Dissociative Disorders Combined Set

1. What is dissociation?

feelings of being disconnected from yourself and the world around you. For example, you may feel detached from your body or feel as though the world around you is unreal.

2. What are the types of dissociative disorders?

(1) Dissociative Identity Disorder;

(2) Dissociative Amnesia;

(3) Depersonalization/Derealization Disorder

a. How does each type of dissociative disorder represent?

DID: at least two distinct personality states or expressions which have their own tone of voice, physical gestures, behaviors, etc.

There must also be a gap in recall of events, information, and/or trauma due to the switching of personalities

These personalities cannot be secondary effects of a substance or medical condition to be diagnosed under DID

DA: inability to recall important autobiographical information, although the information is successfully stored in the individual's memory

DPDR: recurrent episodes of depersonalization and/or derealization which can last hours to months

b. What causes each type of Dissociative Disorder?

a significant stressor or years of ongoing stress

c. What difference (if any) is there in how the different types of dissociative disorders affect men and women?

DID: equal distribution between men and women

DA: females are twice as likely to be diagnosed with this than males

DPDR: equal ratio of men and women experiencing these symptoms

d. What are the treatment options for each type of Dissociative Disorder?

DID: integration to final fusion (therapy)

DA: Hypnosis/Therapy, Medications/Barbiturates

DPDR: The diagnosis alone can effectively reduce symptom intensity because it can relieve the anxiety surrounding the baffling nature of the symptoms

2. alleviating comorbid anxiety and depression

3. SSRIs + psychological treatments (i.e., CBT)

Which are most effective treatment options for the different Dissociative Disorders?

DID: Many individuals recover on their own without intervention

DA: Hypnosis/Therapy, Medications/Barbiturates

DPDR: medications work best when paired with psychological treatments (i.e., CBT) for underlying anxiety and depression

3. What is typically comorbid with dissociative disorders and why?

PTSD, Depressive disorders, and Anxiety.

4. What are the various etiological explanations for why people develop dissociative disorders?

Biological: the combination of genetic and environmental factors, 50-60% heritability rates

Cognitive: memory retrieval deficit (or the combination of psychological stress and various other biopsychosocial predispositions affects the frontal lobe's executive system's ability to retrieve autobiographical memories); hippocampus activation is implicated in DID

Sociocultural: *

Psychodynamic: assumes that the dissociative disorders are caused by an individual's repressed thoughts and feelings related to an unpleasant or traumatic event; DID might result from repeated exposure to trauma because the personalities serve as an escape from reality

What are Dissociative Disorders?

A group of disorders characterized by symptoms of disruption in consciousness, memory, identity, emotion, perception, motor control, or behavior

What do Dissociative Disorders Follow?

a significant stressor or years of ongoing stress

something traumatic

What are the three main types of Dissociative Disorders?

(1) Dissociative Identity Disorder;

(2) Dissociative Amnesia;

(3) Depersonalization/Derealization Disorder

How does DID Form?

Begins in childhood (

As a result of childhood trauma that was so difficult for the young person to face, the consciousness split, and one part retained the experience, while the other did not.

coping mechanism

continued to be used to handle future stress, more splits

What is required to be diagnosed with DID?

at least two distinct personality states or expressions

• have their own tone of voice, physical gestures, behaviors, etc.

There must also be a gap in recall of events, information, and/or trauma

• due to the switching of personalities

cannot be secondary effects of a substance or medical condition to be diagnosed under DID

How many alters do women with DID have on average?

15

How many alters do men with DID have on average?

8

What does switching between personalities (in DID) look like physically?

falling asleep or experiencing excessive bodily movements

How is Dissociative Amnesia identified?

Identified by the inability to recall important autobiographical information, although the information is successfully stored in the individual's memory

What is Localized Amnesia?

the most common type where one is unable to recall events during a specific period

What is Selective Amnesia?

a component of localized amnesia in that the individual can recall some, but not all, the details during a specific time period

What is Generalized Amnesia?

• a rare condition where there is a complete loss of memory of their entire life history, including their own identity; individuals experience deficits in semantic and procedural knowledge (i.e., common knowledge and learned skills)

What is Dissociative Fugue?

the most extreme type of dissociative amnesia where not only does an individual forget personal information, but they also flee to a different location; can last hours to years, after which it goes away suddenly

What is Depersonalization/Derealization Disorder categorized by?

