Dissociative Disorders DSM (all) + DiD lecture + guidelines

Question 1

what disturbance characterizes the dissociative disorders

Answer 1

characterized by disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behaviour

Question 2

what are some of the “positive” dissociative symptoms

Answer 2

fragmentation of identity

depersonalization

derealization

(*unbidden intrusions into awareness and behaviour with accompanying losses of continuity in subjective experience)

Question 3

what is one of the “negative” dissociative symptoms

Answer 3

amnesia

(*inability to access information or to control mental functions that normally are readily amenable to access or control)

Question 4

in what context are many of the dissociative disorders found

Answer 4

in aftermath of trauma

Question 5

what distinguishes depersonalization/derealization from psychosis

Answer 5

the person has intact reality testing

Question 6

what is dissociative amnesia

Answer 6

an inability to recall autobioraphical information that is inconsistent with normal forgetting

may or may not involve purposeful travel or bewildered wandering (fugue)

Question 7

are most individuals with dissociative disorders aware of their amnesias?

Answer 7

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

Question 8

is dissociative fugue common in dissociative amnesia?

Answer 8

no but its common in dissociative identity disorder

Question 9

what are the two components that characterize dissociative identity disorder

Answer 9

1. presence of TWO or more DISTINCT personality states or an experience of POSSESSION
   +
2. recurrent episodes of amnesia

Question 10

criterion A for dissociative identity disorder

Answer 10

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

Question 11

criterion B for dissociative identity disorder

Answer 11

recurrent GAPS in the recall of everyday events, important personal information and/or traumatic events that are INCONSISTENT with ordinary forgetting

Question 12

criterion C for dissociative identity disorder

Answer 12

clinically significant distress/impairment

Question 13

criterion D for dissociative identity disorder

Answer 13

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

Question 14

criterion E for dissociative identity disorder

Answer 14

not attirbutable to substance/med condition etc

Question 15

what helps determine the overtness or covertness of the two personality states characteristic of dissociative identity disorder

Answer 15

varies as a function of psychological motivation, current level of stress, culture, internal conflicts and dynamics, and emotional resilience

Question 16

what other psychiatric symptoms are common in some presentations of dissociative identity disorder

Answer 16

non epileptic seizures and other conversion disorders (especially in non-western settings)

Question 17

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)

Answer 17

“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.”

Question 18

what are the 3 primary ways in which the dissociative amnesia seen in dissociative identity disorder may manifest

Answer 18

1. gaps in REMOTE memory of personal life events i.e periods of childhood, adolescence, getting married, giving birth
2. lapses in DEPENDABLE memory i.e what happened today, well learned skills such as how to do their job, read, drive
3. 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

Question 19

list brain regions that have been implicated in the pathophysiology of dissociative identity disorder

Answer 19

orbitofrontal cortex

hippocampus

parahippocampal gyrus

amygdala

Question 20

what is the 12 month prevalence of dissociative identity disorder in the USA

Answer 20

1.5% (about equal males and females)

Question 21

dissociative identity disorder is associated with what type of life events

Answer 21

overwhelming experiences

traumatic events

and/or abuse occurring in childhood

Question 22

when does dissociative identity disorder usually manifest

Answer 22

can manifest at any time from early childhood to late life

Question 23

psychological decompensation and overt changes in identity in people with dissociative identity disorder may be triggered by what events

Answer 23

1. removal from the traumatizing situation
2. individual’s children reaching same age at which individual was initially traumatized
3. later traumatic experiences
4. the death of or onset of a fatal illness in their abuser

Question 24

list environmental risk factors for dissociative identity disorder

Answer 24

interpersonal physical and sexual abuse

other forms of traumatizing experiences

Question 25

list factors associated with poorer prognosis in dissociative identity disorder

Answer 25

ongoing abuse

later life re-traumatization

comorbidity with mental disorders

severe medical illness

delay in appropriate treatment

Question 26

what % of people with dissociative identity disorder report hx of interpersonal physical/sexual abuse

Answer 26

90%

Question 27

how do you distinguish possession-form dissociative identity disorder from culturally accepted “possession states”

Answer 27

possession-form dissociative identity disorder = involuntary, distressing, uncontrollable and often recurrent or persistent

involves conflict between person and their family/social/work environment

manifested at times and in places that violate the norms of the culture or religion

Question 28

how do presentations differ between female and males with dissociative identity disorder

