Dissociative disorders Flashcards
when do dissociative disorders typically manifest
at any age and typically in the aftermath of trauma
which disorders include dissociative symptoms but are not dissociative disorders
PTSD
acute stress disorder
how are dissociative symptoms experienced
as unwanted intrusions into awareness/behavior
definition of positive dissociative symptoms
loss of continuity in subjective experience
examples of positive dissociative symptoms
division of identity
depersonalization
derealization
definition of negative dissociative symptoms
inability to access information or control mental functions
example of negative dissociative symptom
amnesia
main diagnostic criteria for dissociative identity disorder
2+ distinct personality states (or experience of possession)
recurrent gaps in recall inconsistent with normal forgetting
symptoms cause clinically significant distress or impairment and are not attributable to a substance or medical condition
typical manifestation of different identity states in non-possession DID
typically minor alterations in identity . Large differences in personality states only in small percentage of patients with disorder
characteristics of disruption in identity (criterion A) for DID
-may feel like observer to actions with inability to stop them
-may perceive voices
-may have hallucinations in any sensory modality
-strong emotions/behavior over which the person has no control
how may perception of voices in DID be experienced
as individualized thought streams at the same time
lack of sense of agency
strong emotions, thoughts, impulses, speech that the person has no control over
common manifestations of dissociative amnesia
=gaps in autobiographical history
-forgetting recent events or well learned skills
-finding possession with no recollection of acquiring
-dissociative fugue
-large gaps in ongoing memory
dissociative fugue
amnesia for travel
typical comorbidities to DID
PTSD, depression, anxiety, substance abuse, personality disorders, and self-injury
features that are sometimes associated with DID
nonepileptic seizures
refractory neurological sx (HA, MS sx)
dissociative flashback
-sensory reliving of previous event as if it was happening in the present
-often with a change in identity
-partial or lack of contact with reality during flashback
-subsequent amnesia for event
what is the main thing that predisposes to DID
trauma, particularly early life trauma
what kind of injury is common in DID
non-suicidal self-injury
personality disorder features associated with DID
-often avoidant features
-may display bipolar features when decompensated
-obsessional features are common
-subset has narcissistic/antisocial features
how do children with DID typically present differently than adults
may present with independently acting imaginary companions or personified mood states rather than identity shifting
how do adolescents with DID typically present
with externalizing symptoms, suicidal or self-destructive behavior, or rapid behavioral shifts
how do older persons with DID typically present
symptoms that appear as late-life mood disorders, OCD, paranoia, psychosis, and cognitive disorders attributable to dissociative amnesia
brain regions implicated in DID
orbitofrontal cortex
hippocampus
parahippocampal gyrus
amygdala
suicide risk with DID
high
greater severity of sx correlates to greater risk
what differentiated DID from dissociative amnesia
DID requires 2 distinct personality states
difference in behavioral shifts in DID as opposed to bipolar
DID shifts more rapid than rapid cycling and last minutes too hours but not days
difference in manifestation of depersonalization/derealization in DID as opposed to PTSD
in PTSD it is r/t specific trauma reminders
It is also in an ongoing fashion in daily life in DID
what differentiates dissociative sx in schizophrenia from DID
schizophrenia is usually accompanied by delusional ideas for the reason of sx and DID experiences them as ego-alien and frightening
hypnotic capacity in DID v. schizophrenia
DID has high hypnotic capacity
schizophrenia has low hypnotic capacity
what differentiated DID from personality disorders
DID has variability in personality styles whereas in personality disorders characteristics are pervasive and sustained
localized dissociative amnesia
for a specific event
general dissociative amnesia
involves identity and history
difference between wandering r/t seizure disorders and dissociative fugue
behavior in fugue is purposeful, complex, and goal-oriented while behavior with seizures is purposely wandering
retrospective memory impairments
lost memories for traumatic experience as well as everyday life events in which no trauma occured
selective amnesia
can recall some but not all events during a particular period of time
generalized dissociative amnesia
complete loss of memory for most/all of an individuals life history
length of acute dissociative reactions to stressful events
typically last less than a month
depersonalization/derealization disorder diagnostic criteria
persistent or recurrent sx of depersonalization or derealization, or both
depersonalization
feeling of unreality or detachment
may feel like an observer to own thoughts, feelings, sensations, actions
derealization
experiences of unreality in relation to surroundings
reality testing during episodes of depersonalization/derealization in depersonalization/derealization disorder
typically remains intact
mean age of onset for depersonalization/derealization disorder
16
course of derealization/depersonalization disorder
can be discrete episodes, persistent, of initially episodic that turns continuous
cognitive disconnection schemata of depersonalization/derealization disorder
reflects defectiveness and emotional inhibition w/ themes of abuse, neglect, and deprivation
overconnection schemata in depersonalization/derealization disorder
involves impaired autonomy with themes of dependency, vulnerability, and incompetence
personality disorders commonly comorbid with depersonalization/derealization disorder
avoidant
borderline
obsessive-compulsive
what characterizes Ganzer syndrome
giving approximate answers
clouded consciousness
may have hallucinations, dissociation, somatoform, and conversion sx
what is the current standard of care for dissociative amnesia
phase-oriented tx
what are other therapies for dissociative amnesia besides phase-oriented treatment
cogntiive therapy
hypnosis
group therapy
stage 1 of phasic trauma treatment
stabilization and safety
stage 2 of phasic trauma tx
intensive processing of traumatic memories and transformation of their meaning
stage 3 of phasic trauma treatment
fusion, integration, resolution, and recovery
what types of therapies are typically not helpful in the treatment of DID
self-help and group
medication management of DID
must target symptoms as opposed to tx disorder itself
tx of OCD sx in DID
SSRIs
