Dissociation, Personality Disorders, and Schizophrenia: Key Concepts and Models

What is dissociation?

A disruption in consciousness, memory, identity, or perception of the environment.

What is derealization?

A disconnect from reality that is generally not of clinical concern.

What is Dissociative Identity Disorder (DID)?

A condition characterized by coexisting personalities and attempts to compartmentalize experiences.

What is the Posttraumatic Model in relation to DID?

A model suggesting that 90% of patients with DID report histories of trauma or sexual abuse in childhood.

What is the cognitive mechanism of dissociation?

Memory is often shared between alters, and dissociation may relate to avoidance and false memories.

What is the prevalence of unipolar depressive disorder in children?

1-3% of children meet the criteria for unipolar depressive disorder.

What is the monoamine theory of depression?

The theory suggesting that depression is sometimes due to a depletion of serotonin and norepinephrine.

What role does the hypothalamic-pituitary-adrenal axis play in depression?

It regulates stress response, with high levels of cortisol linked to depression.

What is double depression?

A condition where an individual is moderately depressed on a chronic basis but can slip into major depressive episodes.

What is the negative cognitive triad in Beck's cognitive theory?

It consists of negative views about the self, the world, and the future, leading to depression.

What are the three types of attributions that can affect depression according to Abramson et al.?

Internal/external, global/specific, and stable/unstable attributions.

What are the clinical features of personality disorders?

Inflexible traits that hinder effective functioning and are pervasive, stable, and enduring.

What are the core traits of Cluster B personality disorders?

Dramatic, emotional, or erratic behaviors, including histrionic, narcissistic, antisocial, and borderline personality disorders.

Paranoid personality disorder

Suspicious, read a lot into remarks, blame everybody but themselves, on guard, paranoid about loyalties

It is linked to neuroticism and antagonism, with a prevalence of 1-2% in the population.

Schizoid personality disorder

Coldness, detachment, and a preference for solitary activities, often with little pleasure in life.

Schizotypal personality disorder

Social deficits, odd speech, and transient psychotic symptoms under stress, with moderate heritability.

What is the relationship between histrionic personality disorder and other disorders?

It is often comorbid with borderline, antisocial, narcissistic, and dependent personality disorders.

What are the characteristics of Narcissistic Personality Disorder?

High self-importance, lack of empathy, desire to be admired.

What are the two types of narcissism?

Grandiose narcissism and vulnerable narcissism.

Grandiose narcissism

Dominance, overestimating one's abilities, entitlement, bragging, and unwillingness to forgive.

Vulnerable narcissism

Fragile self-esteem, arrogance as a facade for shame, and hypersensitivity.

What is the relationship between narcissism and empathy?

Both types of narcissism are high in antagonism and low in altruism and empathy.

How do grandiose and vulnerable narcissism differ in terms of neuroticism and extraversion?

Grandiose narcissism is low in neuroticism and high in extraversion, while vulnerable narcissism is high in neuroticism.

What is Antisocial Personality Disorder?

A disorder characterized by aggressive, deceitful, and antisocial behavior, violating others' rights.

What are the diagnostic criteria for Antisocial Personality Disorder?

Must be diagnosed over 18, with a history of conduct disorder before age 15.

What factors contribute to Antisocial Personality Disorder?

Genetic predisposition, environmental factors like low income, abuse, and neglect.

What is Borderline Personality Disorder (BPD)?

A disorder marked by impulsivity, instability, and an unstable sense of self.

What emotional patterns are common in individuals with BPD?

Affective instability, intense emotional responses, and rapid emotional shifts.

What are common comorbidities with BPD?

Mood disorders, anxiety disorders, and substance use disorders.

What are positive symptoms of schizophrenia?

Delusions, hallucinations, disorganized speech, and behavior.

What are negative symptoms of schizophrenia?

Reduced expressive behavior, avolition, anhedonia, and alogia.

What is the significance of the HPA axis in mental health?

Dysregulation of the HPA axis is linked to various mental health disorders, including BPD.

Schizoaffective disorder

Features of both schizophrenia and mood disorders, with delusions or hallucinations occurring without a mood episode.

