dissociative disorders

Question 1

what is dissociation

Answer 1

disruption of normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior

Question 2

reasons dissociation may occur

Answer 2

response to trauma or drugs
allow mind to distance self from experiences that can’t be processed presently
culturally/religiously accepted phenomenon

Question 3

prevalence of dissociation in “normal” people

Answer 3

60-65% of people have had some non-clinically significant dissociative experiences

Question 4

non-pathological dissociations

Answer 4

everyday adaptation- states of selective attention or inattention
therapeutic- hypnosis, anesthesia
“daydream” or fantasy

Question 5

dissociations in development

Answer 5

if child lacks object constancy, may have fantasy and imaginary friends, fluctuating sense of self good/badness, imagined inconstancy or rules, impaired sense of time

Question 6

dissociation and trauma

Answer 6

much more common in traumatized people, but not in all people who have suffered trauma
part of a group of sx common to some victims of childhood physical, psychological, or sexual abuse

Question 7

development of dissociative disorders

Answer 7

usually involves repetitive trauma from which escape is not possible, especially during a phase of life when dissociation is a frequently used adaptive defense

Question 8

dissociation and co-morbid symptoms

Answer 8

often include anxiety, PTSD, low self-esteem, personality disorders, somatization, depression, chronic pain, interpersonal dysfunction, substance abuse, self-mutilation, suicidal ideation or action

Question 9

Freudian explanation of dissociation

Answer 9

unconscious psychological strategy to cope with reality and maintain self image, protect mind from anxiety or environment

Question 10

medical conditions in differential diagnosis for dissociation

Answer 10

neurological disorders, including TBI, CVA
delirium
partial complex seizures
substance use/abuse (ketamine, NO, EtOH, LSD, tiletamine, marijuana, dextromethorphan, PCP, salvia, muscimol, atropine, ibogaine)

Question 11

substances on urine drug screen

Answer 11

amphetamines, opiates, cocaine, cannabis, barbiturates, benzos

Question 12

psychiatric conditions in differential diagnosis for dissociation

Answer 12

PTSD, borderline personality disorder, mood disorders, psychosis, malingering/ factitious, substance abuse

Question 13

dissociative amnesia criteria

Answer 13

1+ episodes of inability to recall important personal information (usually stressful in nature) beyond normal forgetfulness

• does not occur exclusively during other psychiatric disorders or d/t substance or other condition
• not disoriented, may be aware of amnesia, resolves quickly

Question 14

epidemiology of dissociative amnesia

Answer 14

1% males, 2.6% females
sudden onset
risk factors: war, child abuse, natural disaster, prison/concentration camp, genocide

Question 15

dissociative fugue criteria

Answer 15

sudden unexpected travel away from home or work with inability to recall past, confusion about identity or assumption of new identity
does not occur exclusively during dissociative identity disorder, not d/t substance or other condition
*form of dissociative amnesia in DSM5

Question 16

depersonalization/ derealization disorder criteria

Answer 16

persistent/recurrent feelings of detachment from mental processes or body
reality testing remains intact
does not occur during other mental disorder, substance, or other condition

Question 17

epidemiology of depersonalization/ derealization disorder

Answer 17

2% both sexes
mean onset: 16 yo
common in users of THC, LSD, ketamine, MDMA, salvia
often have immature coping mechanisms

Question 18

dissociative identity disorder criteria

Answer 18

2+ distinct identities or personality states, at least 2 of which recurrently take control of person’s behavior
inability to recall important personal information beyond ordinary forgetfulness

Question 19

epidemiology of dissociative identity disorder

Answer 19

1.6% males, 1.5% females in US
over 70% have attempted suicide
90% have hx of childhood abuse or neglect
high comorbidity w psych d/o and malingering

Question 20

clues to dissociative identity disorder diagnosis

Answer 20

large gaps in memory
being recognized by strangers or called different names by them
finding unfamiliar objects in home
being unable to remember injuries on multiple occasions (w/o EtOH)

Question 21

other specified dissociative disorders

Answer 21

identity disturbance - d/t prolonged and intense coercive persuasion/ brainwashing
acute dissociative reactions to stressful events

Question 22

diagnosis and tx of dissociative disorders

Answer 22

no diagnostic tests available, dx based on serial interviews
tx: psychotherapy (supportive, insight-oriented, hypnosis), partial hospitalization, low-dose atypical anti-psychotics, SSRIs (depressive affects), BZDs for anxiety about previously split-off material