Answer 28

females–> more common acute dissociative states

males–> more common criminal or violent behaviour

Question 29

how common is suicide in dissociative identity disorder

Answer 29

very common–> over 70% of those with dissociative identity disorder have attempted suicide

*multiple attempts are common and other self injurious behaviour is frequent

Question 30

what makes assessing for suicide risk in dissociative identity disorder challenging

Answer 30

may be amnesia for past suicidal behaviour

presenting identity may not feel suicidal and is unaware that other dissociated identities do

Question 31

does treatment for dissociative identity disorder improve functioning

Answer 31

yes, often markedly

however some remain highly impaired

Question 32

ddx dissociative identity disorder

Answer 32

other specified dissociative disorder

MDD

bipolar disorders

PTSD

psychotic disorders

sub/med induced disorders

personality disorders

conversion disorder

seizure disorder

factitious disorder and malingering

Question 33

depressive symptoms/disorder in those with dissociative identity disorder often has one particular feature–what is it?

Answer 33

depressed mood and cognitions often FLUCTUATE because they are experienced in some identity states but not others

Question 34

what is the common misdiagnosis in people with dissociative identity disorder

Answer 34

bipolar disorders, especially bipolar II

Question 35

what dissociative symptoms are found in dissociative identity disorder but NOT in PTSD

Answer 35

amnesias for EVERYDAY events (not just traumatic events like in PTSD)

dissociative flashbacks that may be followed by amnesia for the content of the flashback

disruptive INTRUSIONS (unrelated to traumatic material) by dissociated identity states into individuals sense of self and agency

infrequent, full blown changes among different identity states

Question 36

what is a very commonly comorbid disorder with dissociative identity disorder

Answer 36

PTSD

Question 37

other than PTSD, list other conditions that are frequently comorbid with dissociative identity disorder

Answer 37

depressive

trauma and stressor related

personality

conversion

somatic symptom disorder

eating disorders

SUDs

OCD

sleep disorders

Question 38

criterion A for dissociative amnesia

Answer 38

an inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting

*most often consists of LOCALIZED for SELECTIVE amnesia for a specific event or events or generalized amnesia for identity and life history

Question 39

criteria B-D for dissociative amnesia

Answer 39

clinically significant distress

not attributable to substance/neuro/med condition

not better explained by DiD, PTSD, acute stress disorder, somatic symptom disorder, NCD

Question 40

name the specifier available for dissociative amnesia

Answer 40

with dissociative fugue

Question 41

what is dissociative fugue

Answer 41

apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical info

Question 42

how does dissociative amnesia differ from permanent amnesias due to neurobiological damage or toxicity that prevent memory storage/retreival

Answer 42

in dissociative amnesia, memory loss is almost always reversible because the memory has been successfully stored

Question 43

what is localized amnesia

Answer 43

failure to recall events during a circumscribed period of time

may be broader than amnesia for a single traumatic event (i.e may span years of abuse)

*most common form of dissociative amnesia

Question 44

what is selective amnesia

Answer 44

may recall some but not all of the events during a circumscribed period of time

Question 45

what is generalized amnesia

Answer 45

complete loss of memory for ones life history

*rare

may forget personal identity, lose knowledge of the work (i.e semantic knowledge) and can no longer access well learned skills (i.e procedural knowledge)

Question 46

how does generalized amnesia usually present

Answer 46

acute onset

perplexity, disorientation and purposelessness of wandering usually bring them to attention of police or ER services

Question 47

generalized amnesia may be more common amongst which populations

Answer 47

combat veterans

sexual assault victims

individuals experiencing extreme emotional stress or conflict

Question 48

are people with dissociative amnesia usually aware of their memory problems

Answer 48

no they are frequently UNaware of the problem

Question 49

what is systematized amnesia

Answer 49

losing memory for a specific CATEGORY of into–> i.e all memories related to ones family, a particular person etc)

Question 50

what is continuous amnesia

Answer 50

individual forgets each new event as it occurs

Question 51

what is the estimated 12 month prevalence of dissociative amnesia in the USA

Answer 51

1.8% (in a small US community)

Question 52

are men or women more frequently affected by dissociative amnesia

Answer 52

women

Question 53

how does the presentation of dissociative amnesia change over the lifespan

Answer 53

dissociative capacities may decline with age

as amnesia remits, there may be considerable stress, suicidal behaviour, symptoms of PTSD

Question 54

the memory loss of those with dissociative amnesia may be particularly refractory in which patients

