HD 3700 Prelim 2- Dissociative Disorder

Dissociative Disorder, Somatic Symptom Disorder, Anxiety disorders 1&2, OCD

Dissociation

detachment from body, self, and surroundings

everyday dissociation

• zoning out while driving

• getting lost in book, movie, creative activity

• looking at beautiful landscape or very familiar landmark in real life

• even dep daydreaming

What makes Diagnosis of a Dissociative Disorder Different?

change or disturbances in identity, memory, or consciousness

• depersonalization/ derealization disorder

• dissociative disorder

• dissociative identity disorder 

depersonalization/ derealization disorder 

presence of persistent or recurrent experiences of both depersonalization, derealization, or both 

depersonalization

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

• perceptual alterations, distorted sense of tine, unreal or absent self, emotional and/or physical numbing

Derealization

experiences of unreality or detachment with respect to surroundings

• individuals or objects are experiences as unreal, dreamlike, foggy, lifeless or visually distorted

DD diagnosis continued

• during depersonalization or derealization experiences, reality testing remains intact

• symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

• the disturbance is not attributable to the physiological effects of a substance or another medical condition

• disturbance is not better explained by another mental disorder (schizophrenia, panic, MDD, acute stress, PTSD, or another DD)

Other factors of DD

• prevalence: .8-2.8%

• average age of onset: around 16 yrs

• tend to have relative weaknesses in processing speed, attention, and spatial reasoning

• often preceded by periods of intense stress, depression, anxiety, or drug use

• equally prevalent across men and women

Dissociative Amnesia

inability to recall important autobiographical information

• usually of traumatic or stressful nature that’s inconsistent with ordinary forgetting

2 types of amnesia

• localized

• generalized

• people usually unaware or partially aware of their memory problems

localized

events during a specific span of time, usually the first few hours after a disturbing event 

generalized

no memory of life, including identity or previously acquired knowledge

• people usually but not always-retain well-learned skills

Dissociative Amnesia diagnosis cont.

• symptoms cause clinically distress or impairment in social, occupational, or other important areas of functioning

• disturbance is not attributable to the physiological effects of a substance or a neurological or other medical condition

• the substance is not better explained by dissociative identity disorder, PTSD, acute stress, somatic symptoms, or major/mild neurocognitive disorder

dissociative fugue 

apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information

specifier 

can be with or without dissociative fugue 

dissociative disorder facts

• more prevalent in women

• duration of memory loss can range from minutes to decades

• main risk factor is severe, acute, or chronic traumatization

• when memory returns, suicidality is common

are there treatments for DA?

• no evidence based 

• but some recover on their own 

Dissociative Identity disorder

• 2 or more distinct personality states

• marked discontinuity in sense of self and sense of agency, accompanied by related alteration in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning

• recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting

• symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

• disturbance is not a normal part of a broadly accepted cultural or religious practice

• symptoms not attributable to the physiological effects or a substance or medical condition

DID terms

• switch: transition from one personality state to another (can be sudden)

• host: personality of the person before the disorder began

• alters: later-developing personalities

• most have 13-15 alters

• interidentity amnesia: when different identities have no knowledge of each other

memory test

• identity B was given a list of words made up of List A, B, and distractor words

• asked to identify which words appeared on List B

• participants were equally

DID Disorder of Trauma

• virtually all cases of people with DID involve severe trauma, often early in life

• consensus that dissociation to manage trauma

• unusual response: PTSD and depression are more common

False Memories

• 1990s rise is DA

• contributed to confusion around DD

• we know some people do not remember emotionally charged, often traumatic events that have happened to them

• we also know that memory is suggestible and frequently distorted

Freyd’s Betrayal Trauma

• traumas that occur in situations where someone is dependent on the perpetrator for their survival

• freyd hypothesis that divided attention is important to dissociation

DePrince and Freyd (2004)

• asked to memorize list of words

• some related to trauma, some not 

• suggests people high in dissociation can keep threatening information from their awareness, esp if they allocate attention to other tasks in their environment