Lecture 17: Dissociative Disorders

Question 1

Dissociation gets used in many ways in psychiatry and psychology eg, (10)

Answer 1

1. Depersonalization
2. Derealization
3. Flashbacks
4. Hypnosis
5. Trance states
6. Absorption
7. Divided attention
8. Non-organic amnesia
9. Multiple identities
10. Conversion symptoms

Question 2

Dissociation may or may not be a sign of _______

Answer 2

Psychopathology

Question 3

Dissociations can be (3)

List examples of all

Answer 3

1. Benign eg. Highway hypnosis i.e., driving a familiar route and having no memory of how you got there
2. Helpful eg. Meditation blunts stress response/improves immune function
3. Harmful eg. Flashbacks of trauma

Question 4

Evolutionary hypothesis (5)

Answer 4

1. Absorption
2. Tonic immobility
3. Dissociative amnesia
   4.Conversion of stress into somatic symptoms that can help elicit aid from kin/reduce the groups demands on the afflicted individual
4. Dissociative trances are used in shamanistic practices that are experienced as cathartic/healing/promote group cohesion

Question 5

Absorption AKA: ??
What does it facilitate? (2)

Answer 5

Highly selective attention that can be plausibly understood as a type of dissociation

Learning for
1. Implicit knowledge/skills
2. Explicit knowledge/skills

Question 6

Tonic immobility AKA:??
What can it prevent

Answer 6

“Playing dead” - can prevent further attack from predators

Question 7

Dissociative amnesia functions (3)

Answer 7

1. Reduce stress response
2. Produce adaptive self-deception
3. Promote self-interest

Question 8

How does dissociative amnesia reduce stress response?

Answer 8

Keeping anxiety-inducing knowledge of memories out of awareness

Question 9

How does dissociative amnesia produce adaptive self-deception

Answer 9

1. Creates positive illusions about ourselves —> promotes well-being
2. Influence other’s evaluations to be more favorable

Question 10

How does dissociative amnesia promote self-interest

Answer 10

People who are self-deceived are better able to deceive others to promote their own self-interest

Question 11

In dissociative amnesia there is an evolutionary hypothesis (no.4)

Conversion of stress into somatic symptoms can help _____ ____ ___ ___ and ____ ___ ___ ______ on the affected individual

Answer 11

1. Elicit aid from kin
2. Reduce the group’s demands

Question 12

In dissociative amnesia there is an evolutionary hypothesis (no.5)

Dissociative trances are used in shamanistic practices that are experienced as ______ and ______. These practices can also promote _______ _______.

Answer 12

1. Cathartic
2. Healing
3. Group cohesion

Question 13

Dissociation definition: A disturbance to the ______ _______ __ that control ______ ______, which results in pathological ______ or _________

Answer 13

1. Basic mental processes
2. Adaptive actions
3. Detachment
4. Compartmentalization

Question 14

Detachment

Answer 14

Alteration in consciousness resulting in SEPARATION from yourself, the world, and or emotions

Question 15

Detachment examples (3)

Answer 15

1. Depersonalization
2. Derealization
3. Emotional detachment

Question 16

Depersonalization

Answer 16

Alienation from self eg. Not recognizing yourself in a mirror

Question 17

Derealization

Answer 17

Alienation from the world eg. Feeling as if the world is a simulation

Question 18

Emotional detachment

Answer 18

Absence of emotion activation under conditions that would ordinarily produce emotions eg. Feeling “numb” when someone close to you dies

Question 19

Is Depersonalization more prevalent in women or men?

Answer 19

Gender ratio is equal

Question 20

When does the onset of depersonalization usually occur?

Answer 20

adolescence

Question 21

Duration of episodes of depersonalization can range from _____ to _____

Answer 21

Minutes to months

Question 22

Risk factors of depersonalization (6)

Answer 22

1. Childhood trauma
2. High levels of harm-avoidance
3. Primitive defense machinists eg.denial
4. Depression
5. Anxiety - especially oanic attacks
6. Drug use

Question 23

Neurobiology of depersonalization (6)

Answer 23

1. Blunted Autonomic nervous system
2. Overactive baseline levels of HPA, blunted HPA when responding to stressful stimuli
3. Impaired functioning in somatosensory cortex
4. Overactive prefrontal cortical regions
5. Limbic structures inhibited by frontal cortex
6. Overactive serotonergic transmission

Question 24

When the autonomic nervous system is blunted, this means that there are _____ levels of sympathetic nervous system arousal compared to stressful stimuli

Answer 24

LOWER

Question 25

When the prefrontal cortical regions are overactive this leads to excessive inhibition of the _____ _____

Answer 25

Limbic systems

Question 26

When Limbic structures (eg. Amygdala/stiatum) are inhibited by frontal cortex, this leads to the absence of ____ _________ or often described as “_____”

Answer 26

Felt emotion - “numbness”

Question 27

Serotonergic transmission might be overactive in DPDR. Administration of serotonin ________ can induce depersonalization

Answer 27

Agonists

Question 28

Treatments of DPDR (5)

Answer 28

1. CBT 2. Insight-oriented therapy 3. Transcranial magnetic stimulation 4. Trauma-informed therapy 5. SSRI’s for comorbidities anxiety and depression

Question 29

Trauma informed therapy - therapy that provides clients with a sense of (3)

Answer 29

Therapy that provides clients with a sense of 1. Safety/trust 2. Choice 3. Empowerment

Question 30

Superordinate types of dissociation (2)

Answer 30

1. Detachment 2. Compartmentalization

Question 31

Compartmentalization - failure of ______ _____ over mental processes that are ordinarily under control. Typically, the mental processes that are no longer under ______ ______ continue to be _______ or ________ ________

Answer 31

Volitional control Volitional control Partially Entirely functional

Question 32

Compartmentalization examples (3)

Answer 32

1. Hypnosis 2. Conversion disorder 3. Dissociative amnesia

Question 33

Hypnosis - a state of (3)

Answer 33

1. Relaxation 2. Focused attention 3. Suggestibility

Question 34

Conversion disorder (name an example too!)

