Dissociative disorder

Question 1

What was dissociative disorder previously known as?

Answer 1

Hysteria

Question 2

What are the features of dissociative disorder?

Answer 2

Common theme of partial/complete loss of the normal integration between past memories, awareness of identity, and immediate sensations and control of bodily movements:

1. Amnesia – patchy memory loss, usually recent trauma, perplexed, distressed, self neglect, wandering. Must exclude organic, intoxication, fatigue, other MI
2. Fugue – amnesia + apparent purposeful journey, self care maintained, occasional new identity
3. Stupor – diff from schiz/depress stupor
4. Dissociative Identity Disorder (formally called multiple personality disorder)
5. Trance / Possession
6. Movement & Sensation – loss of function/pseudo seizures. adolescents and young adults

Question 3

Is dissociative disorder consciously generated?

Answer 3

NO

Question 4

What is the pathophysiology of dissociative disorder?/Why does it occur?

Answer 4

Not generated consciously but there may be:

a. Primary gain - the exclusion from consciousness of anxiety due to psychological conflict.

b. Secondary gain – • the disorder confers some advantage to the patient, e.g. excused from normal responsibilities, largely socially determined. • Evidence for psychological causation, in the form of a clear association in time with stressful events and problems, or disturbed relationships • Expression of symptom type thought to be modeled closely on recent experience in self or others.

Question 5

What is the epidemiology of dissociative disorder?

Answer 5

• F>M
• Younger
• Epilepsy, MS, Head injury
• More common in those with childhood trauma

Question 6

Name a theory for the aetiology of dissociative disorder.

Answer 6

Neuropsychological: may be an extreme form of state dependent learning such that memory of a traumatic event is not easily recalled as the circumstances surrounding the event are so out of the ordinary

Psychodynamic: amnesia is seen as a defence mechanism used alongside repression and denial as a way of dealing with an emotional conflict or an external stressor

Freud: hysteria was due to emotionally-charged ideas which had become lodged in the unconscious of the patient at some previous time, and which were excluded from consciousness by repression

Question 7

What is the management of dissociative disorder?

Answer 7

Attempts to try and restore the patient’s lost memories by:

• initial interview
• informant history
• ‘abreaction’ via medication or hypnosis
• Psychotherapy therapy
• DBT

Question 8

What is the prognosis with dissociative disorder?

Answer 8

Symptoms usually terminate abruptly and recovery is generally complete with few recurrences