Dissociative Disorder Flashcards
What is the definition of dissociative disorder?
Physical or mental symptoms occurring in the absence of physical disorder to explain them.
DSM-IV: dissociative disorder is mental symptoms, whereas conversion disorder for physical symptoms. ICD-10: both are dissociative disorders.
What is the aetiology of dissociative disorder?
Used to be called hysteria. Psychodynamic theory explains by stating that the symptoms are caused by an unconscious intrapyschic conflict, and the conversion of the resulting anxiety into a physical symptom. The symptomatisaion causes primary resoluton of emotional conflict (primary gain) as well as advantages assuming the sick role (secondary gain). Neurophysiological differences seen between DD and feigning illness.
What is the epidemiology of dissociative disorder?
Associated with instability in life and relationships, chilchood traumatic experiences. V rare.
What might you find in the history and exam of dissociative disorder?
Patient often shows less distress than expected about their symptoms (belle indeifference). Distinchish from illness feigning!
· Dissociative amnesia: patchy loss of memory, often recent trauma.
· Dissociative fugue: amnesia with journey away from home – different identity may be assumed over that time away.
· Dissociative pseudo-dementia: answers questions wrong but with way that suggests they have the right answer in mind.
· Dissociative stupor: motionless and mute, but aware of surroundings.
· Dissociative disorders of movement and sensation: symptoms resemble patient’s idea of physical disorder, but the symptoms are not under voluntary control.
There must be NO EVIDENCE of physical disease explaining symptoms.
What investigations may you do for dissociative disorder?
Exclude physical causes
What is the management of dissociative disorder?
Do not openly confront patient, must resolve without losing face. Minimise benefits of sick role to avoid chronicity if possible. Reassure patient that serious physical illness in excluded. Increase coping skills and encourage insight.
What are the complications and prognosis of dissociative disorder?
May become chronic due to advantages of sick role / avoidance of responsibility.
