lecture 17: dissociative disorders and amnestic disorders

dissociative amnesia

•Inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness

•Linked to overwhelming stress (i.e., Traumatic events such as war, abuse, accidents, or disasters that the person experienced or witnessed)

dissociative disorders

a defense mechanism wherein the brain cannot deal with the trauma

organic disease

though you may suspect dissociative disorders you must rule out

medical until proven otherwise, you should also rule out malingering

-true cases not caused by medical disorders are extremely rare

the cause of dissociative fugue is almost ALWAYS

dissociative fugue

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

•Linked to severe stress (i.e., traumatic events such as war, abuse, accidents, disasters, or extreme violence that the person has experienced or witnessed.

seizures (complex partial seizures most likely)

please rule out ________ as a cause of dissociative fugue

•Remember to rule out cultural or religious features as some cultures may have a "running" syndrome that could be defined as Dissociative Fugue

•Conditions met by a sudden onset of high level of activity in a trancelike state

cultural reasons that may prompt you to erroneously diagnose a dissociative fugue

more severe memory impairment for recent, rather than remote events

-resolves slowly if at all and is not associated with psychological stress

what kind of memory impairment is more likely with a brain injury (test question)

•Presence of 2 or more distinct personality states that recurrently take control of the individual's behavior accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

diagnostic criteria of dissociative identity disorder

multiple personality disorder

dissociative identity disorder is formerly known as

dissociative identity disorder

•Identity fragmentation characterizes this disorder rather than a proliferation of separate personalities

Recurrent gaps in the recall of every day events, important personal info, and/or traumatic events that are inconsistent with ordinary forgetting.

memory impairments associated with dissociative identity disorder

no

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

is people speaking in tongues at church aa sign of dissociative identity disorder?

personality disorders

major ddx associated with dissociative identity disorder

•Self-inflicted injuries or physical abuse

•May have: Migraines, Headaches, Irritable Bowel Syndrome, Asthma

physical exam findigns/medical conditions associated with dissociative identity disorder

depersonalization/derealization disorder

a dissociative disorder marked by the presence of persistent and recurrent episodes of depersonalization or derealization, or both

depersonalization

Experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing)

derealization

Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted)

•Difficulty describing symptoms

•Derealization or a sense of that the external world is strange or unreal

•Anxiety symptoms

•Depressive symptoms

•Obsessive rumination

•Somatic concerns

•Disturbance in one's sense of time

associated features of depersonalization/derealization disorder

dissociative disorders and amnestic disorders

essential features:

•Disruption of usually integrated functions of consciousness, memory, identity, or perception

•Disturbance may be sudden or gradual, transient or chronic

-psychotherapy

-medication to address: depression, severe anxiety, anger, impulse control problems

-ECT

management of dissociative disorders