Answer 54

those with dissociative fugue

Question 55

what is one way to modify the course of dissociative amnesia

Answer 55

removal from the traumatic circumstances underlying the dissociative amnesia (i.e from combat) may bring about rapid return of memory

Question 56

in what types of cultures might the precipitants of dissociative amnesia often not involve frank trauma

Answer 56

cultures with highly restrictive social traditions

amnesia may in these cases be preceeded by severe psychological stresses or conflicts i.e marital conflict, other family disturabnces, attachment problems, conflicts due to restriction or oppression

Question 57

suicidal behaviour may be a particular risk in those dissociative amnesia at what stage of illness

Answer 57

if/when amnesia remits suddently and person is overwhelmed by intolerable memories

Question 58

ddx dissociative amnesia

Answer 58

dissociative identity disorder

PTSD

neurocognitive disorders

substance related disorders

posttraumatic amnesia due to brain injury

seizure disorders

catatonic stupor

factitious disorder and malingering

normal and age related changes in memory

Question 59

in someone with PTSD who cannot recall all or part of a specific traumatic event, when is an additional dx of dissociative amnesia also warranted

Answer 59

when the amnesia extends beyond the immediate time of the trauma

Question 60

how do you distinguish dissociative amnesia from neurocognitive disorders

Answer 60

in dissociative amnesia, intellectual and cognitive abilities are preserved unlike in NCDs

Question 61

feigned (factitious) amnesia is more common in what circumstances/populations

Answer 61

1. acute, florid dissociative amnesia
2. financial, sexual or legal problems
3. a wish to escape stressful circumstances

Question 62

may individuals with dissociative amnesia also have symptoms that meet criteria for what other disorder(s)

Answer 62

somatic symptom disorders and conversion disorder

PDs–> especially dependent, avoidant and borderline

Question 63

criterion A for depersonalization/derealization disorder

Answer 63

presence of persistent or recurrent experiences of depersonalization, derealization or both

Question 64

criterion B for depersonalization/derealization disorder

Answer 64

during the deperson/derealiz. experiences, reality testing remains INTACT

Question 65

criteria C-E for depersonalization/derealization disorder

Answer 65

clinically sig. distress

not attributable to sub/med condition

not better explained by another disorder

Question 66

how might someone with depersonalization describe the experience

Answer 66

detached from entire being or from parts of self (i.e emotions, thoughts)

“The individual may feel detached from his or her entire being (e.g., “I am no one,” “I have no self”). He or she may also feel subjectively detached from aspects of the self, including feelings (e.g., hypoemotionality:303“I know I have feelings but I don’t feel them”), thoughts (e.g., “My thoughts don’t feel like my own,” “head filled with cotton”), whole body or body parts, or sensations (e.g., touch, proprioception, hunger, thirst, libido). There may also be a diminished sense of agency (e.g., feeling robotic, like an automaton; lacking control of one’s speech or movements). The depersonalization experience can sometimes be one of a split self, with one part observing and one participating, known as an “out-of-body experience” in its most extreme form. The unitary symptom of “depersonalization” consists of several symptom factors Sierra et al. 2005; Simeon et al. 2008: anomalous body experiences (i.e., unreality of the self and perceptual alterations); emotional or physical numbing; and temporal distortions with anomalous subjective recall.”=

Question 67

how might someone with derealization describe the experience

Answer 67

“Episodes of derealization are characterized by a feeling of unreality or detachment from, or unfamiliarity with, the world, be it individuals, inanimate objects, or all surroundings (Criterion A2). The individual may feel as if he or she were in a fog, dream, or bubble, or as if there were a veil or a glass wall between the individual and world around. Surroundings may be experienced as artificial, colorless, or lifeless. Derealization is commonly accompanied by subjective visual distortions, such as blurriness, heightened acuity, widened or narrowed visual field, two-dimensionality or flatness, exaggerated three-dimensionality, or altered distance or size of objects (i.e., macropsia or micropsia). Auditory distortions can also occur, whereby voices or sounds are muted or heightened.”