Answer 34

Inability to control motor behavior to attend to some set of sensations eg. Psychogenic blindness

Question 35

Dissociative Amnesia

Answer 35

The inability to retrieve memories that were successfully encoded Inaccessible memories can often be retrieved under hypnosis

Question 36

The two superorder types of dissociation (2) co-occur in people with __________ ________ ________

Answer 36

Dissociative identity disorder

Question 37

Multiple personality disorder

Answer 37

Where there is one primary “host” personality and one or more non-primary personalities often referred to as “alters” or “part”

Question 39

Common characteristics of parts (9)

Answer 39

Different 1. Names - symbolic quality common 2. Ages - typically one part is a child 3. Genders 4. Vocal quality/accents 5. Posture/gait 6. Abilities/skills 7. Emotional states (differences in anger/fear) 8. Access to memories (including ordinary/traumatic 9. Some report hearing voices of their parts when experiencing their primary personality and some don’t

Question 40

Switching

Answer 40

The transition form one personality to another

Question 41

Can people with DID control their switching? What factors in their ability to control?

Answer 41

Some can, some only partially, some not at all Ability to control switching is associated with severity

Question 42

Dissociative amnesia can present as

Answer 42

1. Not being able to remember what you did for some part of the day 2. Not being able to recall any part of specific periods of your life 3. Not remembering how old you are 4. Discovering things at home you don’t remember buying 5. Encountering people who know you but you don’t remember meeting them 6. People calling you by another name 7. Dissociative fugues

Question 43

Dissociative fugues

Answer 43

Switching into a part, traveling somewhere, then switching back to the primary personality, who can’t recall how they got their

Question 44

Is DID only in western countries?

Answer 44

No it’s in wide range of cultures

Question 45

DID is typically caused by ______, ______. ______ ______, particularly ______ and ______ _____

Answer 45

Recurrent, severe childhood abuse, particularly physical and sexual abuse

Question 46

Some people with DID have “_______” identities i.e they experience the part as a spirit, ghost, demon, or other supernatural being

Answer 46

Possession

Question 47

Common comorbidities of DID (10)

Answer 47

1. Depression 2. Anxiety 3. Substance use 4. Self injury 5. Non-epileptic seizures 6. Dissociative flashbacks 7. Suicidal thoughts/behaviors 8. Transient psychosis 9. Conversion symptoms 10. PTSD

Question 48

Neurobiological explanations of DID (2)

Answer 48

1. Smaller amygdala volume 2. Smaller hippocampus volume

Question 49

Smaller amygdala and hippocampus volume explanations for DID (2)

Answer 49

1. People with smaller amygdala/hippocampus are at elevated risk of DID 2. People with TRAUMA have small amygdala/hippocampus due to excitotoxicity

Question 50

Excitotoxicity

Answer 50

Cell death from extreme neuronal firing

Question 51

1. Hippocampus mediates consolidation of ____ ____ ____ into ______ ____ ____ 2. Hippocampus is sensitive to ________ ________ i.e., Time and place 3. Hippocampus is sensitive relational properties between stimuli, helping to bind various stimuli into a ______ ________

Answer 51

1. STM into LTM 2. Context information 3. Unitary representation

Question 52

During stress ______ is released from the adrenal glands. High levels of _______, ________ hippocampal functioning

Answer 52

Cortisol, cortisol, decrease

Question 53

Decreased hippocampal functioning = (3)

Answer 53

1. Impaired LTM consolidation - why people with PTSD/DID recall traumatic events with difficulty/not at all 2. Impaired context information - why people with PTSD/DID have “flashbacks” where they experience a traumatic past as thought it were happening in the present 3. Impairment of binding sensory experiences into unitary representations - why people with PTSD/DID often recall fragments of a traumatic event

Question 54

In DID it’s not just memories that are fragmented but also ___ _____.

Answer 54

The self

Question 55

Treatment of DID is ______ _______ _______

Answer 55

Trauma-informed psychotherapy

Question 56

Trauma informed psychotherapy emphasizes (8)

Answer 56

1. Emotion awareness and regulation 2. Impulse awareness and control 3. Grounding/mindfulness to reduce dissociation 4. Identifying/reducing high-risk behaviors 5. Mapping of personality states 6. Identifying/modifying cognitive disortions due to trauma 7. Processing trauma (controversial - some do it some don’t) 8. Integration of parts into primary personality (controversial - some do it some don’t)

Question 57

Iatrogenic treatment

Answer 57

Treatment that causes harm to people

Question 58

The validity of the diagnosis of DID, and the stories of abuse disclosed by people with DID is denied by some mental health professionals —> Treatment becomes ______

Answer 58

Iatrogenic