Dissociative Disorders Flashcards
What is dissociation in psychiatry?
An unconscious defense mechanism involving the segregation of mental or behavioral processes from the rest of the person’s psychic activity.
Disruption is in one or more mental functions such as memory, identity, perception, consciousness, or motor behavior.
Severe psychological trauma was understood to be the cause until recently. Now, the Dx can be made in the absence of severe psychological trauma since poor coping mechanisms may also predispose to it.
What is the main feature of dissociative amnesia?
Inability to recall important personal/ autobiographical information related to significant trauma or stressor. The information is too extensive to be explained by ordinary forgetfulness.
What differentiates dissociative amnesia from ordinary forgetfulness?
The inability to recall personal or autobiographical information is too extensive to be explained by ordinary forgetfulness.
What conditions must be ruled out for a diagnosis of dissociative amnesia?
Direct physiologic effects of a substance or a neurologic or other general medical condition.
What is a classic presentation of dissociative amnesia ?
An overt, dramatic clinical disturbance that quickly presents for medical attention.
A history of extreme acute trauma. Many have history of prior abuse or trauma.
C/Fs may include
* Physical symptoms
* Alterations in consciousness
* Trance states
* Spontaneous age regression
* Depersonalization
* Derealization
* Ongoing anterograde dissociative amnesia
What typical history is associated with classic presentations of dissociative disorders?
A history of extreme acute trauma.
What is dissociative fugue?
Sudden apparently purposeful travel or bewildered wandering that is associated with amnesia of identity or other important biographical information.
The person is confused about their identity or may assume a new identity.
In classic cases they may live under an alter identity and acc to DSM-5 would be Dx as Other specified dissociative D w/ features of DID
After termination of a fugue the patient may experience amnesia along with perplexity, confusion, Trance-like behaviors, Depersonalization, Derealization, conversion symptoms. Some may experience generalized dissociative amnesia.
As the dissociation recedes, patients may develop mood symptoms, severe S/I, PTSD or anxiety disorder symptoms.
What is the classification of Dissociative Disorders?
DSM 5 has 3 types
1 Dissociative Amnesia (with a specifier for Dissociative Fugue)
2 Dissociative Identity Disorder
3 Depersonalization /Derealization Disorder
Trance & Possession Disorders fall under ?
ICD 10’s Neurotic, stress-related and somatoform disorders has the F44 Dissociative [Conversion] Disorders category.
This includes
44.0 Dissociative Amnesia
44.1 Dissociative Fugue
44.2 Dissociative Stupor
44.3 Trance & Possession Disorders
44.4 Dissociative Motor Disorders
44.5 Dissociative convulsions
44.6 Dissociative Anesthesia & Sensory loss
44.7 Mixed Dissociative [conversion] Disorders
44.8 Other Dissociative [conversion] disorders
44.80 Ganser’s Syndrome
44.81 Multiple Personality Disorder
44.82 Transient Dissociative [conversion] disorders occurring in childhood and adolescence
44.88 Other specified dissociative [conversion] disorders, unspecified
44.9 Dissociative [conversion] disorder, unspecified
What is the non classical presentation of Dissociative Amnesia?
Patients with the non classical presentation of Dissociative Amnesia may present with depression, mood swings, anxiety, panic, sleep disturbances, eating problems, substance abuse, somatoform symptoms, violent outbursts, suicidal or self mutilating impulses and IP problems.
Amnesia may also occur for Flashbacks or behavioral reexperiencing episodes.
What is the duration of dissociative fuguesl?
They can last from minutes to months.
Children and adolescents may be more limited in their ability to travel thus fugues maybe brief and involve short distances.
Note: some patients may report multiple fugues
True or False: Dissociative fugues can involve assuming a new identity.
True.
Synopsis : In classic cases they may live under an alter identity and acc to DSM-5 would be Dx as Other specified dissociative D w/ features of DID
What is a common finding of the past or family history among patients with dissociative symptoms?
Prior personal or family history of somatoform or dissociative symptoms.
Fill in the blank: Dissociative fugues may occur in patients with both dissociative amnesia and _______.
dissociative identity disorder.
What is the relationship between combat intensity and dissociative symptoms?
The intensity of combat appears to be the most crucial variable in the development of dissociative symptoms.
