Dissociative Disorders

Question 1

Would we say that dissociation is a dimensional phenomenon?

Answer 1

Yes we would

Question 2

Who has interpreted the comorbidity of dissociative disorders with so many other illnesses as evidence that it is a transdiagnostic phenomenon?

Answer 2

(Lyn, 2019)

Question 3

What THREE factors underlie the controversy surrounding the Trauma Model of Dissociative Disorders?

Answer 3

1. The correlation between trauma and dissociation is variable
2. Evidence is of mixed quality - e.g., variation in definitions of trauma, lots of self report, cross sectional etc
3. High comorbidity for dissociation and trauma across lots of diagnoses - are they just transdiagnostic antecedents?

Question 4

What’s the THREE (and a bit) part argument of the Socio-cultural model of dissociation?

Answer 4

1. Trauma may contribute, but is less central.
2. Focus instead is on 2A) fantasy proneness
   2B) media influences
   2C) suggestibility
   2D) exaggeration
   2E) cognitive failures/memory lapses
3. DID is likely an individual seeking to make sense of affective instability, using media and popular culture as inspo

Question 5

What’s the THREE part critique of the Socio-Cognitive Model?

Answer 5

1. Weak correlation between suggestibility/false memory and dissociation
2. DID exists in non-western cultures
3. The weak correlations between trauma and dissociations is more a phenomenon in non-clinical populations. It’s tighter in clinical populations.

Question 6

What do Trauma and Socio-Cognitive models agree on?

Answer 6

Dissociation is a disorder of self-awareness and self-understanding

Question 7

What does Kim think about this debate?

Answer 7

1. There is insufficient evidence to resolve it at present.

Question 8

What some of the SEVEN things that Lyn et al (2019) says there is evidence for?

Answer 8

1. Impaired meta-consciousness
2. Alexythymia
3. Poor emotional reg
4. Dysregulated interceptive awareness
5. Poor executive control
6. Source monitoring deficits
7. Sleep deficits (potential non-trauma pathway to dissociation?)

Question 9

Putting aside aetiology, what’s the neurobiology say?

Answer 9

There’s evidence of divergent neural networks and connectivity patterns.

Question 10

How does the neurobiology of dissociation compare to the neurobiology of hyper-arousal?

Answer 10

1. In hyper-arousal, you have DECREASED activity in the prefrontal cortex, leading to UNDERmodulation of emotional experience
2. In dissociation, you have INCREASED activity in the prefrontal cortex, leading to OVERmodulation of emotional experience

Question 11

What are the three phases of treatment of dissociative disorders?

Answer 11

1. Establish safety - stabilisation, symptom reduction
2. Confronting - working through and integrating trauma memories and self
3. Integration and rebuilding life

Question 11

When assessing dissociative disorders is it important to do a functional analysis of the dissociation?

Answer 11

Yes it is

Question 12

What are the FOUR key components of Phase 1 - Establishing safety/stabilise/reduce symptoms?

Answer 12

1. Risk
2. Psycho-ed
3. Symptom monitoring / emotional awareness
4. Grounding / Self soothing / distress tolerance

Question 13

What are the two big things during Phase 2 - Trauma processing and establishing self of self

Answer 13

1. Trauma processing - Any of the big ones, written exposure, imaginal exposure, EMDR, imagery describing, body work
2. Self identify, agency, schemas - Core belief stuff, schema stuff

Question 14

What are FOUR key elements of Phase 3 - Rebuilding life

Answer 14

1. Values / goals
2. Support networks
3. Boundaries
4. Self-compassion / self care

Question 15

What are FOUR COGNITIVE interventions for core beliefs

Answer 15

1. Continuum method
2. Positive data log
3. Predictive diary (Beck)
4. Old vs New diary

Question 16

What is the TWO key BEHAVIOURAL technique for core beliefs

Answer 16

1. Behavioural experiments - test the core belief
2. Role playing and reverse role playing

Question 17

What are two EMOTIONAL techniques for core beliefs

Answer 17

1. Letter writing
2. Imaginal rescripting