Dissociative Disorders COMPLETE Flashcards
What is dissociation?
The lack of normal integration of:
Thoughts
feelings
experiences
into the stream of consciousness and memory.
What are the key features of dissociation?
A disruption of:
Sense of self
Sense of body/surroundings
Memory or self- identification
What are the categories of Dissociative disorders?
Derealisation/depersonalisation disorder
Dissociative amnesia
Dissociative identity disorder
What is depersonalisation?
A separation of thoughts emotions and sense of self
You feel as if you are outside of your own body
What is derealisation?
Your surroundings appear surreal and dreamlike.
You feel detached from your surroundings.
What can cause derealisation/ depersonalisation
You can experience mild forms due to sleep deprivation
What is the DSM criteria of depersonalisation/ derealisation disorder?
- recurring and persistent experience of depersonalisation and or derealisation.
- Insight remains intact during the episodes
- Causes distress/ impairment
Why is Depersonalisation/ Derealisation Disorder classified as a differential diagnosis?
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?
What is dissociative amnesia
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.
What is retrieval in relation to memories?
Bringing information back to conscious awareness.,ie. being told a familiar name and it rings a bell
What is encoding in relation to memories
Inputting information into memory, ie. visual- seeing something and you remember it cuz it stands out
What is Dissociative Fugue?
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
Give a case example of dissociative fugue
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
What is the case example for Dissociative Fugue?
Describe what happened
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.
What was Dissociative Identity Disorder priorly refered to as
Why did the name change?
Multiple personality disorder- but the symptoms were incorrectly associated with schizophrenia.
What is DID?
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
What are other ways to describe personality states
Alters
Alternatives
Ego states
How is DID often portrayed in the media
Violent,ie. Billy Milligan, serial killer who claimed DID but was lying to get off
Split- ‘the beast’
Describe the case of Sybill
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.
Why is DID a controversial diagnosis?
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.
What is the prevalence of derealisation/depersonalisation
2.5%
What is the prevalence of dissociative amnesia?
7.5%
what is the prevalence of DID
1.5%
What are dissociative disorders often co morbid with?
BPD
Somatic symptom disorders
Major depression
PTSD
suicide history attempt