What is the role of genetic factors in schizophrenia?

Familial connections exist, with a 48% concordance rate in monozygotic twins, indicating a genetic component.

What environmental factors may contribute to schizophrenia?

Prenatal exposures, viral infections during pregnancy, and complications during birth.

What is the significance of the MAOA gene in antisocial behavior?

Low activity of the MAOA gene may be linked to aggression and antisocial behavior.

What is the chance of recovery with antipsychotic treatment after 15-25 years?

14% chance of recovery

First generation antipsychotics

Thorazine and Haldol, block dopamine receptors. Afffect positive symptoms, which are not usually bothersome to patients.

What is a significant advantage of second generation antipsychotics?

They have fewer side effects.

What psychosocial approaches are used in treatment?

Case management, family therapy, psychoeducation, social skills training, and CBT.

What is anhedonia?

The inability to enjoy things one used to.

What are common symptoms of a depressive episode?

Weight changes, sleep disturbances, psychomotor agitation or retardation, feelings of worthlessness, and suicidal ideation.

Mania

An elevated mood lasting at least one week.

What is the prevalence of Bipolar I disorder?

Lifetime prevalence is 1-2%.

What distinguishes Bipolar II disorder from Bipolar I?

Bipolar II includes hypomania and one or more major depressive episodes.

What are common causal factors for unipolar mood disorders?

Genetic factors, neurochemicals (serotonin and norepinephrine), stress, and personality traits.

What is a significant risk associated with MAOIs?

They have many side effects and can interact negatively with certain foods.

What is lithium and what is a major concern with its use?

Lithium is a natural salt used as a mood stabilizer, but it can cause liver toxicity and is easy to overdose on.

What is the concept of 'concept creep' in relation to mood disorders?

It refers to the broadening use of the term depression to describe normal emotional states.

What is the typical duration of a depressive episode?

More than two weeks.

What is psychomotor agitation?

Bodily restlessness that is very unpleasant.

What does 'rapid cycling' mean in the context of bipolar disorder?

Experiencing multiple episodes (4 or more) within a year.

What are somatic symptoms?

Bodily symptoms or health issues suggesting medical problems without an organic basis.

Conversion disorder

A condition where individuals lose motor control or sensory function due to psychological processes, not neurologically possible.

Illness anxiety disorder

Previously known as hypochondriasis, it involves intense health anxiety leading to misinterpretation of mild symptoms as serious diseases.

Somatic symptom disorder treatments

Cognitive therapy to challenge beliefs about illness, behavioral techniques to modify perceptions, and SSRIs to mitigate anxiety.

What is the secondary reinforcement hypothesis in somatic symptom disorders?

The idea that special care or attention received due to bodily sensations reinforces the perception of those sensations as symptoms.

What is the primary focus of cognitive-behavioral therapy (CBT) for somatic symptom disorders?

To improve coping strategies and personal adjustment, reducing pain and inappropriate illness behavior.

What characterizes conversion disorder?

Symptoms affecting voluntary motor or sensory functions that are not intentionally produced and cannot be explained by medical conditions.

Factitious disorder

The intentional production of physical or psychological symptoms for the purpose of assuming the sick role without external incentives.

Factitious disorder by proxy

A condition where a caregiver intentionally produces illness in another person, often a child, to gain attention or sympathy.

Dissociative disorders

Conditions characterized by persistent, maladaptive alterations in consciousness, often involving zoning out or daydreaming.

Conversion disorder treatment

PTSD therapy can be effective in treating conversion disorder symptoms, as they may be trauma-related.

What is the prevalence of somatic symptom disorders in non-Western cultures?

Somatic symptoms are more commonly understood and accepted in non-Western cultures compared to Western contexts.

How do childhood sickness experiences contribute to somatic symptom disorders?

Childhood sickness can lead to an attentional bias towards illness-related information, influencing adult perceptions of health.

What is the significance of maladaptive thoughts in somatic symptom disorder?

Maladaptive thoughts, feelings, and behaviors are essential for diagnosing somatic symptom disorder, alongside a history of symptoms.

What remains intact during depersonalization/derealization?

Reality testing; individuals are aware of who and where they are.

