Week 10 Lecture 10a) Dissociative Disorders - Peter Enticott (DN) Flashcards
DSM-5 references
Dissociative Disorders pp.291-307
Somatic Symptom and Related Disorders pp. 309-327
Substantial changes from DSM-IV-TR(2000)
What was Dissociative Disorder previously known as?
previously known as multiple personality disorder
Where have the main changes been seen in DSM-5 from DSM-IV-TR?
in the Somatic Symptom and Related Disorders
Why are Dissociative & Somatic presented in the same lecture
historically were grouped with anxiety - neuroses
although anxiety not always present
DSM-III there was a shift
What was the shift that took place in DSM-III with regard to the Dissociative and Somatoform Disorders?
Moved to being based on symptoms, rather than aetiology
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Dissociative Disorders: what changed from DSM-IV-TR to DSM-5
DSM-IV-TR > (DSM-5)
Dissociative Amnesia
*Dissociative Fugue (subsumed under Dissociative Amnesia)
*Depersonalisation Disorder (Depersonalisation/Derealisation Dis)
Dissociative Identity Disorder
Dissociative Disorder NOS
Dissociative Fugue was subsumed under Dissociative Amnesia
Derealisation added to Depersonalisation Disorder
What do DID’s have in common
- onset related to stressful, traumatic event associated with psychological trauma
What are we really talking about when we are talking about a Dissociation?
- failures of consciousness, thoughts & experience are not accessible
- lack of association between experiences
- problems integrating:
consciousness
memory
identity
emotion
perception
body representation
motor control
behaviour - Memory: vulnerability of memory to impacts of stress (e.g., eyewitness accounts)
What is a very important component of the Dissociative disorders?
differential effects of stress on MEMORY
substantial changes - even severe amnesia
What is Dissociative Amnesia
Psychological reaction to trauma
effects explicit memory - for events, personal info.com
7:20
What is an interesting point about memory in relation to emotion and dissociative symptoms?
- normally emotionally charged events enhance memory
- we see the opposit in Dissociative Amnesia where an emotional event represses memory
What is Dissociative Fugue?
- follows stress/trauma
- more extensive memory loss
- no memory of previous life
- typically brief
- no recollection of fugue state
- 0.2% lifetime prevalence
In DSM-5 - it has become a subtype of Dissociative Amnesia
i. e., ‘Fugue subtype’
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Why was Dissociative Fugue subsumed under Dissociative Amnesia in DSM-5?
It is quite difficult to distinguish them with certainty
Depersonalisation/Derealisation Disorder
- known as Depersonalisation disorder in DSM-IV-TR
- linked to trauma (often linked to childhood disorder)
- no memory loss, but disrupted perception of self & surroundings
- detachment of self, unreality of surroundings
- distorted perception: size of limbs, sounds of voice, mirror reflection
- not explained by drugs or another disorder (but can co-occur)
14: 25
Dissociative Identity Disorder
- Extremely Rare
- Previously Multiple Personality Disorder
- Develops in childhood, diagnosed in adulthood
- Minimum of at least 2 separate personalities (2-4)
- not active at same time
- independent thinking, behaving, feeling (stable characteristics)
- often lack of awareness of one another
- no memory, experienced as lost time
- far more serious, complex, intractable than other DDs
- really difficult to treat
What is the controversy around DID?
- some people doubt the existence of DID
- many think its malingering
traced back to Ken Bianchi “The Hillside Strangler”
Hoe did the Psychiatrist reveal Ken Bianchi was malingering?
Asked made statements, certain questions and observed Ken’s response
e.g., said need 3 personalities to be diagnosed
next session Ken had another personality
What evidence exists that there is some commonality across different personalities in DID?
Implicit learning effects across personalities
What are two interpretations of Aetiology behind DID?
Coping mechanism
maybe learned roles in response in response to therapy
What is an area that should be treated with caution by psychologists/psychiatrists when diagnosing Dissociative states?
Can be misused in criminal justice system to diminish responsibility for crime.
e.g., Ken Bianchi
e.g., Arthur Freeman - through daughter over westgate bridge
assessed by many psychiatrists - all but one said he was culpable
only one argued he had a dissociative state & wasn’t in his right mind)
sentenced to 32years
What are some different approaches to the treatment of DID?
- Integration of personalities into a single form
- Stress management
- Psychodynamic approaches focus on overcoming repressed states
- Hypnosis - idea that more personalities may be more accessable
What are some main issues in establishing treatment programmes for DID?
- they are so rare
- lack of controlled studies
so not a lot of good research comparing techniques with controls - Comorbid depression/anxiety: treated as would treat outside of DID (e.g., psychopharmacology) so perhaps not focussed on DID treatment
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What are some issues confronted by researchers into DID?
Limited
Counfounded by traumatic experience
No firm evidence in brain structure issues as exists in PTSD
Athough one 2006 study suggested reduced hippocampal/amygdala volume in DID
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What did the Reinders et al., (2006) PET scanning study:
1) investigate
2) find
1) Looked at the different types of “dissociative identity states” (DIS)
a) Neutral identity states (traumatic memories inhibited)
b) Traumatic identity states (access & responses to traumatic memories)
2) Different neural networks activated by different dissociative identity states
a) neutral identity
b) trauma identity - a lot more subcortical activation
May suggest some kind of inhibition in neutral identity state
36:00
DSM-5 - Other Specified or Unspecified Dissociative Disorder
Why does this category exist?
What is the criteria?
Just because an underlying medical cause cannot be established, it does not mean that it does not exist
Criteria:
- features of one DD, but don’t meet diagnostic criteria
e. g., - indistinct personality states
- partial or atypical amnesia
- Dissociative “trance” (amok)
- Loss of consciousness (unidentifiable medical cause)
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