Dissociative Disorders- Exam 2 Flashcards
____ intense, irrational fear of a particular object or situation
phobia
What pt population are phobias more common in?
young women
What is the criteria for a phobia?
Persistent (6+ months) of marked fear/anxiety about a specific
object or situation
Phobic object/situation almost always causes immediate fear/anxiety
Phobic object/situation is actively avoided or endured with intense fear or anxiety
Fear/anxiety is out of proportion to the actual danger posed by object/situation
Fear/anxiety or avoidance causes distress or functional impairment
Syndrome is not better explained by another mental disorder
What is first line treatment for phobias? 2nd?
CBT with exposure
INfrequently encountered: PRN treatment with BZD
Frequently encountered stimulus: SSRI/SNRI
____ segregation of any group of mental processes from the rest of someone’s psychological activity. Often associated with ____
dissociation
psychological trauma as part of the unconscious defense mechanism
What are the 5 core symptoms of dissociative disorders?
amnesia
depersonalization
derealization
identity confusion
identity alteration
What is depersonalization?
Sense of detachment or disconnection from one’s self
Feeling like a stranger in one’s own body, or like part of your body does not belong to you
Feeling detached from emotions, or like a “robot” or on “autopilot”
What is derealization?
Sense of disconnection from familiar people or one’s surrounding
Close relatives or friends, one’s home or workplace may seem unreal or unfamiliar
“watching myself carry out reality”
____ Sense of acting like a different person some of the time
identity alteration
_____ potentially reversible memory impairment that primarily affects autobiographical memory. Give an example
dissociative amnesia
Cannot recall personal information
Typically affects memories of a traumatic or stressful nature, but can also impact other memories
_____ - sudden unexpected travel or wandering in a dissociated state, with subsequent dissociative amnesia for the episode
dissociative fugue
When is dissociative amnesia most often seen?
most often seen in late adolescence/early adulthood
both men and women
**What are some comorbidities with dissociative amnesia?
MDD (up to 60%), bipolar, substance abuse, other anxiety disorders
____ inability to recall important autobiographical information, usually of a traumatic or stressful nature, inconsistent with ordinary forgetting.
___ is for a specific event
___ is for identity and life history
dissociative amnesia
localized/selective amnesia
generalized amnesia
What are some types of dissociative amnesia?
localized
continuous
generalized
selective
systematized
What is the treatment for dissociative amnesia? give first line then other.
1st line: phase oriented therapy
CBT
Hypnosis
Group therapy
Pharmacotherapy - no use in treatmentPharmacotherapy - no use in treatment
Transient Depersonalization/Derealization Disorder last ____. up to ___ % What kinds of patient is this common in?
last 12 months, 20%
Common in patients with a hx of seizures or migraines; psychedelic drugs, medications, head injury
Lifetime, Depersonalization / Derealization Disorder about ___% What gender?
1-3%
equally common in men and women
What are risk factors for DDD?
acute or chronic trauma, substance abuse, psychiatric disorders, Depression, anxiety, OCD, avoidant or borderline personality disorder
_____ etiology is possible serotonergic involvement, response to traumatic stress, ego defense mechanism in the face of major negative life events
Depersonalization / Derealization Disorder
**What is the criteria for DDD?
The presence of persistent or recurrent experiences of depersonalization, derealization, or both:
-Depersonalization - experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions¹
-Derealization - Experiences of unreality or detachment with respect to surroundings²
During the depersonalization/derealization, reality testing remains intact (aka can respond normally when prompted)
What is the treatment for DDD?
Months of treatment!!
Psychotherapy (mixed results): stress management and relaxation techniques
SSRIs may be helpful
Dissociative Identity Disorder is characterized by ??
Characterized by the presence of two or more “selves” or “personalities” with distinct memories, thoughts, opinions, and goals
What pt population is most at risk for DID?
women in their 20-30s, with a comorbidity of PTSD, depression, substance abuse, personality disorders usually with a childhood trauma
Define the criteria for DID?
Presence of two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and itself
Amnesia must occur
Gaps in recall of everyday events, personal information, and/or traumatic events
Syndrome causes distress and/or functional impairment
Disturbance is not part of normal cultural or religious practices
Ex. an “imaginary friend” is not considered indicative of a separate personality state alone
What is the treatment for DID?