What is dissociative amnesia?

An inability to recall previously stored information, typically related to stressful or traumatic experiences.

What type of memory is lost in dissociative amnesia?

Autobiographical memory, not skills or learned information.

What is the sociocognitive theory regarding DID?

It posits that DID may arise from the power of suggestion and media influence.

What is anorexia nervosa?

An eating disorder characterized by restriction of calorie intake, intense fear of gaining weight, and distorted body perception.

What weight percentage defines anorexia nervosa?

A body weight of 85% or below of what is considered normal.

What are some medical problems associated with anorexia nervosa?

Loss of bone mass, low blood pressure, heart rate slowing, and potential cardiac arrest.

What is bulimia nervosa?

An eating disorder involving recurrent episodes of binge eating followed by compensatory behaviors like vomiting or excessive exercise.

What distinguishes binge-eating disorder from bulimia nervosa?

Binge-eating disorder involves eating large amounts of food without compensatory behaviors.

What is the gender ratio for eating disorders?

Approximately 10:1 female to male, with higher rates among trans men and nonbinary individuals.

What is the Maudsley model in treating anorexia nervosa?

A family therapy approach that involves refeeding and parental involvement in treatment.

What is the role of serotonin in eating disorders?

Malnourishment can prevent the production of serotonin, affecting mood and eating behaviors.

What is the dimensional approach to diagnosing personality disorders?

It recognizes varying severity rather than strict categorical definitions.

What are common comorbidities with anorexia nervosa?

Anorexia is often comorbid with obsessive-compulsive disorder (OCD).

What is the typical treatment for bulimia nervosa?

Cognitive Behavioral Therapy (CBT) is commonly used to treat bulimia.

What is the relationship between trauma and personality disorders?

Many personality disorders are trauma-related and can develop from chronic emotional dysregulation.

What is the diagnostic challenge with personality disorders?

Diagnostic criteria are often vague and overlapping, making it difficult to classify and treat these disorders.

What is the difference between episodic and chronic disorders?

Episodic disorders fluctuate over time, while personality disorders are more stable and pervasive.

What is the onset period for personality disorders?

Typically begins in adolescence or early childhood, often difficult to distinguish from normal developmental phases.

What are the treatment options for bulimia and binge-eating disorders?

Cognitive Behavioral Therapy (CBT) is commonly used for both conditions.

What are the cultural factors influencing eating disorders?

Cultural emphasis on thinness, particularly in North America, Europe, and Japan, contributes to higher rates of eating disorders.

What is the role of genetics in eating disorders?

Having a relative with anorexia increases the risk by 11 times and by 4 times for bulimia.

What is the significance of the term 'set point' in relation to weight?

The set point refers to the body's natural weight range that it tries to maintain, which can be disrupted by eating disorders.

What is the importance of identity functioning in personality disorders?

Identity functioning assesses how well a person understands themselves, which is crucial for diagnosing personality disorders.

What psychosocial approaches are used in treating mood disorders?

Case management, family therapy, psychoeducation, social skills training, and CBT.

Bulimia treatment

SSRIs can be effective in reducing symptoms

MAOIs

A class of antidepressants that inhibit the enzyme monoamine oxidase, leading to increased levels of neurotransmitters in the brain.

What is the role of ketamine in treatment?

Ketamine is a dissociative drug used as an antidepressant, administered in-office through infusion.

How do SSRIs and SNRIs potentially affect the brain?

They may increase activity in the glutamate system.

What is Electroconvulsive Therapy (ECT)?

ECT is a rapid antidepressant treatment used for severe depression.

What is the difference between Dissociative Amnesia and Dissociative Fugue?

Dissociative Amnesia involves memory loss of autobiographical information, while Dissociative Fugue includes sudden travel and identity confusion.

What is the significance of Criterion A in personality functioning?

It assesses identity, self-direction, empathy, and intimacy on a scale from 0-5.

What are the pathological personality traits in Criterion B?

Negative affectivity, detachment, antagonism, disinhibition, and psychoticism.

What are the characteristics of Cluster A personality disorders?

They include paranoid, schizoid, and schizotypal disorders, often resembling psychotic disorders.