Dissociative Disorders

Question 1

Dissociative Identity Disorder Diagnostic Criteria

Answer 1

A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual
B. Recurrent gaps in the recall of everyday events, important personal information and/or traumatic events that are inconsistent with ordinary forgetting
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice, and in children the symptoms are not better explained by imaginary playmates or other fantasy play.
E. The symptoms are not attributable to the physiological effects of a substance or another medical condition.

Question 2

Dissociative Identity Disorder Gender-Related Diagnostic Issues

Answer 2

Adults- Females exhibit more acute dissociative states (Amnesia, fugue, hallucination, self-mutilation etc.) diagnosed more that males as males are more likely to deny/minimize their symptoms.
Children- Ratio is the same

Question 3

Dissociative Identity Disorder Comorbidity

Answer 3

PTSD is especially common and 70% have attempted suicide, usually multiple times. Depressive disorders, Trauma/Stressor related, personality disorders (Esp. Avoidant and Borderline), conversion disorder, somatic symptom disorder, eating disorders, substance-related disorders, OCD and sleep disorders are also commonly comorbid.

Question 4

Dissociative Amnesia Diagnostic Criteria

Answer 4

A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. ( Most often consist of localized or selective amnesia for specific events or generalized amnesia for identity and life history)
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance or a neurological or other medical condition
D. The disturbance is not better explained by another disorder.

Question 5

Dissociative Amnesia Specifiers

Answer 5

IF: With dissociative fuge

Question 6

Dissociative Fuge

Answer 6

Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information (AKA during an episode of Dissociative Amnesia)

Question 7

What is the most and least common forms of Dissociative Amnesia

Answer 7

Most- localized amnesia

Least- generalized amnesia

Question 8

localized amnesia

Answer 8

A failure to recall events during a circumscribed period of time. Can be for a single event or for months or years as is often the case with survivors of child abuse or comat.

Question 9

selective amnesia

Answer 9

The individual can recall some, but not all, of the events during a circumscribed period of time. Thus, the individual may remember part o a traumatic event but not other parts. Can co-occur with localized amnesia.

Question 10

generalized amnesia

Answer 10

A complete loss of memory for one’s life history. Can include personal identity, semantic knowledge and procedural knowledge. Characterized by an acute onset.

Question 11

How do individuals with dissociative amnesia generally feel about their memory problems?

Answer 11

Sufferers are frequently unaware of the problem, and especially in the case of localized amnesia, may minimize the importance of the memory loss and become uncomfortable when prompted to address it.

Question 12

systematized amnesia

Answer 12

Memory loss for a specific category of information, for example about a particular person or childhood sexual abuse

Question 13

continuous amnesia

Answer 13

an individual forgets each new event as it occurs

Question 14

Development and course of dissociative amnesia

Answer 14

Sudden onset for generalized, but localized and selective amnesias are less harder to detect and therefore have unknown onset patterns and onset may be delayed from the traumatic event for hours days or longer.
History of dissociative amnesia predisposes someone for future ones. Duration of episodes vary (minutes to decades). Amnesia may remit suddenly or slowly and be replaced with distress, suicidal behavior and PTSD symptoms.
Can occur in children, but is especialy hard to diagnose due to developmental level and diagnosis may be reliant on observations from multiple adult sources (teachers, parents, case workers etc.)

Question 15

Risk Factors for Dissociative Amnesia

Answer 15

Environmental- traumatic experiences, risk increases with number of exposures, severity an younger ages of exposure
Course Modifiers- Removal from traumatic situation may cause rapid reversal of symptoms,

Question 16

Dissociative Amnesia Comorbidity

Answer 16

Risk of suicide is high, during symptom remission dysphoria, grief, rage, shame, guild, etc. are high; depressive disorders, trauma/stressor related disorders, and somatic disorders are common as are the following personality disorders- dependent, avoidant & borderline

Question 17

Depersonalization/Derealization Disorder Diagnostic Criteria

Answer 17

A. The presence of persistent or recurrent experience of depersonalization, derealization or both
B. During the depersonalization and/or derealization experiences, reality testing remains intact
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance or another medical condition
E. The disturbance is not better explained by another mental disorder.

Question 18

depersonalization

Answer 18

Experiences of unreality, detachment or being an outside observer with respect to ones thoughts, feelings, sensations, body or actions. For example, perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing.

Question 19

derealization

Answer 19

Experiences of unreality or detachment with respect to surroundings. For example, individuals or objects are experienced s unreal, dreamlike, foggy , lifeless, or visually distorted

Question 20

Depersonalization/Derealization Disorder Prevalence

Answer 20

Transient D/D episodes are common w/ lifetime prevalence of about 50%; for the actual disorder lifetime prevalence is about 2% in the US with men and women equally effected.

Question 21

Depersonalization/Derealization Disorder Age of Onset

Answer 21

16 years is mean age of onset, but can start in middle childhood
20% of individuals have an onset after 20 YO
5% have onset after 25 YO
Onset after 40 YO is very unusal

Question 22

Depersonalization/Derealization Disorder Course

Answer 22

Onset can be sudden or gradual and course is fairly evenly distributed between discrete episodes, continuous experience of symptoms, and discrete episode that eventually become continuous. Intensity can vary or remain consistent.