Week 10 Lecture 10a) Dissociative Disorders - Peter Enticott (DN)

Question 0

DSM-5 references

Answer 0

Dissociative Disorders pp.291-307
Somatic Symptom and Related Disorders pp. 309-327

Substantial changes from DSM-IV-TR(2000)

Question 1

What was Dissociative Disorder previously known as?

Answer 1

previously known as multiple personality disorder

Question 2

Where have the main changes been seen in DSM-5 from DSM-IV-TR?

Answer 2

in the Somatic Symptom and Related Disorders

Question 3

Why are Dissociative & Somatic presented in the same lecture

Answer 3

historically were grouped with anxiety - neuroses

although anxiety not always present
DSM-III there was a shift

Question 4

What was the shift that took place in DSM-III with regard to the Dissociative and Somatoform Disorders?

Answer 4

Moved to being based on symptoms, rather than aetiology

4:00

Question 5

Dissociative Disorders: what changed from DSM-IV-TR to DSM-5

Answer 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

Question 6

What do DID’s have in common

Answer 6

• onset related to stressful, traumatic event associated with psychological trauma

Question 7

What are we really talking about when we are talking about a Dissociation?

Answer 7

• 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)

Question 8

What is a very important component of the Dissociative disorders?

Answer 8

differential effects of stress on MEMORY

substantial changes - even severe amnesia

Question 9

What is Dissociative Amnesia

Answer 9

Psychological reaction to trauma
effects explicit memory - for events, personal info.com

7:20

Question 10

What is an interesting point about memory in relation to emotion and dissociative symptoms?

Answer 10

• normally emotionally charged events enhance memory

- we see the opposit in Dissociative Amnesia where an emotional event represses memory

Question 11

What is Dissociative Fugue?

Answer 11

• 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’
11: 00

Question 12

Why was Dissociative Fugue subsumed under Dissociative Amnesia in DSM-5?

Answer 12

It is quite difficult to distinguish them with certainty

Question 13

Depersonalisation/Derealisation Disorder

Answer 13

• 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

Question 14

Dissociative Identity Disorder

Answer 14

• 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

Question 15

What is the controversy around DID?

Answer 15

• some people doubt the existence of DID
• many think its malingering
  traced back to Ken Bianchi “The Hillside Strangler”

Question 16

Hoe did the Psychiatrist reveal Ken Bianchi was malingering?

Answer 16

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

Question 17

What evidence exists that there is some commonality across different personalities in DID?

Answer 17

Implicit learning effects across personalities

Question 18

What are two interpretations of Aetiology behind DID?

Answer 18

Coping mechanism

maybe learned roles in response in response to therapy

Question 19

What is an area that should be treated with caution by psychologists/psychiatrists when diagnosing Dissociative states?

Answer 19

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

Question 20

What are some different approaches to the treatment of DID?

Answer 20

• 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

Question 21

What are some main issues in establishing treatment programmes for DID?

Answer 21

• 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
  34:00

Question 22

What are some issues confronted by researchers into DID?

Answer 22

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

34:50

Question 23

What did the Reinders et al., (2006) PET scanning study:

1) investigate
2) find

Answer 23

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

Question 24

DSM-5 - Other Specified or Unspecified Dissociative Disorder
Why does this category exist?
What is the criteria?

Answer 24

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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