Categorized by recurrent episodes of depersonalization and/or derealization which can last hours to months

What triggers Depersonalization/Derealization Disorder?

Intense stress or trauma

What is Depersonalization?

a feeling of unreality or detachment from oneself; can feel like an outer body experience; a lack of speech, motor control deficits, and distortions of one's physical body are also possible

What is Derealization?

includes feelings of unreality or detachment from the world, including individuals, objects, or their surroundings; can include sensory changes and distortions in time, distance, and size/shape of objects

What is the prevalence rate of DID?

1.5%, equal distribution between men and women

What is the prevalence rate of Dissociative Amnesia?

1.8% of the population; females are twice as likely to be diagnosed with this than males

What is the prevalence rate of depersonalization/derealization symptoms to a clinical degree?

About 2% of people

there is an equal ratio of men and women experiencing these symptoms

When do Dissociative disorders generally onset?

late adolescence to early adulthood (expect for DID)

What disorder are comorbid with dissociative disorders?

PTSD and Depressive disorders

What is the biological etiology for dissociative disorders?

The heritability rates for dissociation rage from 50-60% but it is really the combination of genetic and environmental factors that develop dissociative disorders

What is the cognitive etiology for dissociative disorders?

• memory retrieval deficit (or the combination of psychological stress and various other biopsychosocial predispositions affects the frontal lobe's executive system's ability to retrieve autobiographical memories); hippocampus activation is implicated in DID

What is the sociocultural etiology for dissociative disorders?

Lilienfeld and colleagues argue that mass media and its publications of dissociative disorders provide a model for individuals to not only learn about the disorders, but to engage in similar behaviors; mass media can also affect how clinicians gather data about their patients

What is the psychodynamic etiology for dissociative disorders?

assumes that the dissociative disorders are caused by an individual's repressed thoughts and feelings related to an unpleasant or traumatic event; DID might result from repeated exposure to trauma because the personalities serve as an escape from reality

How are dissociative disorders treated?

DP/DR - Many individuals recover on their own without intervention

DID - Integration of subpersonalities to a point of final fusion (Not the goal of everyone)

What are the four steps of integration to final fusion?

1. The clinician must build a strong rapport with the primary personality

2. Then, they can encourage gradual communication and coordination between the subpersonalities

3. Focus switches to fusion which occurs when two or more alternate identities join

4. Final fusion is reached when the individual identifies themselves as one unified self

Is final fusion the goal of every individual with DID?

No, although not achieving this puts the individual at risk for relapse

What are the treatments for Dissociative Amnesia?

(Experimental) Hypnosis - allows the individual to contain, modulate, and reduce the intensity of the amnesia symptoms, thus allowing them to process the traumatic or unpleasant events underlying the amnesia episode; then, the clinician helps walk them through the events during the amnesic time to reorient the individual

Barbiturates, or "truth serums" can also help relax the individual and free their inhibitions

How is Depersonalization/ Derealization Disorder treated?

1. The diagnosis alone can effectively reduce symptom intensity because it can relieve the anxiety surrounding the baffling nature of the symptoms

2. Goal of treatment is often alleviating the anxiety and depression that is comorbid with this disorder

3. SSRIs can be effective in improving mood, but medications work best when paired with psychological treatments (i.e., CBT)

Dissociative disorders are characterized by a disruption in

perception

memory

motor control

The gap in recall of events, information, or trauma in an individual with dissociative identity disorder is due to what?

switching of personalities

In DID, when sudden and unexpected, the switching of personalities is generally precipitated by what?

a significant stressor

The inability to recall events during a specific period describes…

localized amnesia

When an individual can recall some, but not all, of the details during a specific period, they have…

selective amnesia

Complete loss of memory of entire life history, including identity describes…

generalized amnesia

Failing to recall a specific category of information describes….

systematized amnesia

A soldier may experience dissociative amnesia during the time they were deployed, yet still remember friends from combat, they are experiencing…

selective amnesia

The onset of dissociative disorders is generally _, with the exception of dissociative identity disorder.

late adolescence to early adulthood

Many dissociative disorders have been found to have a high comorbidity with _?

PTSD and anxiety

What part of the brain has been linked to dissociative identity disorder?

hippocampus

What treatment has been shown to be the most beneficial to patients with depersonalization/derealization disorder?

Therapy and Medication