Dissociative Disorders Flashcards
Dissociation
Disruption or discontinuity in integrating aspects of psychological functioning
•affects attention, memory, and laps in consciousness, perceptions (delusions), and motor control (body feels off)
•most people have experienced a form of dissociation at some point
•ex: zoning out, daydreaming, highway hypnosis
•drug effects: being drunk/not understanding what people are saying
Many psychological processes are unconscious
•Implicit and procedural memory (riding a bike, breathing - can’t really explain how you do it but you just do it)
•unconscious because it’s sensory overload/too demanding without relying on the unconscious
•what is conscious vs unconscious is usually adaptive/flexible (what you have to think about vs what you don’t)
Dissociative disorders
Dysregulation for whats conscious vs unconscious
•conceptualized as maladaptive/coping strategy (ex: learned helplessness -MDD)
•distances from disliked parts of self, distressing and overwhelming environments, or socially unacceptable wishes/choices
•historically in western societies: rise in anxiety, depressive disorders - fall in DID
•dissociation symptoms can be seen in other disorders (flashbacks in PTSD)
Depersonalization and Derealization Disorder
Depersonalization: loss of sense of reality in oneself
•sensation from outside your body (floating, detached)
•body is automatic, doing routine patterns without persons input
Derealization: loss of sense of reality in external world
•sensation of external world is distinct/strange/lifeless
•feels like life is a dream/movie/video game/behind glass, or people are robots
Both: isolating, numbing, frightening
•reality testing intact (know it’s not real)
•can have one or the other, but it often occurs together
•can happen when sleep deprived
Psychological and biological factors
Psychological
•we don’t know much
•emotional experiences reduced during dissociation (less connection with sad film)
•emotional states can prompt dissociation (more fragmented memories following watching emotional films)
•distortions in perceptions of time and memory impairments
•fears of going crazy (especially near beginning) result in further anxiety
Prevalence for depersonalization and derealization
Very poor data
•lifetime: 1.2%
•50% of adults have had some experience with it
•equal gender ratio
•age: 16 (older than middle age probably another problem - dementia)
•onset can be gradual or sudden, is persistent, chronic, but usually not progressive
•comorbidities: depression, anxiety, PTSD, borderline, avoidant, OCPD
Treatment
- education about treatment
- manage anxiety/stress coping
- psychotherapy (much is unknown)
•mindfullness/self hypnosis seems to help if done well but if done bad can make it worse
•conscious emotional awareness helps
•exploring underlying stress/desires (knowing you don’t like something means you can avoid it)
Amnesia
Amnesia: memory deficit with disruption in retrieval of memories due to psychological factors (two types)
1. Anterograde: difficulty in making new memories
•common in brain injury, dementia, and neurological disorders
2. Retrograde: difficultly recalling old memories
•forgetting who you are (very rare), forgetting your childhood (usually dissociation)
•forgetting this much usually is a global decline (you’re literally falling apart)
Dissociative amnesia
Partial or total inability to recall autobiographical information
•memories can be retrieved through: hypnosis, sodium amytal (similar to hypnotic state), or spontaneous remission
•can last for days - years
•mostly have one episode, but can have several overtime
•impaired: autobiographical and episodic
•not impacted: procedural and semantic memory (general knowledge about doing things) working memory, ability to learn, language, and daily functioning/independent living
Dissociative fugue
When you have dissociative amnesia and you escape from life/home surroundings
•confusion about identity (John Doe)
•may adopt new identity (but not rapid swiping like in DID)
•while in the state they’re unaware of their previous life, but can remember new events
•lifestyle/behaviour is normal, but often different from previous life
Fugue remission
•person often confused when fugue remits
•spontaneous revision, forceful reminders, or repeated questioning
•when fugue remits, amnesia remits (but often new amnesia develops for experiences in fugue state)
We think fugue is avoidance of overwhelming stress/other problems in original life
Psychological and biological factors
Similar as conversion disorder (trying to separate trauma from your life)
•retrograde: neurological dysfunction without a cause
•reduced right temporal lobe and frontal lobe activation in autobiographical memory tasks (similar to organic memory task - very small sample)
Psychological: implicit memory for autobiographical details are often correct
•ex: guess names of loved ones/phone numbers correctly
•ex2: german immigrant forgot language, but better functioning on german memory tests
Prevalence of dissociative amnesia
Very incomplete data
•12 month: 1.8%
•possibly more common in women
•onset is often sudden (at least for total identity loss)
•comorbidities: depression, anxiety, PTSD, borderline, avoidant, OCPD
Treatment
- keep person safe
- removal from stressful situation sometimes promotes return of memories
- medications (benzos, barbiturates, sodium amytal)
- future psychotherapy to work through distress around memories, but recovered memories should not be taken at face value
Dissociative identity disorder
Disruption of persons experience of identity with two or more personality states
•disruption: changes in affect/emotional cognition, behaviour, psychomotor function, and sensory motor function (vision), consciousness, memories
•each identity can have different: names, age, gender, personal history, self image, preferences, skills, language (must’ve been learned at some point)
•body can feel different based on identity
•must be observed by others (DSM-4) or self reported (DSM-5)
•comes from difficulty with integrating various aspects of the self
Not:
•a possession state
•voluntary, cultural, or spiritual rituals
The identities
•Ego dystonic: person may experience trains of thought (voices), impulses, and emotions beyond control (push and pull)
•Host: carries persons real name and is most frequently (not always most adaptive identity)
•Alter identities: others (child, different g)
•switching personalities can be quick or gradual
•memory gaps when another identity is in control is common
•asymmetry can occur: some alters know more about other alters
•dissociative amnesia features common
Psychological factors
- Post traumatic theory: in the face of severe child abuse (60-90%) often recovered via hypnosis
Children dissociate and escape to fantasy (imagines abuse is happening to “someone else”)
•perhaps only in dissociation children
•because they can’t control environment, this is there coping mechanism that shifts into adulthood - Sociocognitive/iatrogenetic theory
•suggestible, dissociation probe patients induced to show multiple alters by well meaning but unskilled clinicians
•patient picks up on clinicians unconscious pull for more drama (media portrayals of DID in 70s), resulting in alters more present after treatment
Blurry areas
•Hillside Strangler - exaggerated DID
•recovered memories are important but not always reliable
•trauma/abuse: DID is a trigger for people more prone to fantasy (others would have anxiety, depression, etc)
•response is dependent on persons gene environment interaction
Prevalence and treatment of DID
Unknown, but extremely rare
One year: 1.5%
•3-9x more likely in females, and report more alters
•childhood onset, but usually not diagnosed until adulthood
Comorbidities: PTSD, depression, substance us, borderline, suicidality, other dissociation diagnosis, conversion and psychotic symptoms
•stressors can precipitate (often related to prior abuse)
•overtime, theres been more reports (more alters, more bizarre alters (ducks, satan), more dramatic recovered memories
Treatment: usually psychodynamic
- hypnosis to uncover other alters, repressed memories, hidden fears and desires
- support the person in coming to terms with uncovered content
- integration of various alters/aspects is the goal
- preservation of host identity is not important (should reserve the most adaptive alter, or create new integrated sense of self)
- other psychotherapy, medication, support for comorbid diagnosis and stressful environment
