Dissociative disorders

Question 1

Dissociative Disorders

Answer 1

• Conditions marked by disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior
• Hallmarks – shifts in consciousness, the sense of self, and perceptions of the environment

nicer words –> disturbance or dysfunction in the self… and in the perception/consciousness of being WHOLE

Question 2

Dissociative identity Disorder (DID)

Answer 2

• Disruption of identity by two or more distinct personality states and recurrent gaps in the recall of everyday events, personal information, and/or traumatic events inconsistent with ordinary forgetting
• Distinct personality states instead of distinct personalities

Question 3

Demographics / possible presentations of DID

Answer 3

• 5% of the population
• trait occupy one person and they may (personalities) may not be aware of one another
  -various personalities may have different eye prescriptions
• some personalities speak different languages
• some personalities have different EEG ratings
• sometimes there is a “main” dominant personality
• alternate personalities can include:
  children ; adolescence; opposite gender; animals

Question 4

Ross et al. study on abuse children & DID

Answer 4

Ross et al. did a study looking at abused children (sexual) and found that there is a mean # of “alters” (16)

• in this population, about 86% had DID
• 10% had a psychotic personality

Question 5

Skepticism in DID

Answer 5

• DID can be influenced in vulnerable people
  this was demonstrated with a psychologist who reported that she could influence her patients to take on multiple roles on cue. “ Show me Michael now!”
• DID Is a rare disorder…it is kind of impossible for her to just happen to have many patients who had it.

Question 6

Dissociative Amnesia (formerly psychogenic amnesia)

Answer 6

• Inability to recall important information of trauma or a stressful experience that is beyond simply forgetting.
• DA–> amnesia as a result of psychological reasons.
• Dissociative Amnesia is milder form of DID
• DA is reversible b.c it is not neurologically based
• the recall of dissociative memories can occur gradually and/or spontaneously

Question 7

Types of Dissociative Amnesia

Answer 7

Types:
• Localized – specific time period is lost to memory.
i.e. inability to recall car accident events
• Selective – some, but not all events for a specific period of time
i.e. forget the year of the affair, but not the guilt after
• Generalized – can’t recall anything about their entire lives
i.e. forget who they are, what they did, who they live with.
• Continuous – forget each new event as they occur. Everything from a specific time is lost.
• Systematized – loss of memory of actual systems…categories
i.e. forgetting “college years” or “family”

o Last 3 much more rate, and may be manifestations of DID

Question 8

Dissociative Fugue

Answer 8

• considered as a condition that may accompany DA (used to be its own dx)
• reversible amnesia for personal identity.
• short lived (hours to days)
• involves unplanned travel or wandering, and is sometimes accompanied by establishing a new identity (they create a new life) .

Question 9

Depersonalization/Derealization Disorder (formerly depersonalization disorder)

Answer 9

• Depersonalization: experiences of unreality, feelings of detachment or being an outside observer of one’s thoughts, feelings, sensations, or actions, unreal or absent sense of self, phys/emo numbing, time distortion
• Derealization: unreality or detachment with respect to one’s surrounding that include the experience of individuals or objects as unreal, dreamlike, foggy, visually distorted, or lifeless
• Most common , least controversial
• Reality testing remains intact
• Aware the sensations are not real and are not experiencing a break from reality
• Persistent depersonalization, derealization, or both

Question 10

Dissociative Experiences Scale -II (DES-II)

Answer 10

• a lot of other disorders can score on this as well
• Dissociativeness is based on a spectrum if they score high on this –> warrants a clinical assessment of DID
• People with PTSD score high on this

Question 11

Scales on the DES-II

Answer 11

• Amnesia Factor- memory loss
• Depersonalization-derealization Factor - detachment of the self and of the immediate environment
• Absorption Factor - being so preoccupied or absorbed by something going on around you

Question 12

systems involved in dissociative disorders

Answer 12

automatic information processing
controlled information processing
incidental information processing

Question 13

automatic information processing

Answer 13

something is automatized - it requires no effort

Question 14

controlled information processing

Answer 14

tasks you do that require constant effort. the theory says that as you get good at doing tasks you can use more automatic processing. (i.e. driving a car, or reading)

Question 15

incidental information processing

Answer 15

is not learned, but it does not require much effort to do.

Question 16

Learning cognitive perspective on DID

Answer 16

• plays on information processing
• people learn to use cognitive avoidance in order for it to be negatively reinforcing to not think /process situations associated with guilt and shame.
• reinforced by reducing anxiety/shame
• providing an escape
• many times they become so absorbed in their role play that they forget they are acting and the role becomes reinforced to avoid processing negative emotions.

