Dissociative Disorders COMPLETE

Question 1

What is dissociation?

Answer 1

The lack of normal integration of:
Thoughts
feelings
experiences
into the stream of consciousness and memory.

Question 2

What are the key features of dissociation?

Answer 2

A disruption of:
Sense of self
Sense of body/surroundings
Memory or self- identification

Question 3

What are the categories of Dissociative disorders?

Answer 3

Derealisation/depersonalisation disorder

Dissociative amnesia

Dissociative identity disorder

Question 4

What is depersonalisation?

Answer 4

A separation of thoughts emotions and sense of self
You feel as if you are outside of your own body

Question 5

What is derealisation?

Answer 5

Your surroundings appear surreal and dreamlike.

You feel detached from your surroundings.

Question 6

What can cause derealisation/ depersonalisation

Answer 6

You can experience mild forms due to sleep deprivation

Question 7

What is the DSM criteria of depersonalisation/ derealisation disorder?

Answer 7

1. recurring and persistent experience of depersonalisation and or derealisation.
2. Insight remains intact during the episodes
3. Causes distress/ impairment

Question 8

Why is Depersonalisation/ Derealisation Disorder classified as a differential diagnosis?

Answer 8

Its stress triggered, so os PTSD a better description

No insight- could it be schizophrenia

If they’re a habitual drug user, their symptoms may be marijuana induced?

If it only happens during panic attacks? What could this mean?

Question 9

What is dissociative amnesia

Answer 9

An inability to recall autobiographical info- usually that of stressful/traumatic nature.

Not linked to substance use/brain injury or another psychological condition like PTSD.

The symptoms cause significant distress/ impairment

Memories can be recovered, the problem is in retrieval and not encoding.

Question 10

What is retrieval in relation to memories?

Answer 10

Bringing information back to conscious awareness.,ie. being told a familiar name and it rings a bell

Question 11

What is encoding in relation to memories

Answer 11

Inputting information into memory, ie. visual- seeing something and you remember it cuz it stands out

Question 12

What is Dissociative Fugue?

Answer 12

Occurs with dissociative amnesia, it is purposeful travel

A person may leave their home, take up a new job or travel long distances

But not an example of being intoxicated or dementia

Question 13

Give a case example of dissociative fugue

Answer 13

Albert Dadas-
Age of 12 had first episode and went to a town and became umbrella salesman and saw someone he knew and came out of it
Then he went very far to Russia

Question 14

What is the case example for Dissociative Fugue?
Describe what happened

Answer 14

Patient NN was 39 and stayed in streets of south Germany and Austria in a state of dissociative fugue for 2 weeks

They lost all autobiographical memory and their sense of self after. However, they remembered implicit skills and public events, like the death of princess Diana.

Question 15

What was Dissociative Identity Disorder priorly refered to as
Why did the name change?

Answer 15

Multiple personality disorder- but the symptoms were incorrectly associated with schizophrenia.

Question 16

What is DID?

Answer 16

It is characterised by experience of at least 2 distinct personality states

A marked discontinuity in identity

Recurrent memory gaps

Each alter has independent autobiographical and episodic memories.
But they all share implicit memories and skills

Question 17

What are other ways to describe personality states

Answer 17

Alters
Alternatives
Ego states

Question 18

How is DID often portrayed in the media

Answer 18

Violent,ie. Billy Milligan, serial killer who claimed DID but was lying to get off
Split- ‘the beast’

Question 19

Describe the case of Sybill

Answer 19

A Girl Not Named Sybil

Concerned a woman who had been abused by her mother as a child and created multiple personalities for herself.
She started seeing her psychoanalyst in 1950s, developing 16 personalities.
Case bought about discussion as once the DSM included multiple personality disorder, it went from being extremely rare to very common.

