Describe: Derealization (1)

Answer 6

experiences of unreality or detachment with respect to the surroundings (i.e. feeling as if in a dream, or that the world is not real; external visual world is foggy or distorted)

Question 7

Describe: Fugue (1)

Answer 7

Purposeful travel or bewildered wandering while in amnesic state

Question 8

During depersonalization or derealization, patients usually have ___ reality testing, which adds to their alarming nature

Answer 8

During depersonalization or derealization, patients usually have intact reality testing, which adds to their alarming nature