Somatic and Dissociative Disorders Flashcards
What are dissociative disorders often linked to in terms of trauma?
They can have a basis in trauma and stress exposure, with models implicating a history of sexual and physical abuse.
What role does stress exposure play in the development of dissociative disorders?
Stress exposure, particularly chronic or extreme stress, is a significant factor in triggering dissociative symptoms.
Which types of trauma are frequently implicated in the development of dissociative disorders?
A history of sexual and physical abuse.
Why might individuals with dissociative disorders not recall their trauma experiences easily?
A: Dissociation can serve as a psychological defense mechanism, causing memory gaps or altered awareness to protect the individual from emotional pain.
How do trauma aetiology models explain the onset of dissociative disorders?
These models suggest that exposure to severe trauma, such as sexual and physical abuse, can lead to dissociation as a coping mechanism.
What is the hallmark feature of dissociative disorders?
The hallmark feature is when a memory—normally involving integrated sensory elements like sight, sound, and smell—becomes fragmented. Instead of being fully recalled, parts of the memory are separated, leading to experiences where an individual feels unexpectedly transported back to the original time and place of the memory.
What does the historical view of dissociation suggest about the integration of experiences?
Dissociation is seen as a gap or lack of integration in how we process and experience events. Normally, the brain integrates sensory and mental processes automatically, without conscious awareness. When this integration fails, parts of the experience are split off from awareness.
What important similarity is shared between traumatic stress disorders, dissociative disorders, and somatic symptom disorders (SSDs)?
They all involve dissociation, which is the disruption of normally integrated mental processes.
Why is dissociation thought to have a protective purpose?
Dissociation is theorized to protect individuals from overwhelming experiences by splitting off complex mental activities, allowing them to avoid processing all aspects of the experience simultaneously. This is similar to protective mechanisms seen in somatic disorders, where avoidance of fear may play a key role.
How can dissociation be induced experimentally?
Through the rubber hand illusion, where individuals experience a sense of controlling a hand that is not theirs, leading to confusion about what is part of their body. This demonstrates a distortion of self and shows how the sense of identity can be disrupted, similar to what occurs in identity disorders.
What are the specific dissociative disorders recognized in the DSM-5?
Dissociative Amnesia
Depersonalisation/Derealisation Disorder (combined in DSM-5)
Dissociative Identity Disorder (formerly known as multiple identity disorder)
Dissociative Fugue (dropped from DSM-5)
What is the core feature of dissociative disorders?
The core feature is a persistent, maladaptive disruption in the integration of memory, consciousness, identity, emotion, perception, body representations, motor control, and behavior.
How do trauma and stress influence dissociative disorders?
Trauma and stress can overwhelm coping mechanisms, causing memory to disconnect from experiences. This can lead to fragmented memories, especially in cases of severe trauma, where the memory becomes vulnerable to disintegration from the actual experience.
What is the hallmark feature of dissociative disorders, and how does it differ from PTSD?
The hallmark feature of dissociative disorders is dissociation, specifically the inability to remember parts of an experience that stand out. In contrast, PTSD involves trauma or stress as the symptomatic feature, whereas in dissociative disorders, dissociation itself is the defining symptom.
How does DSM-5 expand the understanding of DID compared to DSM-IV?
DSM-5 now includes possession-like phenomena and emphasizes that identity disruptions may be observable by others or self-reported. It also highlights recurrent gaps in memory not just for traumatic events, but for everyday occurrences as well.
Why was “multiple identity disorder” renamed to “dissociative identity disorder” (DID) in the DSM-5?
The term “personality” was challenging for the field, and the DSM-5 group preferred the term identity over personality to reflect the condition more accurately.
How does DSM-5 handle cultural considerations, such as religious experiences, when diagnosing Dissociative Identity Disorder (DID)?
DSM-5 allows for religious experiences, such as possession states, to meet diagnostic criteria if they induce both distress and impairment. However, care is taken to avoid over-expanding the concept to prevent cultural bias.
Why are dissociative disorders considered controversial in scientific investigation?
Dissociative disorders are controversial because integration and disintegration of mental processes are difficult to prove, making it challenging to study these phenomena rigorously through scientific methods.
What is another definition of dissociation?
Dissociation is the ability to mediate complex mental activities in channels split off from or independent of conscious awareness.
What is a distinguishing characteristic of Dissociative Identity Disorder (DID)?
Multiple identities may be present instead of distinct personalities, though this condition is relatively rare.
What key changes were made to DID diagnostic criteria from DSM-IV to DSM-5?
Alternate identity states no longer need to be observed by others—they can be self-reported.
Memory loss is now considered amnesia without needing to be connected to trauma.
The DSM-IV required proof of trauma history or personal memory gaps, but DSM-5 allows memory issues to involve any type of information.
These changes might reflect an attempt to lower the diagnostic threshold and adapt to the rarity of DID diagnoses and diagnostic constraints.
What are the key diagnostic criteria for Dissociative Identity Disorder (DID) in DSM-5?
A. Presence of two or more distinct identities or personality states, observable by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, personal information, or traumatic events, inconsistent with ordinary forgetting.
