Chapter 6

Question 1

Dissasosciation

Answer 1

the lack of normal integration of one of more aspects of psychological functioning, such as identity, memory, consciousness, sensorimotor fumctioning, and behaviour

Question 2

Dissociative amnesia

Answer 2

• inability to recall significant personal information in the absence of organic impairment (no medical causes)

Question 3

Memory loss patterns

Answer 3

• Localised amnesia - for a time, the person has no memory of the traumatic event at all
• selective amnesia - forgetting only some of the events during a certain period of time or only part of a traumatic event
• generalised amnesia - most severe - forget all personal information - acute onset - suddenly is disorientated
• continuous amnesia - forget each new event - occurs when the individual has no memory of events occurring after a particular event
• systemised amnesia - all memories with a specific person or place

Question 4

Dissociative amnesia in the DSM-5

Answer 4

A. An inability to recall important autobiographic information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. *Culture matters Note: Dissociative Amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The disturbance is not attributable to the physiological effects of a substance
(e.g., alcohol or other drug abuse, a medication) or a neurological or other
medical condition (e.g., partial complex seizures, transient global amnesia,
sequelae of a closed head injury/traumatic brain injury, other neurological condition).

D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder

Question 5

Fugue

Answer 5

• During a Dissociative Amnesia
  with Fugue, a person normally
  acts in a way which is purposeful
  and has a specific goal; fugue
  states may last for days, weeks, or
  longer
• A fugue occurs when there is
  sudden and unexpected travel
  away from home or work in
  combination with amnesia for a
  person’s past, and either identity
  confusion or assumption of a new
  identity

Question 6

depersonalisation

Answer 6

a distinct sense of unreality and detachment from thoughts, feelings, sensations, actions, body (eg. my thoughts don’t feel like mine)

Question 7

derealisation

Answer 7

feelings of unreality and detachment from one’s surroundings (can happen during a panic attack, can be related to stress)

Question 8

depersonalisation/derealisation disorder

Answer 8

A. The presence of persistent or recurrent experiences of depersonalization, derealization or
both:

1) Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).

2) Derealization: “Experiences of unreality or detachment with respect to surroundings (e.g., individuals
or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted.”

B. During the depersonalization or derealization experiences, reality testing remains intact.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or other medical condition (e.g., seizures).

E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.

Question 9

Differential diagnosis for depersonalisation/derealisation disorder

Answer 9

Illness anxiety disorder
* Major depressive disorder
* Obsessive-compulsive disorder
* Other dissociative disorders – Dissociative Identity Disorder
* Anxiety disorders
* Psychotic disorders
* Substance abuse

Question 10

Dissociative identity disorder

Answer 10

• alters and switching
• normally diagnosed later in life (29-35)

Question 11

Comorbid disorders to DID

Answer 11

-Depression
- anxiety
- substance abuse
- self-injury,
- non-epileptic seizures

Question 12

brain regions involved in Dissociative identity disorder

Answer 12

• orbitofrontal cortex
• hippocampus
• parahippocampal gyrus
• amygdala

Question 13

Dissociative identity disorder in DSM-5

Answer 13

A Disruption of identity characterized by two or more distinct personality
states, which may be described in some cultures as an experience of
possession. The disruption in identity involves marked discontinuity in
sense of self and sense of agency, accompanied by related alterations in
affect, behaviour, consciousness, memory, perception, cognition, and/or
sensory-motor functioning. These signs and symptoms may be observed
by others or reported by the individual

B. Recurrent gaps in the recall of everyday events, important personal
information, and/or traumatic events that are inconsistent with ordinary
forgetting

C. The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.

D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: in children, the symptoms are not better explained by imaginary playmates or other fantasy play

Question 14

Freud - recovered memory therapy

Answer 14

• roots in psychoanalysis
• DID is due to problems due to childhood experiences of incest - people began to remember under hypnosis

Question 15

False memory syndrome

Answer 15

• under hyponsis people remembered things, but they were false
• we are suggestible, it is easy to have a fake memory

