Lecture 2: Borderline and Dissociation Flashcards
Define the concept of dissociation.
Dissociation refers to a disruption or discontinuity in the normal, subjective integration of one or more aspect of psychological functioning, including memory, identity, consciousness, perception and motor control.
Name the three symptom categories of dissociation and give an example respectively.
- ) Loss of continuity in subjective experience. Example: dissociative flashbacks (intrusions).
- ) Inability to access information or control mental functions that are normally amenable to such control or access. Example: dissociative amnesia.
- ) Sense of experiential disconnectedness, including distorted perceptions about the self or the environment. Example: derealization and depersonalization.
Name possible functions and problems of dissociation in psychological trauma.
Dissociation can be seen as emotional over-modulation, that helps to create an inner distance from overwhelming experiences. However, salient sensory information is processed and encoded in a distorted way.
Name characteristics of the dissociative identity disorder.
Presence of two or more identities, with the person behaving differently depending on the current identity. The person might forget important, personal information that should normally not be forgotten. The symptoms must not be explained by drug intake or imagination in children.
Name characteristics of the borderline personality disorder.
In general a pervasive pattern of instability: fear of abandonment, intense and unstable relationships, identity diffusion, risky and impulsive behavior, suicidal tendency and self-harm, unstable affect, feelings of emptiness, intense anger and stress-related dissociation.
Which brain areas are involved in dissociation?
Somatosensory regions, amygdala, anterior cingulate cortex, orbital prefrontal cortex and dorsal prefrontal cortex.
How do Sierra & Berrios (1998) explain the mechanisms of depersonlization?
“Depersonalization results from the combination of two mechanisms“:
1) Inhibitory component: prefrontal mechanism that inhibits amygdala (and indirectly ACC) causing a dampening of emotional response and sympathetic outflow
2) Excitatory component driven by uninhibited arousal
How can Post-Traumatic-Stress Disorder (PTSD) be differentiated from PTSD with dissociation regarding the neural bases?
In regular PTSD there is a bottom-up connectivity tendency from the periaqueductal gray (PAG) and the amygdala to the ventromedial prefrontal cortex (vmPFC), while in PTSD with dissociation, this pattern is turned around, with a top-down tendency from the vmPFC to the amygdala and PAG.
How does the emotion over-modulation hypothesis of dissociation relate to the dissociative identity disorder (DID)?
In DID, the ‘normal’ identity state might be characterized by self-control and suppressed emotions / memories, with a decreased activation of the amygdala. The ‘emotional’ identity stage (personality parts that have witnessed the abuse) might be characterized by hyperarousal and increased amygdala activity.
How does dissociation relate to the default mode network?
There is an increased functional connectivity of the amygdala with regions of the default mode network during dissociation.
Name and describe a method to trigger dissociative experiences in patients (for research purposes, not torture them of course..).
A method used is the script-driven imagery in which patients should recall a specific autobiographical memory of dissociation with sensory details of the experience.
What is the general outcome of emotional working memory tasks and emotional stroop tasks after the induction of dissociation in borderline personality disorder?
Dissociation has an impact on affective-cognitive information processing, which may hinder therapy outcome in borderline personality disorder. Moreover, evidence for reduced activity in limbic(-related) temporal areas (amygdala, superior temporal gyrus, fusiform gyrus), increased frontal activity (inferior frontal gyrus, dlPFC) and altered interactions between these regions during dissociation in BPD.