Diagnosis:
The DR had an interest in MPD and told Sybil to look into it, this was when she began to develop these multiple personalities.
Came to the practice as a girl named ‘peggy’, and the Doctor was pleased that she had MPD so offered to treat her for free.
She administered:
Thorazine: Anti-psychotic which had side effects of hallucinations
Intravenous Barbiturates: Cause fantasies which seem very real

Discussion:
The doctor added leading questions which would focus on the mother, implying that these personalities were generated because of this.
The diagnosis of DID will exist where an expert is actively interested in finding and diagnosing it
Not suggesting that people are faking it, once they have the diagnosis they act it out, consciously or not.

Question 20

Why is DID a controversial diagnosis?

Answer 20

People don’t believe that it is real

Disorders like anxiety, depression have been well document throughout all of history but DID was only introduced in the late 19th century.

Was only added to DSM-3 in 1980

Is the person malingering- like billy Milligan

Or did the patient get it itrogenically,ie. through treatment like Sybill/shirely mason

The consequences for the legal system in recognising this disorder is complex- interferes with free will and knowing right from wrong.

Question 21

What is the prevalence of derealisation/depersonalisation

Answer 21

2.5%

Question 22

What is the prevalence of dissociative amnesia?

Answer 22

7.5%

Question 23

what is the prevalence of DID

Answer 23

1.5%

Question 24

What are dissociative disorders often co morbid with?

Answer 24

BPD
Somatic symptom disorders
Major depression
PTSD
suicide history attempt

Question 25

What is the problem with the unclear criteria for dissociative disorders?

Answer 25

If clinicians interested in the area of study, may make their criteria lighter so more people to diagnose.

Some studies rely on the dissociative disorder interview- Ross- and the probes from this interview are so vague that the diagnostic rates might be overestimated.

Very General Probes:
Dissociative amnesia probe: “Have you ever experienced sudden inability to recall important personal information or events that is too extensive to
be explained by ordinary forgetfulness?”

People vary in their definition of ordinary forgetfulness!

Question 26

What causes dissociation?

Answer 26

Sleep deprivation
Stress
Drugs

Question 27

What are the 2 types of models in relation to studying the causes of dissociation?

Answer 27

Post Traumatic Model
The socio-cognitive model

Question 28

What does the post traumatic model posit?

Answer 28

That DD’s are an elaborated but selective form of PTSD due to the common symptoms.
Syndrome may arise as one attempts to restore balance and stability and cope with life following chronic/acute trauma

Question 29

What do Psychoanalysis in regards to the Post traumatic model contend about DD?

Answer 29

That dissociative symptoms are an innate mechanism to protect the individual from stress.

Question 30

What do neurobiologists in regards to the Post traumatic model contend about DD?

Answer 30

Stress interferes with memory consolidation

Question 31

What evidence supports the post traumatic model?

Answer 31

Trauma is the primary risk factor for dissociative disorder
* High rates of childhood trauma
o Sexual: 57%-90% o Emotional: 57%
o Physical: 63%-82% o Neglect: 63%

Note: there is a lack of prospective studies

Question 32

What does the socio-cognitive model posit?

Answer 32

DID might be elicited by the therapist

People seek explanations and suggestions made by therapists or media might cause alters to “appear” (i.e. iatrogenic)

This doesn’t mean people are intentionally making it up

Question 33

What did modestin et al conclude?

Answer 33

A small number of clinicians contribute most of the diagnoses of DD

Question 34

What is the treatment for DD’s

Answer 34

There have been no randomised trials

Psychotherapy

Medication- none have been approved

Question 35

What are the 2 types of psychotherapy used?

Answer 35

Cognitive approaches
Psychodynamic approaches-mostly used

Question 36

Describe the cognitive approaches.

Answer 36

aim to help a client form more adaptive coping techniques and manage stressors.

In DID, the aim is to convince the individual that they do not need their different identities to be safe anymore.-re-integration of their identity

Question 37

Describe the psychodynamic approaches.

Answer 37

Focus on repressed memories.
Can make things worse. False memory inductions that have been proven wrong later. Lots of lawsuits.