Question 68

what is a commonly associated symptom with depersonalization/derealization disorder

Answer 68

subjectively altered sense of time (i.e too fast or too slow)

subjective difficulty in recalling past memories and owning them as personal and emotional

Question 69

with regard to physiologic reactivity to emotional stimuli, how do those with depersonalization/derealization disorder differ from normal controls

Answer 69

those with depersonalization/derealization disorder have been found to have physiological HYPOreactivity to emotional stimuli

Question 70

list the neural substrates of interest in depersonalization/derealization disorder

Answer 70

hypothalamic-pituitary-adrenocortical axis

inferior parietal lobule

prefrontal cortical-limbic circuits

Question 71

do people in the general population experience depersonalization/derealization

Answer 71

yes–> transient symptoms lasting hours to days are common in the general population

approx. half of all adults have experienced at least one episode of depersonalization/derealization

*full disorder is MUCH less common–seems to be lifetime prevalence of about 2% for full disorder

Question 72

are males or female more affected by depersonalization/derealization disorder

Answer 72

equal

Question 73

what is the mean age at onset of depersonalization/derealization disorder

Answer 73

16 years old

*less than 20% of people experience onset after age 20 and only 5% after age 25
*onset in 4th decade of life or later is highly unusual

Question 74

what is the natural course of depersonalization/derealization disorder

Answer 74

can be sudden or gradual onset

duration of episodes can vary widely (brief = hours or days to prolonged = months or years)

course is often PERSISTENT

1/3–> discrete episodes of depersonalization/derealization
1/3–> continuous symptoms from the start of symptom onset
1/3–> initially episodic course that eventually becomes continuous

Question 75

list some factors that can trigger exacerbations of depersonalization/derealization disorder

Answer 75

stress

worsening mood or anxiety symptoms

novel or overstimulating settings

physical factors like lack of sleep

Question 76

list 3 temperamental characteristics common to those with depersonalization/derealization disorder

Answer 76

harm-avoidant temperament

immature defenses

both disconnection and overconnection schemata

Question 77

list some of the immature defenses common in those with depersonalization/derealization disorder

Answer 77

idealization/devaluation

projection

acting out resulting in denial of reality and poor adaptation

Question 78

describe cognitive “disconnection schemata” (predispose to depersonalization/derealization disorder)

Answer 78

reflect DEFECTIVENESS and emotional inhibition

subsume themes of abuse, neglect and depreivation

Question 79

describe cognitive “overconnection schemata” (predispose to depersonalization/derealization disorder)

Answer 79

involved IMPAIRED AUTONOMY with themes of dependency, vulnerability and incompetence

Question 80

list environmental risk factors for depersonalization/derealization disorder

Answer 80

clear association with depersonalization/derealization disorder and childhood interpersonal traumas (not as pervalent as in other dissociative disorders)
–> esp. emotional abuse and emotional neglect

physical abuse

witnessing domestic violence

growing up with seriously impaired, mentally ill parent

unexpected death or suicide of family member or close friend

(sexual abuse = much less common antecedent but can be encountered)

Question 81

list the most common PROXIMAL precipitants of depersonalization/derealization disorder

Answer 81

severe stress

depression

anxiety (esp. panic attacks)

illicit drug use

Question 82

list substances that can specifically induce depersonalization/derealization disorder

Answer 82

THC

hallucinogens

ketamine

MDMA

salvia

*marijuana use may precipitate new onset panic attacks and depersonalization/derealization disorder simultaneously

Question 83

how do people with depersonalization/derealization disorder often appear affectively

Answer 83

may be affectively flattened or robotic–> at odds with extreme emotional pain reported by those with the disorder

*hypoemotionality may lead to significant interpersonal dysfunction

Question 84

ddx depersonalization/derealization disorder

Answer 84

illness anxiety disorder

MDD

OCD

other dissociative disorders

anxiety disorders

psychotic disorders

sub/med induced disorders

due to another medical condition

Question 85

in what % of cases of depersonalization/derealization disorder can the onset be tied to ingestion of a substance (with symptoms persisting beyond intox/withdrawal)

Answer 85

about 15%

Question 86

if someone were to present with symptoms of depersonalization/derealization disorder after age 40, what tests should you do to rule out an underlying medical condition

Answer 86

consider:
lab studies

viral titres

EEG

vestibular testing

visual testing

sleep studies

brain imaging

may need ambulatory EEG if think there is a seizure disorder

Question 87

which type of epilepsy is most commonly implicated in cases where patients present with depersonalization/derealization symptoms

Answer 87

temporal lobe epilepsy

patietal and frontal epilepsy is also possible

Question 88

list commonly comorbid conditions with depersonalization/derealization disorder

Answer 88

unipolar depressive

anxiety disorders

comorbidity with PTSD was LOW

Question 89

what are the 3 most commonly comorbid personality disorders with depersonalization/derealization disorder