Question 16

Dissociative Disorders Etiology

Answer 16

Trauma model
- Diathesis - stress - already had likelihood of disassociating, previous experience of doing it

personality traits - high hypnotisability, fantasy proneness, and openness to altered states of consciousness

• Genetic heritability
• Attachment theory (types of attachment)

Question 17

socio-cognitive model etiology of dissociative disorders

Answer 17

role-playing
DID is a learnt social role
hypnotizability

Question 18

Dissociative disorders comorbidity

Answer 18

• anxiety
• bipolar
• depression
• personality disorders
• eating disorders
• borderline personality disorder
• substance abuse disorder
• suicidal thoughts

Question 19

Somatic symptoms and related disorder

Answer 19

• a predominant focus on bodily concerns
• somatic symptom disorder - when a person has a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning
• illness anxiety disorder - a psychiatric disorder defined by excessive worry about having or developing a serious undiagnosed medical condition.
• conversion disorder - a psychiatric disorder characterized by symptoms affecting sensory or motor function. These signs and symptoms are inconsistent with patterns of known neurologic diseases or other medical conditions.
• psychological factors affecting other medical conditions
• factitious disorder - a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury.

Question 20

hypochondriasis

Answer 20

preoccupied with the fear that they may have a serious medical disease

• leads to somatic symptom disorder or illness anxiety disorder

Question 21

somatic symptom disorder

Answer 21

Primary Symptoms
- Multiple, recurrent somatic symptoms: pain, fatigue, nausea, muscle
weakness, numbness, indigestion

Subtype: SSD-Predominant Pain
When pain persists beyond its expected time span, a patient can often
benefit from a consideration of the role of psychosocial factors.

Question 22

Somatic symptom disorder in DSM-5

Answer 22

A. One or more somatic symptoms that are distressing or result in significant
disruption of daily life.

B. Excessive thoughts, feelings, or behaviors related to the somatic
symptoms or associated health concerns as manifested by at least one of the following:

1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health
   concerns.

C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Question 23

illness anxiety disorder

Answer 23

• Preoccupied with the fear that they may have a serious medical
  disease, despite the fact that thorough medical examination reveals
  there is nothing seriously wrong with them.
• Not focussed on specific bodily symptoms, just primarily concerned
  with the general idea of being “ill.”
• Extensive “research” into suspected diseases
• Becomes a central part of their self-identity

Question 24

Illness anxiety disorder - DSM-5

Answer 24

A. Preoccupation with having or acquiring a serious illness.

B. Somatic symptoms are not present or if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.

C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.

D. The individual performs excessive health-related behaviours (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g, avoids doctor appointments and hospitals).

E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.

Question 25

High comorbidity between conversion disorders and dissociative disorders

Answer 25

High scores on measures of dissociative experiences and hypnotizability, and history of
childhood abuse and trauma

Question 26

conversion disorder

Answer 26

• Also called Functional neurological
  symptom disorder
• motor deficit - eg. paralysis - loss of sensation - doesn’t make sense neurologically

Question 27

conversion disorder in the DSM-5

Answer 27

A. One or more symptoms of altered voluntary motor or sensory function.

B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.

C. The symptom or deficit is not better explained by another medical or
mental disorder.

D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
or warrants medical evaluation.

Question 28

Factitious Disorder
Munchausen Syndrome

Answer 28

• Deliberate faking of illness or
  injury to get medical attention
• Will fake physical symptoms
  and psychiatric symptoms
• Not to get money
• Motivation is to get sympathy,
  care and attention

Question 29

Factitious Disorder in DSM-5

Answer 29

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.

B. The individual presents himself or herself to others as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The behavior is not better explained by another mental disorder, such as
delusional disorder or another psychotic disorder.

Question 30

Somatic Symptom and Related Disorders
Etiology

Answer 30

• Psychoanalytic explanations - dealing with stress and didn’t want to deal with it
• Conversion of the anxiety associated with unconscious conflicts
• Physiological factors: HPA axis
• Cognitive factors: dysfunctional beliefs about illness
• Personality traits
• Early life experiences - used to be sick
• Social learning: adopt the sick role - gain attention from being sick