Dissociative Disorders 👯‍♀️

what is dissociative disorder?

mental disorders that involve experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions, and identity

they are escaping reality in unhealthy and involuntary ways, which causes problems functioning in every day life

how does dissociative disorder develop?

usually develop as a reaction to severe psychological trauma and help keep difficult memories at bay

times of stress can worsen sxs

what are the types of dissociative disorder?

1. Dissociative identity d/o

2. Dissociative amnesia

3. Depersonalization/derealization d/o

when does depersonalization frequently occur with dissociative disorder?

with anxiety disorders, PTSD, and severe depression

what is normal dissociation?

an adaptive defense used to cope with overwhelming psychic trauma

commonly encountered during disasters, criminal assault, sudden loss, war

• Unclear whether pathologic dissociation is an extreme or more

enduring form of normal dissociation

• Psychological, neurocognitive, traumagenic, and psychosocial

theories re: basis of pathologic dissociation

what is dissociative identity disorder (DID)?

a disruption of identity characterized by two or

more distinct personality states which some

cultures describe as possession

what does DID cause?

a marked discontinuity in sense of self an agency, accompanied by alterations in affect, behavior, consciousness, memory, perception, cognition, and sensory-motor functioning

Disturbances should not be a normal part of a

*broadly accepted cultural or religious

practice*

LOST TIME between personalities

when do s/sxs usually begin in DID?

usually not able to dx until late 20s, but typically begins much earlier in childhood

what types of s/sxs do DID pts exhibit?

transient depression, mood swings, sleep disturbances, nightmares, and suicidal behavior

may have had years of tx before correct diagnosis is made

how do DID pts act/are they dangerous? what do they usually report?

self-injurious and exhibit host of dissociative sxs (amnesia, episodes of LOST TIME, depersonalization, fugue, and hallucinations)

what positive sxs may DID pts have?

most pts have auditory and/or visual hallucinations and quasi delusions

what types of auditory hallucinations do DID pts have?

may be parts of convos heard during traumatic experiences or hostile voices that disparage patient or command them to harm themselves or commit suicide

what are micro dissociations?

discontinuities of thought and "though slippages" that may occur resulting in intrusion of traumatic theme into stream of consciousness

what prior interventions have more DID pts had?

most have has medical and neurological investigations

may have been tx for mood d/o, anxiety d/o, or schizophrenia

what is the cardinal feature of DID?

multiple personalities

2+ entities, each having a characteristic and separate personality, history, affect, values, and function (usually ~10 but can be more)

when do alters usually emerge in DID?

during childhood in from of imaginary protectors that help child cope with recurrent abuse and fear

Usually two dimensional in quality → includes a host personality,

child personalities (e.g., innocent child, traumatized child, ...), a

persecutor, an opposite-sex alter, an internal helper, a brazen and

promiscuous alter, a demon, and "no one"

when would we elicit alters?

this can be difficult, the clinician must have reasonable suspicion that DID is present*

what would elicit reasonable suspicion that DID is present?

abrupt changes in demeanor, "lost time," total amnesia of childhood, and physical sxs

what do you do to elicit an alter?

exploration of puzzling events or lost time

what are the most often differential diagnoses of DID?

partial complex seizures, schizophrenia,

bipolar d/o, MD with psychotic features, Munchausen syndrome, and

malingering

what may be confused with alter switching?

partial complex seizures that last a few seconds

why are DID pts often misdx with schizophrenia?

because pt with DID freq. report quasi delusions, ideas of being externally controlled, auditory hallucinations, and ideas of thought loss

how can DID and schizophrenia be differentiated?

by lack of emotional incongruity, dramatic presentation, history of severe trauma, alter personalities, and high scores on dissociation scales

what may be useful in distinguishing DID from schizophrenia?

hypnosis

what is sometimes confused with mood swings by alter switching in DID?

rapid cycling bipolar disorder

why are DID pts misdx with mood disorders with psychotic features? what differentiates them?

pts with DID have associated depressive mood

in mood d/o, auditory hallucinations and delusions are consistent with depressive mood

what is dissociative amnesia?

inability to recall important autobiographical information, usually of traumatic or stressful nature, that is inconsistent with ordinary forgetting

what does dissociative amnesia often consist of?

localized or selective amnesia for specific event or events