Dissociative Disorders Flashcards
DSM-5 criteria for DID
- Two or more distinct personality states; marked discontinuity in sense of self; alternations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.
- Recurring gaps in the recall of events
History of DID - dates and # of cases
- Only 77 cases between 1791 and 1962
- 8 DID cases in 1944–70
- 36 from 1970-79
- 100 DID cases “in treatment” in 1982
- 171 outcome analyses in 1984
When was the first scholarly monograph devoted to DID?
1986
DID hosts come into clinic with what symptoms?
depression, anxiety, headache
Describe an alter
- encapsulate memories, affects the host doesn’t want to experience (defense mechanism)
- have specific roles, situations in which they appear
what percent of cases have 10 or more alters
50%
In which ways do personalities vary
age, ethnic background, ancestry, accents, vocabulary,species, physiology (visual acuity, allergies, handedness)
List the percentages of patients experiencing the different signs of multiplicity discovered by Cummings reported by ross
-Sense another person existing inside - 90%
-Hearing voices talking - 87%
-Voices inside talking - 82%
-Another person taking control - 81%
Amnesia for childhood - 81%
-Using ‘we’ during interview = 74%
-Persona inside has different name - 71%
-Blank spells, time distortion, lapses - 68%
prevalence of DID in 1994 (us task force)
10%
DID prevalence in 1998 (psychiatric hospital)
1%
1990 Lifetime prevalence of Dissociative disorders (winnipeg)
11.2 (all disorders) o Dissociative amnesia: 7% o Depersonalization 2.4% o DID: 1.3% o Dissociative fugue: 0.2% o DD NOS: 0.2%
DSM-5: U.S. sample (DID annual) prevalence
together - 1.5%
men: 1.6%
Women: 1.4%
We will decide that overall the lifetime prevalence of DID is?
1%
Kluft’s 7 signs of DID
- prior treatment failure
- 3 or more prior diagnosis
- Both somatic and psychiatric symptoms
- Fluctuating symptoms/level of functioning
- severe headaches
- Others note observable changes
- First hand schizophrenia symptoms (feelings of imposed ideas, arguing voices in head)
psychodynamic view of DID
- No Dissociation; only repression
- Process of removing unacceptable content out of consciousness
Trauma-Dissociation Model
- Predisposition for dissociation
- Has trauma exceeding coping capacity
- Removes trauma to non-ego consciousness
What percent of DID patients report abuse (Kluft)
98% (children who can’t escape scenario escape inwardly by abandoning ownership of memories)
Sociocultural model of DID
Individual unconsciously plays culturally-sanctioned dissociative role (hypnotic state, mediumship, spirit possession)
Sources of cultural socialization according to the sociocultural model
- MEdia depictions
- Religious beliefs
- Therapist suggestions/descriptions
proponents of trauma-memory debate
Amnesia exists for trauma including:
- Disaster victims
- Combat trauma
- Prisoners, torture victims
- Violent crime victims
Opponents of trauma-memory debate
- trauma victims may just be too young to remember
- Few fail to remember trauma, i.e holocaust
- response to trauma is usually PTSD (enhanced memory of event)
What are the 2 types of trauma
Type 1; single event = no amnesia
Type 2: Extended events = amnesia
Jennifer freyd proposed that types of trauma differ. In what ways?
“terror traumas” enhance memories i.e. combat
“Betrayal traumas” impair memory through dissociation i.e. incest (as she believes herself to be a victim)
how many cases of DID did boysen and VanBergen discover while reviewing literature b/w 200-2010?
How many from the west?
How many cases outside of therapy?
1170 new DID cases 82% from West (50% from US., Canada)
79% non-Western cases from Turkey only 3% outside therapy:
What were kluft’s treatment steps
- share diagnosis with patient
- Make contact with alters - via hypnosis
- Alters come forward; patients remember and tries to defeat other personalities
- Alters recieve treatment for concerns
- Patient encouraged to facilitate inter-alter communication
What are the 2 types of alters discussed in class?
1) internal self-helper (in 50-80% of cases)
2) Prosecutor (child/adolescent that torments the host)
When do animal alters typically appear
When host is under threat, they play a protective role
what does iatrogenisis mean?
“caused by doctor”
What is Kihlstrom’s opinion of DID
“DID symptoms are created, legitimized and maintained by social reinforcement”
Simulators (pretending to have DID) were similar to DID in what ways?
DES (dissociative experiences scale), implicit memory, ERP
What were some problems when we discussed the success of therapy for DID
Evaluation of therapy was unclear, no common protocols, absence of so treatment controls, no alternate approaches were tested
in recent (e.g., post 1980) cases of DID, the average number of alters is
7-10.
more cases have been diagnosed in the past 20 years than in
all of previously recorded history.
