Dissociative disorders

Question 1

when do dissociative disorders typically manifest

Answer 1

at any age and typically in the aftermath of trauma

Question 2

which disorders include dissociative symptoms but are not dissociative disorders

Answer 2

PTSD
acute stress disorder

Question 3

how are dissociative symptoms experienced

Answer 3

as unwanted intrusions into awareness/behavior

Question 4

definition of positive dissociative symptoms

Answer 4

loss of continuity in subjective experience

Question 5

examples of positive dissociative symptoms

Answer 5

division of identity
depersonalization
derealization

Question 6

definition of negative dissociative symptoms

Answer 6

inability to access information or control mental functions

Question 7

example of negative dissociative symptom

Answer 7

amnesia

Question 8

main diagnostic criteria for dissociative identity disorder

Answer 8

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

Question 9

typical manifestation of different identity states in non-possession DID

Answer 9

typically minor alterations in identity . Large differences in personality states only in small percentage of patients with disorder

Question 10

characteristics of disruption in identity (criterion A) for DID

Answer 10

-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

Question 11

how may perception of voices in DID be experienced

Answer 11

as individualized thought streams at the same time

Question 12

lack of sense of agency

Answer 12

strong emotions, thoughts, impulses, speech that the person has no control over

Question 13

common manifestations of dissociative amnesia

Answer 13

=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

Question 14

dissociative fugue

Answer 14

amnesia for travel

Question 15

typical comorbidities to DID

Answer 15

PTSD, depression, anxiety, substance abuse, personality disorders, and self-injury

Question 16

features that are sometimes associated with DID

Answer 16

nonepileptic seizures
refractory neurological sx (HA, MS sx)

Question 17

dissociative flashback

Answer 17

-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

Question 18

what is the main thing that predisposes to DID

Answer 18

trauma, particularly early life trauma

Question 19

what kind of injury is common in DID

Answer 19

non-suicidal self-injury

Question 20

personality disorder features associated with DID

Answer 20

-often avoidant features
-may display bipolar features when decompensated
-obsessional features are common
-subset has narcissistic/antisocial features

Question 21

how do children with DID typically present differently than adults

Answer 21

may present with independently acting imaginary companions or personified mood states rather than identity shifting

Question 22

how do adolescents with DID typically present

Answer 22

with externalizing symptoms, suicidal or self-destructive behavior, or rapid behavioral shifts

Question 23

how do older persons with DID typically present

Answer 23

symptoms that appear as late-life mood disorders, OCD, paranoia, psychosis, and cognitive disorders attributable to dissociative amnesia

Question 24

brain regions implicated in DID

Answer 24

orbitofrontal cortex
hippocampus
parahippocampal gyrus
amygdala

Question 25

suicide risk with DID

Answer 25

high greater severity of sx correlates to greater risk

Question 26

what differentiated DID from dissociative amnesia

Answer 26

DID requires 2 distinct personality states

Question 27

difference in behavioral shifts in DID as opposed to bipolar

Answer 27

DID shifts more rapid than rapid cycling and last minutes too hours but not days

Question 28

difference in manifestation of depersonalization/derealization in DID as opposed to PTSD

Answer 28

in PTSD it is r/t specific trauma reminders It is also in an ongoing fashion in daily life in DID

Question 29

what differentiates dissociative sx in schizophrenia from DID

Answer 29

schizophrenia is usually accompanied by delusional ideas for the reason of sx and DID experiences them as ego-alien and frightening

Question 30

hypnotic capacity in DID v. schizophrenia

Answer 30

DID has high hypnotic capacity schizophrenia has low hypnotic capacity

Question 31

what differentiated DID from personality disorders

Answer 31

DID has variability in personality styles whereas in personality disorders characteristics are pervasive and sustained

Question 32

localized dissociative amnesia

Answer 32

for a specific event

Question 33

general dissociative amnesia

Answer 33

involves identity and history

Question 34

difference between wandering r/t seizure disorders and dissociative fugue

Answer 34

behavior in fugue is purposeful, complex, and goal-oriented while behavior with seizures is purposely wandering

Question 35

retrospective memory impairments

Answer 35

lost memories for traumatic experience as well as everyday life events in which no trauma occured

Question 36

selective amnesia

Answer 36

can recall some but not all events during a particular period of time

Question 37

generalized dissociative amnesia

Answer 37

complete loss of memory for most/all of an individuals life history

Question 38

length of acute dissociative reactions to stressful events

Answer 38

typically last less than a month

Question 39

depersonalization/derealization disorder diagnostic criteria

Answer 39

persistent or recurrent sx of depersonalization or derealization, or both

Question 40

depersonalization

Answer 40

feeling of unreality or detachment may feel like an observer to own thoughts, feelings, sensations, actions

Question 41

derealization

Answer 41

experiences of unreality in relation to surroundings

Question 42

reality testing during episodes of depersonalization/derealization in depersonalization/derealization disorder

Answer 42

typically remains intact

Question 43

mean age of onset for depersonalization/derealization disorder

Answer 43

16

Question 44

course of derealization/depersonalization disorder

Answer 44

can be discrete episodes, persistent, of initially episodic that turns continuous

Question 45

cognitive disconnection schemata of depersonalization/derealization disorder

Answer 45

reflects defectiveness and emotional inhibition w/ themes of abuse, neglect, and deprivation

Question 46

overconnection schemata in depersonalization/derealization disorder

Answer 46

involves impaired autonomy with themes of dependency, vulnerability, and incompetence

Question 47

personality disorders commonly comorbid with depersonalization/derealization disorder

Answer 47

avoidant borderline obsessive-compulsive

Question 48

what characterizes Ganzer syndrome

Answer 48

giving approximate answers clouded consciousness may have hallucinations, dissociation, somatoform, and conversion sx

Question 49

what is the current standard of care for dissociative amnesia

Answer 49

phase-oriented tx

Question 50

what are other therapies for dissociative amnesia besides phase-oriented treatment

Answer 50

cogntiive therapy hypnosis group therapy

Question 51

stage 1 of phasic trauma treatment

Answer 51

stabilization and safety

Question 52

stage 2 of phasic trauma tx

Answer 52

intensive processing of traumatic memories and transformation of their meaning

Question 53

stage 3 of phasic trauma treatment

Answer 53

fusion, integration, resolution, and recovery

Question 54

what types of therapies are typically not helpful in the treatment of DID

Answer 54

self-help and group

Question 55

medication management of DID

Answer 55

must target symptoms as opposed to tx disorder itself

Question 56

tx of OCD sx in DID

Answer 56

SSRIs