BH E3- Dissociative Disorders

What conditions are characterized by a disruption in the normal integration of consciousness, memory, identity, behavior, emotion, motor control & perception of environment?

Dissociative disorders

When do dissociative disorders frequently occur?

After severe trauma intolerable or overwhelming to the patient

The following criteria is associated with what condition?

• Inability to recall important autobiographical info (name, address), usually of/after traumatic or stressful nature

  • inconsistent w ordinary forgetting

• significant distress or impairment

• not attributable to other condition or substance

  • requires workup- labs, imaging, etc

• not better explained by DID, PTSD, acute stress disorder, somatic sx disorder, or neurocognitive disorder

Dissociative amnesia

What is localized amnesia?

Inability to recall events related to circumscribed period of time

What is selective amnesia?

Ability to remember some, but not all, of events occurring during circumscribed period to time

What is generalized amnesia?

Failure to recall one’s entire life

What is continuous amnesia?

Failure to recall successive events as they occur

What is systematized amnesia?

Amnesia for certain categories of memory (ex- related to ones family or a particular person)

What is dissociative fugue?

Bewildered wandering or purposeful travel in search of identity or for other important personal information

Permanent or dissociative amnesia?

• d/t neurological damage or toxicity that prevents memory storage or retrieval

• not reversible

Permanent amnesia

Permanent or dissociative amnesia?

• always potentially reversible

• memory has been successfully stored

Dissociative amnesia

What are RF for dissociative amnesia?

Greater number of adverse childhood experiences (particularly physical or sexual abuse), interpersonal violence, inc severity, frequency & violence of trauma

How does generalized amnesia usually onset?

Sudden

How does localized or selective amnesia usually onset?

Delayed (hrs, days, or longer)

Describe the course of dissociative amnesia.

Forgotten events can range from minutes to decades, can resolve rapidly or become chronic & profoundly disabling, may gradually recall yrs later

*declines with age → distress occurs as amnesia remits → most develop PTSD

Dissociative amnesia or PTSD?

• memory loss extends beyond immediate traumatic event

Dissociative amnesia

What is the treatment for dissociative amnesia?

Refer psych → cognitive therapy, hypnosis, journaling

*no meds indicated

Depersonalization or derealization?

• experiences of unreality, detachment or being an outside observer in respect to one’s body, feelings, actions, sensations or thoughts

• feeling robotic, as if in a dream watching themselves

• altered sense of time - too fast or slow

• sense of no control over actions

Depersonalization

Depersonalization or derealization?

• experiences of unreality or detachment with respect to surroundings

• may feel as if they were in a fog or dream or a veil / glass is between themselves and the world

• subjective visual disturbances → view other individuals or objects with blurriness narrowed visual field, 2 dimension or flat

Derealization

What medical conditions is depersonalization or derealization common?

Seizure, migraine, head injury, during or after life threatening injury

What is the etiology of depersonalization / derealization disorder?

Overwhelming experience or trauma, emotional abuse & neglect as a child

What is the average age of onset for depersonalization / derealization disorder?

16 y/o

What is the treatment for depersonalization / derealization disorder?

Refer psych → cognitive or behavioral therapy, grounding techniques

± SSRIs, mood stabilizers, antipsychotics

*remits w/ tx of underlying d/o if one is associated

What condition is characterized by the presence of ≥2 distinct identities (alters) or personality states that recurrently take control of the individual’s behavior?

*recurrent gaps in the recall of important personal info, everyday events, traumatic events

DID

What is the etiology of DID?

Overwhelmingly severe experiences, traumatic events, abuse in childhood

What symptoms pertaining to sense of self are seen with DID?

May feel as outside observer of their “own” speech/actions to which they can’t control, may report their bodies feel different (opposite gender, like small child or protector), can be witnessed by other individuals

What memory & amnesia sx are associated with DID?

Vary in their awareness of amnesias, amnesia not limited to traumatic events, may discover evidence of tasks they do not recall doing, or suddenly find themselves on a beach or at work (dissociative fugue)

What are common comorbid conditions with DID?

PTSD (most will develop if not present), avoidant & borderline personality disorder, conversion disorder

*70% have attempted suicide

What DID patients have a worse prognosis?

Comorbid mental disorders, ongoing abuse, later life retraumatization, severe medical illnesses

How does DID differ from psychotic disorders?

Become different alters rather than just hearing voices

What is the treatment for DID?

Refer to psychiatrist, psychotherapy with range of techniques, & meds for associated sx / psychiatric disorder

What needs to be done in the evaluation of depersonalization / derealization disorder?

*also a good idea to complete for DID evaluation as well

Thorough workup → standard labs, EKG, EEG, brain CT / MRI, neurological exam, drug or alcohol screen,