Dissociative Disorders

Question 1

Dissociative Disorders Description

Answer 1

• defined by loss of memory, identity, or sense of self (sense of self = normal integration of one’s thoughts, behaviors, perceptions, feelings, and memory into a unique pattern)
• amnesia and feelings of detachment often arise suddenly and may be temporary
• symps never due to underlying medical condition or substance abuse
• onset related to stressful life event
• many patients history of trauma or abuse during childhood

Question 2

Examples of dissociative disorders

Answer 2

dissociative amnesia
dissociative fugue
dissociative identity disorder (multiple personality)
depersonalization disorder

Question 3

Dissociative Amnesia description

Answer 3

amnesia must be the only dissociative symptom present (many other dissociative disorders have amnesia as a prominent symptom); patients are usually aware they are having difficulty remembering but are not very troubled

Question 4

Dissociative Amnesia DSM IV

Answer 4

• at least 1 episode of inability to recall importnat personal information, usually involving a traumatic or stressful event
• amnesia cannot be explained by ordinary forgetfulness
• symps cause sig distress or impairment in daily functioning and cannot be explained by another disorder, medical cond, or sub. abuse

Question 5

Epidemiology Diss. Amnesia

Answer 5

most common diss. disorder
more common women
more common young adults
inc. incid of comorbid MDD and anxiety

Question 6

Diss. Amnesia Course/Prognosis

Answer 6

most patients abruptly return to normal after a few minutes or days
recurrences are uncommon

Question 7

Diss. Fugue Description

Answer 7

characterized by sudden, unexpected travel away from home + inability to recall parts of one’s past or identity; patients often assume an entirely new identity and occupation after arriving in new location; patient is UNAWARE of his amnesia/new identity; never recall the period of fugue

Question 8

Diss. fugue DSM IV

Answer 8

• sudden unexpected travel away from home or work plus inability to recall one’s past
• confusion about personal identity or assumption of new identity
• not due to DID or the physiological effects of sub. abuse or medical disorder
• symps cause impairment

Question 9

Diss. fugue epidemiology

Answer 9

• rare
• predisposing factors: heavy use of alcohol, major depression, history of head trauma, epilepsy
• onset ass with stressful life event (often viewed as a response to life stressor or personal conflict)

Question 10

Diss. fugue course/prognosis

Answer 10

usually last a few hours to several days but may last longer

after the episode, patient will assume his or her old identity w/o ever remembering his time in fugue

Question 11

Diss. fugue treatment

Answer 11

same as diss. amnesia: must help patients recover memories to prevent recurrences. hypnosis or sodium amobarbital or lorazepam during interview may help patients talk more freely. psychotherapy recommended. ativan is safer and better tolerated than sodium amobarbital

Question 12

Key difference diss. amnesia and diss. fugue

Answer 12

diss amnesia patients know they have lost memories, diss. fugue patients are not aware that they have forgotten anything

Question 13

Dissociative Identity Disorder (Formally, major personality disorder) description

Answer 13

patients have two or more distinct personalities that alternately control their behaviors and thoughts; patients are often unable to recall personal info. while one personality is dominant, that personality is usually unaware of events that occurred during prior personality states

personality def = integration of one’s thoughts, feelings, and behavior into a sense of unique self

Question 14

DID DSM IV

Answer 14

• presence of 2 or more distinct identities
• at least 2 of the identities recurrently take control of the person’s behavior
• inability to recall personal information of one personality when the other is dominant
• not due to effects of substance or medical condition

Question 15

Epidemiology of DID

Answer 15

• women are 90% of patients
• most patients have exp. trauma, esp. childhood physical or sexual abuse
• avg. age diagnosis 30 yo
• high incid. of MDD, anxiety, borderline, and sub. abuse
• up to 1/3 attempt suicide

Question 16

DID Course/Prognosis

Answer 16

• usually chronic w/incomplete recovery
• worst prognosis of all diss. disorders
• earlier onset = poorer prognosis

Question 17

DID treatment

Answer 17

hypnosis, drug-assisted interviewing, insight-oriented therapy
pharmacotherapy for comorbid disorders ie MDD

Question 18

Diff. diagnosis DID

Answer 18

symptoms similar to borderline p. disorder

Question 19

Depersonalization Disorder Description

Answer 19

• persistent or recurrent feelings of detachment from one’s self, environ. (derealization), or social sit.
• patients feel sep. from bodies and mental processes > “outside observer”
• are aware of symptoms and often fear they are going crazy
• often accompanied by anxiety or panic

*TRANSIENT symps of depersonalization are common in HEALTHY people during times of stress

Question 20

Depersonalization DSM IV

Answer 20

• persistent or recurrent experiences of being detached from one’s body or mental processes
• reality testing remains intact during episode
• causes social/occupational impairment and cannot be accounted for by another mental or physical disorder

Question 21

Depersonalization disorder epidemiology

Answer 21

Women 2x as common
avg. onset b/w 15 and 30 yo
inc. incid of anxiety and MDD
severe stress is a predisposing factor

Question 22

Depersonalization disorder course/prognosis

Answer 22

often chronic but may remit w/o treatment

Question 23

Depersonalization disorder treatment

Answer 23

antianxiety agents or SSRIs to treat associated symptoms of anxiety or MDD