C. The symptoms cause distress or impairment.
D. The behavior is not a normal part of cultural or religious practices.
E. Symptoms are not attributable to substance use or medical conditions.
How might daydreaming relate to dissociation?
Daydreaming can be seen as a mild form of dissociation, where part of the mind takes a different focus. When dissociation becomes persistent and maladaptive, it can interfere with the ability to integrate experiences and lead to psychopathology.
How does DSM-5 address cultural factors in diagnosing Dissociative Identity Disorder (DID)?
DSM-5 ensures that the diagnostic process does not overpathologize cultural or religious practices, emphasizing that behaviors like possession states must cause distress or impairment to meet the diagnostic criteria.
What major change in criteria for Dissociative Identity Disorder (DID) occurred between DSM-IV and DSM-5?
In DSM-IV, DID required two or more distinct identities controlling behavior, accompanied by memory loss or gaps beyond ordinary forgetfulness. DSM-5 redefined this as a “disruption of identity”, including self-reported or observed identity states, possession-like experiences, and recurrent amnesia for any type of information or events.
What does Criterion A for Dissociative Identity Disorder (DID) in DSM-5 describe?
Criterion A defines DID as a disruption of identity involving two or more distinct personality states. This disruption may appear as possession-like experiences in some cultures and includes significant discontinuity in the sense of self and agency. It is accompanied by changes in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor function. These symptoms can be either observed by others or reported by the individual.
Why is the geographical distribution of Dissociative Identity Disorder (DID) controversial?
Most DID cases are diagnosed by a small group of “ardent” clinicians and occur primarily in the USA and Canada, which is unusual for a psychopathology and raises questions about the disorder being location-dependent.
What was the aim of the Queensland study on DID, and how was it conducted?
Aim: To determine if the cases of DID in Queensland matched those reported in other countries.
Design: A descriptive case series with 62 patients, focusing on trauma history, symptom profiles, and dissociative phenomenology, mostly in a specialist setting.
What did the Queensland study reveal about patients’ time in the mental health system?
On average, patients in Australia spent 12 years in the mental health system before receiving a DID diagnosis, compared to 7 years in other studies.
What were the key findings on memory from the Queensland study?
Most patients could give a reasonable outline of their life, despite episodes of amnesia.
All patients showed compartmentalization of memory, with varying degrees of completeness.
What were the conclusions of the Queensland study on DID?
DID was found in both inpatient and outpatient settings in Brisbane.
Dissociation was viewed as part of a complex syndrome associated with severe childhood trauma.
There were design limitations, as the study was open and uncontrolled.
The study suggested that DID is often underdiagnosed and called for better awareness among Australian psychiatrists.
What controversies and limitations are associated with DID?
DID is rare, and most cases come from limited regions and clinicians, raising questions about bias.
Suggestibility is considered a potential issue, though the Queensland study claimed that dissociation was mostly independent of suggestion.
There is concern that trauma exposure may be underreported compared to other studies.
How did the book and movie Sybil contribute to the controversy around DID?
The release of Sybil was followed by a rapid increase in reported cases of DID, raising questions about whether media exposure influences the prevalence of the disorder.
What role might suggestibility or iatrogenesis play in the increase of reported DID cases?
Suggestibility and iatrogenesis (disorders created or worsened by medical treatment or suggestion) may contribute to the rising number of reported identities in DID cases, suggesting that external factors could shape symptoms.
Is DID real or faked? What is the controversy surrounding this question?
While faked or fakable psychopathology is not unique to DID, the binary view of “real or faked” overlooks nuance.
Media exposure may contribute to increased reports of DID, complicating the distinction between real and exaggerated symptoms.
Why is DID more challenging to diagnose than depressive disorders?
The symptoms of DID are more extreme and not as clearly represented in the diagnostic criteria, making analysis and diagnosis more difficult compared to disorders like depression.
How can malingering or secondary benefits affect reports of DID?
Some individuals may exaggerate or fake symptoms to gain secondary benefits, such as avoiding a sentence. This phenomenon, known as malingering, forces clinicians to carefully assess the validity of reported experiences.
What is iatrogenesis, and how does it relate to Dissociative Identity Disorder (DID)?
Iatrogenesis refers to the manufacturing of a disorder through treatment or suggestion. It has been implicated in the formation of recovered or manufactured memories, with some suggesting that clinicians’ framing might influence DID symptoms.
How do clinical interviews impact the reporting of symptoms in DID?
Clinical interviews may be influenced by power dynamics and the way questions are asked, leading people to admit to experiences or tailor their responses to fit certain narratives.
How can the power of suggestion impact the diagnosis of DID?
A therapist might suggest the presence of multiple identities or trauma. Clients, wanting to please the therapist or seeking care, might agree with these suggestions, which can shape the narrative and lead to a clinical picture that fits DID symptoms.
What role does the clinician-client power dynamic play in DID cases?
Clients may feel pressure to conform to the clinician’s expectations due to the power differential. This can result in clients aligning with the clinician’s framing of their symptoms or memories, potentially leading to false or exaggerated reports.
