First Aid: Dissociative Disorders Flashcards
List some examples of dissociative disorders.
Dissociative amnesia
Dissociative fugue
Dissociative identity disorder
Depersonalization disorder
True or false: dissociative disorders are NEVER due to an underlying medical condition or substance use.
TRUE
Amnesia is a prominent symptom in all dissociation disorders except which?
Depersonalization disorder
What specific condition is required for the diagnosis of dissociative amnesia?
Amnesia is the ONLY dissociative symptom present
What is the DSM-IV criteria for diagnosis of dissociative amnesia?
- At least 1 episode of inability to recall personal information, usually involving a traumatic or stressful event
- The amnesia cannot be explained by ordinary forgetfulness
- Symptoms cause significant distress or impairment in daily functioning and cannot be explained by another d/o, medical condition or substance abuse
Are people with dissociative amnesia usually aware of their deficits?
YES: they are aware they are having difficulty remembering but are not troubled by it
What types of things do people with dissociative amnesia forget?
things like their name but can remember obscure details
In what gender is dissociative amnesia more common?
women
In what age group is dissociative amnesia more common?
younger adults
What are the common comorbidities with dissociative amnesia?
- MDD
- Anxiety disorders
What is the prognosis for dissociative amnesia?
- Many return to normal abruptly after minutes or days
- Recurrences are uncommon
What is the treatment for dissociative amnesia?
- Help patients retrieve lost memories to prevent future recurrences
- Subsequent psychotherapy
What drugs may help a patient with dissociative amnesia talk in an interview?
Hypnosis or sodium amobarbital or lorazepam
What is the risk in using sodium amobarbital?
respiratory depression
What is the word for the strong reaction that patients often get when retrieving traumatic memories?
Abreaction
What is the most common dissociative disorder?
dissociative amnesia
What is the DSM-IV criteria for diagnosing dissociative fugue?
- Sudden unexpected travel away from home or work plus inability to recall one’s past
- Confusion about personal identity or assumption of new identity
- Not due to dissociative identity disorder or the physiological effects of a substance or medical d/o
- Symptoms cause impairment in social or occupational functioning
What is a major difference between dissociative amnesia and dissociative fugue?
those with dissociative fugue are not aware that they have forgotten anything
What are the major predisposing factors for dissociative fugue?
- Heavy use of alcohol
- Major depression
- History of head trauma
- Epilepsy
What is the trigger for dissociative fugue?
-Stressful life event (life stressor or personal conflict)
How long do fugues usually last?
A few hours to several days (but may last longer)
What usually happens after a fugue?
Person will assume his or her old identity without ever remembering the time of the fugue
How do you treat dissociative fugue?
same as dissociative amnesia
What is the DSM-IV criteria for diagnosing dissociative identity disorder (multiple personality disorder)?
- Presence of 2 or more distinct identities
- At least 2 of the identities recurrently take control of the person’s behavior
- Inability to recall personal information of when personality when the other is dominant
- Not due to effects of substance or medical condition
Can a pt with dissociative identity disorder remember events that occur when an alternate personality is present?
not usually
What gender more commonly has dissociative identity disorder?
Women (more than 90%)
What is a commonality between the pasts of most patients with dissociative identity disorder?
Prior trauma (especially childhood physical or sexual abuse)
What is the average age of diagnosis for dissociative identity disorder?
30
What are the common comorbidities of dissociative identity disorder?
- MDD
- Anxiety disorders
- Borderline personality disorder
- Substance abuse
- Suicide (up to 1/3 of patients commit suicide)
What is the prognosis for dissociative identity disorder?
- Usually chronic course with incomplete recovery
- Worst prognosis of all dissociative disorders
- Earlier the onset, worse the prognosis
What is the treatment for dissociative identity disorder?
- Hypnosis
- Drug-assisted interviewing
- Insight-oriented psychotherapy
What is the DSM-IV diagnostic criteria for depersonalization disorder?
- Persistent or recurrent experiences of being detached from one’s body or mental process
- Reality testing remains intact during episode
- Causes social/occupational impairment, and cannot be accounted for by another mental or physical disorder
What is required for diagnosis of depersonalization disorder (as far as timeline)?
Episodes are recurrent or persistent
Is depersonalization ever normal?
yes! during times of stress
Are those with depersonalization disorder aware of their symptoms?
yes (fear they are going crazy)
What are common comorbid feelings in depersonalization disorder?
Anxiety
Panic
MDD
What is the gender difference in depersonalization disorder?
women 2X more common
What is the average age of onset in depersonalization disorder?
between 15 and 30
What is usually the trigger for depersonalization disorder?
severe stress
What is the prognosis for depersonalization disorder?
- usually chronic (with steady or intermittent course)
- may remit without treatment