Answer 89

avoidant

borderline

OCPD

Question 90

list 4 examples of presentations that can be specified using the “other specified” designation for dissociative disorders

Answer 90

1. chronic and recurrent syndromes of mixed dissociative symptoms
2. identity disturbance due to prolonged and intensive coercive persuasion
3. acute dissociative reactions to stressful events
4. dissociative trance

Question 91

define “chronic and recurrent syndromes of mixed dissociative symptoms”

Answer 91

includes identity disturbance associated with less-than-marked discontinuities in sense of self and agency

or alterations of identity or episodes of possession in an individual who reports no dissociative amnesia

Question 92

define “identity disturbance due to prolonged and intensive coercive persuasion”

Answer 92

individuals who have been subjected to intense coercive persuasion (i.e brainwashing, thought reform, indoctrination while captive, torture, long term political imprisonment, recruitment by sects/cults or by terror organizations) may present with prolonged changes in, or conscious questioning of, their identity

Question 93

when might you use the diagnosis “acute dissociative reactions to stressful events”

Answer 93

for acute, TRANSIENT conditions that typically last LESS THAN one month (sometimes only a few hours or days)

characterized by CONSTRICTION of consciousness, depersonalization, derealization, perceptual disturbances (i.e time slowing), microamnesias, transient stupor, and/or alterations in sensory-motor functioning (i.e analgesia, paralysis)

Question 94

what is “dissociative trance”

Answer 94

condition characterized by narrowing or complete loss of awareness of immediate surroundings that manifests as profound UNRESPONSIVENESS or INSENSITIVITY to environmental stimuli

unresponsiveness may be accompanied by minor or stereotyped behaviours (i.e finger tapping) of which the individual in unaware and/or that they cannot control as well as transient paralysis or loss of consicousness

NOT a normal part of a broadly accepted cultural or religious practice

Question 95

is dissociative identity disorder a valid cross-cultural diagnosis

Answer 95

appears to be, according to guidelines for treating DiD in adults from 2011

Question 96

what model of therapy is the state of the art approach for treatment of complex PTSD

Answer 96

phase based or sequential model

Question 97

at what age does dissociative capacity “peak”

Answer 97

around age 9-10 and rapidly declines during adolescence (i.e absorption in every day activities, daydreaming, fantasy, dreaming)

Question 98

is there a biological predisposition to dissociation

Answer 98

yes–> pathological dissociation appears to be inherited

hypnotizability also is a biological predisposition, with higher predisposition to hynotizability seen in dissociation disorders

Question 99

what is the developmental window after which it is difficult/unlikely for trauma to cause dissociative identity disorder

Answer 99

infancy to age 6 –> after age 6, difficult to cause DiD

trauma is usually repetitive and severe

associated with disturbed parental/child affective communications contributing to disorganized-dissociative attachment

Question 100

what parenting style is associated with DiD in the child

Answer 100

rigid

authoritarian

role inversion

Question 101

what are the four factors in Klufts “4 factor theory” of DiD

Answer 101

1–> capacity to dissociate (relates to hypotizability and other factors)

2–> overwhelmed by traumatic events or circumstances, including losses

3–> personality and sense of “self” forms around traumas, using various defences especially dissociation

4–> failure of significant others to protect and nurture the child

Question 102

hyper-arousal and re-experiencing in the face of trauma is hypothesized to be related to what neurobiological dysfunction

Answer 102

failure of CORTICOLIMBIC inhibition

i.e UNDER-modulation by medial prefrontal cortex to limbic structures especially the amygdala

Question 103

dissociation in the face of trauma is hypothesized to be related to what neurobiological dysfunction

Answer 103

OVER-modulation of limbic structures (including amygdala) by the medial prefrontal and anterior cingulate cortices (i.e too much inhibition of these areas)

–> see reduced hippocampal and amygdala volume on imaging in PTSD + DD but not with DD alone

Question 104

who came up with the “autohypnosis theory” of conversion disorder

Answer 104

Dr. Pierre Janet in 19th century

–> innate hypnotic capacities to induce self-hypnosis as a defence against trauma/unbearable emotions

