Dissociative Disorders DSM (all) + DiD lecture + guidelines Flashcards
what disturbance characterizes the dissociative disorders
characterized by disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behaviour
what are some of the “positive” dissociative symptoms
fragmentation of identity
depersonalization
derealization
(*unbidden intrusions into awareness and behaviour with accompanying losses of continuity in subjective experience)
what is one of the “negative” dissociative symptoms
amnesia
(*inability to access information or to control mental functions that normally are readily amenable to access or control)
in what context are many of the dissociative disorders found
in aftermath of trauma
what distinguishes depersonalization/derealization from psychosis
the person has intact reality testing
what is dissociative amnesia
an inability to recall autobioraphical information that is inconsistent with normal forgetting
may or may not involve purposeful travel or bewildered wandering (fugue)
are most individuals with dissociative disorders aware of their amnesias?
most are initially UNaware of their amnesias
awareness of amnesia occurs only when personal identity is lost or when circumstances make these individuals aware that autobiographical information is missing
is dissociative fugue common in dissociative amnesia?
no but its common in dissociative identity disorder
what are the two components that characterize dissociative identity disorder
- presence of TWO or more DISTINCT personality states or an experience of POSSESSION
+ - recurrent episodes of amnesia
criterion A for dissociative identity disorder
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 involved MARKED DISCONTINUITY in sense of SELF and sense of AGENCY, accompanied by related alterations in behaviour, consciousness, memory, perception, cognition and/or sensory-motor functioning
s/s may be observed by others or reported by the individual
criterion B for dissociative identity disorder
recurrent GAPS in the recall of everyday events, important personal information and/or traumatic events that are INCONSISTENT with ordinary forgetting
criterion C for dissociative identity disorder
clinically significant distress/impairment
criterion D for dissociative identity disorder
the disturbance is not a normal part of a broadly accepted cultural or religious practice
in kids–> symptoms not better explained by imaginary playmates or fantasy play
criterion E for dissociative identity disorder
not attirbutable to substance/med condition etc
what helps determine the overtness or covertness of the two personality states characteristic of dissociative identity disorder
varies as a function of psychological motivation, current level of stress, culture, internal conflicts and dynamics, and emotional resilience
what other psychiatric symptoms are common in some presentations of dissociative identity disorder
non epileptic seizures and other conversion disorders (especially in non-western settings)
how might those with dissociative identity disorder describe their subjective experiences (answer is copied from DSM cuz i’m lazy and just want a reminder)
“Individuals with dissociative identity disorder may report the feeling that they have suddenly become depersonalized observers of their “own” speech and actions, which they may feel powerless to stop (sense of self) Dell 2006; Spiegel et al. 2011. Such individuals may also report perceptions of voices (e.g., a child’s voice; crying; the voice of a spiritual being). In some cases, voices are experienced as multiple, perplexing, independent thought streams over which the individual experiences no control. Strong emotions, impulses, and even speech or other actions may suddenly emerge, without a sense of personal ownership or control (sense of agency). These emotions and impulses are frequently reported as ego-dystonic and puzzling. Attitudes, outlooks, and personal preferences (e.g., about food, activities, dress) may suddenly shift and then shift back. Individuals may report that their bodies feel different (e.g., like a small child, like the opposite gender, huge and muscular). Alterations in sense of self and loss of personal agency may be accompanied by a feeling that these attitudes, emotions, and behaviors—even one’s body—are “not mine” and/or are “not under my control.” Although most Criterion A symptoms are subjective, many of these sudden discontinuities in speech, affect, and behavior can be witnessed by family, friends, or the clinician.”
what are the 3 primary ways in which the dissociative amnesia seen in dissociative identity disorder may manifest
- gaps in REMOTE memory of personal life events i.e periods of childhood, adolescence, getting married, giving birth
- lapses in DEPENDABLE memory i.e what happened today, well learned skills such as how to do their job, read, drive
- discovery of evidence of their every actions and tasks that they do not recollect doing i.e finding unexplained objects in their shopping bags, perplexing writings or drawings that they must have created, discovering injuries, “coming to” in the midst of going something
list brain regions that have been implicated in the pathophysiology of dissociative identity disorder
orbitofrontal cortex
hippocampus
parahippocampal gyrus
amygdala
what is the 12 month prevalence of dissociative identity disorder in the USA
1.5% (about equal males and females)
dissociative identity disorder is associated with what type of life events
overwhelming experiences
traumatic events
and/or abuse occurring in childhood
when does dissociative identity disorder usually manifest
can manifest at any time from early childhood to late life
psychological decompensation and overt changes in identity in people with dissociative identity disorder may be triggered by what events
- removal from the traumatizing situation
- individual’s children reaching same age at which individual was initially traumatized
- later traumatic experiences
- the death of or onset of a fatal illness in their abuser
list environmental risk factors for dissociative identity disorder
interpersonal physical and sexual abuse
other forms of traumatizing experiences