Dissociative Disorders (Palmeri) - 10/24/16

Question 1

Dissociative disorders (2)

Answer 1

1. Dissociative identity disorder
   
   1. Formerly known as multiple personality disorder
   2. Presence of 2 or more distinct identities or personality states
   3. More common in women
   4. Associated w hx of sexual abuse, PTSD, depression, substance abuse, borderline personality (ongoing stressors)
   5. Chronic and most severe
      
      1. 70% attempt suicide
2. Depersonalization/derealization disorder
   
   1. Persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions (depersonalization) or one’s environment (derealization).
   2. High level of distress, feel like going crazy
   3. Sudden onset

Question 2

Dissociative Amnesia

Description

5 types

Answer 2

Inability to recall important personal information (usually after severe trauma or stress)

May be accompanied by dissociative fugue (abrupt travel or wandering during a period of dissociative amnesia)

• Localized
  
  • ​Failure to recall events during a circumscribed time
• Selective
  
  • ​Recalls some but not all of the events of a circumscribed time
• Generalized
  
  • ​Complete loss of memory for one’s personal identity
• Systemized
  
  • ​Loss of memory for one category of knowledge (family)
• Continuous
  
  • ​Loss of memories as each new event occurs

Question 3

Neurobiology of Dissociation (6)

Answer 3

• NMDA, 5 HT, and endogenous opioid dysregulation
• Autonomic blunting
• Blunted reactivity to stress
• Disruptions in sensory cortex (somatosensory, auditory, visual)
• Dec. hippocampal and amygdala volumes
• Frontal inhibition of limbic structures (hypo-emotionality)

Question 4

Diagnostic Interview

Answer 4

• Blackouts/time loss
• Disremembered behavior
• Fugues (did you remember how you got here)
• Unexplained possessions (how did i end up with this article of clothing)
• Changes in relationship to same person
• Fluctuations in skills/habits/knowledge
• Fregmentary recall of personal hx
• Negative hallucination (dissociation… I don’t hear or see what other ppl heard or saw)
• Depersonalization/derealization

Question 5

Dissociative Experiences Scale

Answer 5

28 item patient rated scale

Scoring

• 5-15 normals
• 25 suspicious DID or DDNOS
• >30 amnesia/fugue or depersonalization
• >45 likely DID or DDNOS