**Psychotherapy
meds aimed at managing major symptoms
ECT: for refractory mood disorders
Define Impulse Control Disorder
Characterized by inability to resist the impulse, desire, or drive to perform a particular act that is obviously harmful to self, others, or both
Act is preceded by mounting tension and/or anticipatory pleasure
Completing action results in immediate gratification and relief
Action is followed by remorse, guilt, self-reproach, dread
Individuals are often secretive about activity
How are impulse control disorders and OCD different?
Impulse control disorders they want to do (blank) activity vs OCD they DO NOT want to do it but feel the need to do it anyway
What are the s/s of pathologic gambling? How many signs do you need?
Persistent and recurrent maladaptive gambling behaviors
5 or more of the following:
Preoccupation with gambling
Need to gamble with increasing amounts of money to get desired excitement
Repeated unsuccessful efforts to reduce or stop gambling
Restless or irritable when trying to reduce or stop gambling
Gambles to improve mood or escape from problems
After losing money, returns another day to win the money back
Lies to others to conceal the extent of gambling
Has committed illegal acts to finance gambling
Jeopardizes or loses relationships, jobs, or opportunities because of gambling
Relies on others to provide money to relieve a situation caused by gambling
Tension or anxiety immediately before pulling out hair, or when resisting the urge is _____. What will happen next?
Trichotillomania
Pleasure, gratification, or relief when pulling hair
Kleptomania is the recurrent theft of items (needed/not needed) for personal use or monetary value
not needed
feel pleasure, gratification or relief when stealing
What are the key points of pyromania? What is the major one?
purposeful fire setting
Tension or anxiety immediately before setting fire, or when resisting the urge
Pleasure, gratification, or relief when setting fires, or when witnessing or participating in their aftermath
fascination with fire
**NOT for monetary gain, no real reason other than they want to/due to impaired judgement
What is the treatment for Kleptomania?
psychotherapy with SSRI or lithium
What is the treatment for pyromania?
psychotherapy and early intervention programs
What is the treatment for pathologic gambling?
psychotherapy and SSRIs or Naltrexone, Naloxone
What is the treatment for trichotillomania?
Clomipramine (Anafranil)
**SSRIs not strongly shown to be beneficial
Define Intermittent Explosive Disorder. Do patients show regret?
Discrete episodes of losing control of aggressive impulses
Can result in serious assault, property destruction
Aggressiveness is grossly out of proportion for any stressor which may have precipitated the episode
Symptoms appear and remit spontaneously and quickly
Between episodes…
Patients show genuine regret or self-reproach
No generalized impulsivity or aggressiveness
genetic predisposition; exposure to abuse/violence as a child; narcissistic defence mechanism
Also see decreased serotonergic activity
Increased rates of brain inflammation, hx of T. gondii infection
What am I?
Intermittent Explosive Disorder
**What is the criteria for Intermittent Explosive Disorder? How old?
Presence of recurrent behavioral outbursts representing a failure to control aggressive impulses, as manifested by either of the following:
Verbal or physical aggression towards property, animals, or other individuals, occurring twice weekly on average for a period of 3 months; the aggression does not result in damage or destruction of property or physical injury
OR
3+ behavioral outbursts involving damage/destruction of property or physical injury against animals or other individuals occurring within a 12-month period
The magnitude of aggressiveness during the outbursts is grossly out of proportion to the provocation or any precipitating stressors
The aggressive outbursts are not premeditated and are not committed to achieve a tangible objective
Chronological age is at least 6 years (or equivalent developmental level)
_____ is common in the elderly so will need to rule out demenita/delirium
Intermittent Explosive Disorder
What is the treatment for Intermittent Explosive Disorder?
Psychotherapy and meds
group and family therapy is helpful
(sometimes these patients have problems setting limits with therapists and may have outburst in therapy)
Meds: SSRIs, trazodone, buspirone
lithium, carbamazepine, valproate/divalproex, phenytoin, gabapentin may be helpful
antipsychotics, beta blockers, calcium channel blockers
How is Oppositional Defiant Disorder classified?
Enduring pattern of negativistic, hostile, disobedient behavior
Frequently argue with adults and authority figures
Often angry, resentful, easily annoyed
Inability to take responsibility for mistakes: places blame on others for their own transgressions or omissions
often have problems with peer relationships and in school
DO NOT display much physical aggression or violent behavior: more verbal aggression, reactive to rules and overt (shouting)
What are the 3 major subtypes of ODD?