** in DID you become SOOO absorbed in the role that you forget about the trauma

Cognitive point of view:
- use of avoidance, negative reinforcement, and roleplaying

Question 17

The consciousness in DID

Answer 17

DID suggests that individuals can splinter their consciousness into different roles. You become different roles as opposed to integrated roles organized as a whole

**is it such a far leap to suggest that consciousness can be splintered?

Question 18

Role of Childhood Trauma in DID

Answer 18

Trauma Dissociation Model - states that DID develops to deal with sexual/physical abuse.

DID–> way to distance from trauma

Question 19

DID stats

Answer 19

about 83% report a history of sexual/physical abuse

2/3s of patients in the study report incest

DID occurs due to childhood trauma usually from a caretaker or guardian

another study found that 95% of 102 people suffered form childhood physical and sexual abuse

Question 20

Trauma Dissociation model

Answer 20

The model indicates that children learn how to distance the self. This is referred to as. Psychological Escape.

Question 21

Psychological Escape ( as a part of the Trauma Dissociation Model)

Answer 21

• going somewhere else in the mind (imagining themselves to be somewhere else)
• imagining themselves as stronger or smarter
• allows the creation of associations… and keeping them outside of conscious awareness and detached from the trauma. Provides an ________ effect where they do not feel the pain.

Question 22

DID based on age

Answer 22

if trauma occurs during childhood–> developing of DID increases

if trauma occurs during adolescence you are more likely to repress –> develop DA

As an adult with DID, if you are in an emotional situation you are likely to trip those personalities and activate them. You use the same escape and these personalities are triggered to deal with situations/responsibilities.

Question 23

Controversy behind suppressed memories

Answer 23

• can we say childhood memories that recall abuse are real?
• some people become aware of some memories after intensive therapy (hypnosis)
• memories can be planted by therapists…

Question 24

MRI and DID

Answer 24

individuals with DID have reduced hippocampus activation (responsibility for STM and LTM, processing neg. emotions/traumatic memories)

hippocampus can be a biological consequence to abuse
TRAUMA –> Reduced hippocampus –> cortisol increases –> likely to develop DID

Question 25

Treatment of DID

Answer 25

-treating the anxiety can reduce dissociation

• you can use hypnosis
  
  • although you may create false memories.
  • serper said hes never seen this work
• Tx to combine the alters, which takes 3 years. (another flashcard for this)
• skills to deal with memory loss
• coping strategies with stress/trauma

Question 26

Medication for DID

Answer 26

• medication is difficult, there is NO drug that can combine the personalities.
• it is also difficult to convince people to take medication because all personalities have to agree
• perhaps prescription : antidepressant, or anti-anxiety medication (anxiolytics)

Question 27

Tx to combine alters (DID)

Answer 27

This supposedly takes 3 years ; highly structured

• 1st phase- Developing trusting relationship
• 2nd phase- Communicate with the alters and enlist them into the therapy (build cooperation)
• 3rd phase- Recapitulation and incorporating gains made in the last 2 phases
• 4st phase - the client learns a new way of living in which the menace of trauma no longer lurks in memory as a threat to personality.

Question 28

-1st phase- Developing trusting relationship

Answer 28

Educated on dissociation and trauma

Mapping out the system of alters
Who is aware of who? Is there conflict between personalities?

Question 29

-2nd phase- Communicate with the alters and enlist them into the therapy (build cooperation)

Answer 29

the mean # of alters is 16) need to build rapport with each alter and have them consent & cooperate to treatment.

Helping the patient recognize and cope with pass trauma.

Uses hypnosis to facilitate access to memories

Allows patient to confront and release painful emotions

Patient is told to give up dissociative defenses and allow memories into consciousness; psychic release of the trauma

Question 30

-3rd phase- Recapitulation and incorporating gains made in the last 2 phases

Answer 30

Relegating the trauma to the distant past

Encouragement to build a personality that merges the other alters; build an integrated personality that subsumes the others.

Develop a healthy single personality

Question 31

• 4st phase - the client learns a new way of living in which the menace of trauma no longer lurks in memory as a threat to personality.

Answer 31

Face the trauma without dissociative strategies.

Question 32

Psychodynamic approach to DID

Answer 32

Aims to help patient to deal with childhood trauma

All personalities can be asked to talk about their feelings and dreams

Make them conscious

Free the psychic energy trapped by them

Anxiety during a session may cause a switch in the session to alter because it is a means of coping with it.

Eventually the idea is that early experiences may be brought out into light so that reintegrating of the personalities become possible

Question 33

Behavioral Approach to DID

Answer 33

Exposure - face the trauma

Extinguish- ignore the personalities