–> conversion symptoms involve dissociation of sensory and motor processes

Question 105

what scales/questionnaires can be used to assess for dissociative disorders

Answer 105

Dissociative Experiences Scale

Traumatic Experiences Questionnaire

Dissociative Disorders Interview Schedule

Multidimensional Inventory of Dissociation

Question 106

borderline personality disorder is diagnosable in what % of DiD sufferers

Answer 106

30-70%

Question 107

DiD IS diagnosed in what % of those with BPD

Answer 107

10-27%

Question 108

what is the most common comorbid disorder with dissociative disorders

Answer 108

depressive

Question 109

what types of psychological treatments might be indicated for DiD

Answer 109

psychodynamic psychotherapy –> deal with alters

CBT

hypnosis

Question 110

what types of medications might be indicated to treat DiD

Answer 110

SSRIs and lorazepam

Question 111

are there any RCTs for psychotherapies in DiD

Answer 111

no–> expert concensus

Question 112

why should you avoid working directly with the “alters” in DiD too much (vs via the host)

Answer 112

working around the host too much of the time colludes with the fragmented system

i.e “ask the angry one why that happened”

Question 113

how is treatment for DiD approached

Answer 113

phase-oriented, like c-PTSD

Question 114

describe the developmental model for the etiology of DiD

Answer 114

hypothesizes that alternate identities result from the inability of many traumatized children to develop a unified sense of self that is maintained across various behavioural states, especially if the trauma first occurs before age 5

Freud–> fragmentation and encapsulation of traumatic experiences may serve to protect relationships with important (though inadequate or abusive) caregivers and allow for more normal maturation in other developmental areas (i.e intelelctual, interpestonal, artistic endeavors)

“these developmental models posit that DiD does not arise from a previously mature, unified mind or “core personality” that becomes fractured but rather results from a failure of normal developmental integration caused by overwhelming experiences and disturbed caregiver-child interactions during critical early developmental periods”

Question 115

what should patients be asked about when screening for DID

Answer 115

episodes of amnesia

fugure

depersonalization

derealization

identity confusion

identity alteration

Question 116

what type of psychotherapy may be particularly helpful for resolving somatoform symptoms seen in DID

Answer 116

sensorimotor psychotherapy

Question 117

how should the therapist understand the DID patient

Answer 117

as a whole adult person (not as a collection of separate people sharing the same body) with the identities sharing responsibility for daily life

generally must hole the whole person (i.e system of alternate identities) responsible for the behaviour of any or all of the constituent identities even in the presence of amnesia or the sense of lack of control or agency over behaviour

Question 118

what is the goal of treatment of DID

Answer 118

“integrated functioning”

treament should move the patient toward better integrated functioning whenever possible

helping the identities be aware of one another as legitimate parts of the self and to negotiate as resolve their conflicts is at the very core of the therapeutic process

want sufficiently integrated and coordinated functioning among alternate identities to promote optimal functioning –> either through “resolution” (cooperation among alters) or “final fusion” (no remaining separation between identities remaining)

Question 119

what are the 3 phases of DID treatment

Answer 119

1. safety–> establishing safety, stabilization and symptom reduction
2. confronting, working through and integrating traumatic memories
3. identity integration and rehabilitation

Question 120

what is often an essential component of the first/safety phase of DID treatment

Answer 120

skills training

–enhacing emotional awareness + regulation
–decreasing affect phobia
–building distress tolerance
–learning to optimize effectiveness in relationships

i.e Seeking Safety program

Question 121

what is the primary treatment modality for DID

Answer 121

outpatient psychotherapy

usually requires years of treatment

minimum frequency usually once a week

Question 122

what is the most commonly recommended psychotherapeutic treatment orientation for DID

Answer 122

individual psychodynamically oriented psychotherapy

–
*hypnosis may be adjunctive
*may incorporate some ideas from CBT

Question 123

is group therapy generally recommended for DID

Answer 123

generally not great for DID, especially as primary treatment modality–have trouble tolerating affects of others especially if discussing trauma

Question 124

is pharmacology a primary treatment modality for DID

Answer 124

no–however most people with DID are on meds for some aspect of presentation

Question 125

what symptoms are most commonly targeted by meds in DID

Answer 125

hyperarousal and intrusive symptoms of PTSD and comorbid conditions like mood d/os and OCD symptoms

think of meds as “shock absorbers” rather than as curative interventions

Question 126

what older medication might be particularly helpful for those with DID

Answer 126

clomipramine (TCA)

Question 127

in what context might naltrexone be used for the treatment of DID

Answer 127

may have some efficacy in decreasing the pressure for self mutilation or other self destructive and self stimulatory behaviours (especially if patient reports a “high” from self harm)