Angry/Irritable
Argumentative/Defiant
Vindictive
What type of ODD? _____ often lose their tempers; easily annoyed; feel angry most of the time
angry/irritable
What type of ODD? _____ in addition to clashing with authority, tend to engage in vengeful and spiteful behavior
Vindictive
What type of ODD? _____ habitually argue with authority figures; actively refuse to comply with requests; intentionally break rules; purposely annoy others
Argumentative/Defiant
What is the ages for ODD? What gender?
begins as young as 3, average age at onset is 6; identified by age 14
more common in males before puberty; equal post-puberty
What is the criteria for ODD?
For a pt who is younger than 5, what is the timing for ODD? 5 and older?
Pt < 5 y/o - Behavior should occur on most days for a period of at least 6 months
Pt 5+ y/o - Behavior should occur at least once per week for at least 6 months, unless otherwise noted
How is the severity gauged in ODD?
based on the number of settings:
Mild - Symptoms are confined to only one setting
Moderate - Some symptoms are present in at least two settings
Severe - Some symptoms are present in three or more settings
Similar to ODD, pt shows less disregard for rules/authority specifically, behavior is not deliberately antagonistic, patients show remorse after outbursts.
What am I?
Disruptive Mood Dysregulation Disorder
Similar to ODD but the pt is MORE likely to have a physical aggression.
What am I?
Conduct Disorder
**What is first line treatment for ODD?
**Family therapy and individual therapy
meds only indicated for comorbid conditions
25% of the time ODD progresses to ____
Conduct disorder
may also develop mood disorders, anxiety, ADHD or learning delays
_____ Enduring set of behaviors in a child or adolescent that evolves over time, usually characterized by aggression and violation of the rights of others. Physical aggression, destruction of property, thefts, acts of deceit and frequent violation of age appropriate rules
Conduct disorder
What are some psychosocial factors that point to conduct disorder?
Childhood maltreatment
Harsh or punitive parenting
Family discord
Lack of appropriate parental supervision
Lack of social competence
Low socioeconomic level
What is the MC pt with conduct disorder?
4-12x more common in males
typically starts in adolescence
comorb: ADHD, substance use, anxiety disorders (including PTSD), mood disorders, learning disorders
Risk factors: impulsivity, poor parental supervision, harsh/punitive parental discipline, low IQ, poor school performance; regular alcohol use
What is the criteria for conduct disorder? **How many criteria in what time frame?
Pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as determined by 3+ of the following 15 criteria in the past 12 months (at least 1 in the past 6 months):
Often bullies, threatens, or intimidates others
Often initiates physical fights
Has used a weapon that can cause serious physical harm to others
Has been physically cruel to people
Has been physically cruel to animals
Has stolen while confronting a victim
Has forced someone into sexual activity
Has deliberately set a fire with intent to cause serious damage
Has deliberately destroyed others’ property (other than by fire setting)
Has broken into someone else’s house, building, or car
Often lies to obtain goods or favors or to avoid obligations
Has stolen items of nontrivial value without confronting a victim
Often stays out a night despite parental prohibitions, beginning before age 13 years
Has run away from home overnight at least twice, or once without returning for a lengthy period
Is often truant from school, beginning before age 13 years
What are the different types of onset for conduct disorder? Explain
Childhood-onset type - At least one symptom present prior to age 10
Adolescent-onset type - No symptoms present prior to age 10
Unspecified onset - Unable to clarify age at onset of symptoms
What is the severity of conduct disorder based on?
Mild: few extra conduct criteria other than the ones required to make the dx cause relatively minor harm to others
Moderate: more criteria and intermediate harm to others (stealing w/o confronting a victim, vandalism)
Severe: many extra criteria and considerable harm to others
____ is subtype of conduct disorder. What is the criteria?
Conduct disorder with limited prosocial emotions
must display 2+ of the following traits persistently for over 1 year, in multiple relationships and settings (need multiple information sources to verify):
Lack of remorse of guilt (lack of concern about consequences)
Lack of empathy
unconcerned about performance: blames others
shallow or deficient affect (do not express feelings or emotions)
⅓ to ½ of all children with ADHD have comorbid ____! When are they often seen together?
ODD
males, children with divorced parents, and children with low socioeconomic status
What is the treatment for conduct disorder?
psychotherapy: the earlier the better (kindergarden)
reinforcement of positive, prosocial behaviors
Meds: Risperidone, SSRIs, anticonvulsants
treat other comorbities (ADHD)
Psychotherapy for Conduct disorder, helps more with ____ symptoms than ___ symptoms
overt (aggression) than covert (lying, stealing)
