dissociative disorders

what are dissociative disorders ?

group of disorders with disruption of memory, consciousness, identity, perception; separating parts of person's consciousness/identity from central identity

are dissociative disorders based on discontinuum or continuum ?

continuum (day dreaming—highway hypnosis—pathological dissociation)

what are features of dissociative disorders ?

common with extreme anxiety, individual undergoes experience or identity alteration, memory disturbance of dissociation period events

how does dissociation exist as an adaptive feature ?

low end: boredom, self-stimulation, fantasy

extreme end: escape from overwhelming reality

what is depersonalization ?

feeling detached from/observer of one's mental processes or body, losing sense of OWN reality

what is derealization ?

sense of external world's reality is lost (ex. things change size, form, etc.)

what are clinical features of depersonalization disorder ?

sense that one is detached from body and mind, floating sensation, not feeling like oneself, feel like observing self/being outside of self

what is depersonalization disorder ?

feeling detached from oneself, accompanied with experiences of derealization

what're other disorders depersonalization can be an aspect of ?

dissociative and anxiety disorders

what is dissociative amnesia ?

1+ episodes of inability to recall important personal information that isn't induced organically (eg. brain injury);

usually traumatic in nature

what is confabulation ?

feature of dissociative amnesia where patients lie/fabricate events to fill gaps in memory

what is hypnosis' relation to dissociative amnesia ?

historically believed to allow access to hidden memory, but it's controversial now and not backed by evidence

what is spontaneous remission ?

sudden and natural memory recovery, typically in dissociative amnesia

what is dissociative amnesia with dissociative fugue ?

sudden, unexpected, and unexplained travel from one's customary place of work paired with inability to recall past or memory, leading to a new identity;

short-lasting and paired with serious pathological stress/trauma

what is dissociative identity disorder (DID) ?

presence of 2+ distinct identities or personality states called alter personalities

what is the diagnosis critieria for DID ?

presence of 2+ distinct alters with own sense of self and environment; recurrently take control of person's behavior; inability to recall important personal information that's too extensive to be explained by normal forgetfulness

what is switching (DID) ?

changing from one alter to another (may be unconscious, conscious, or environmentally triggered)

what are differential diagnoses for DID ?

schizophrenia (has hallucinations, psychosis), bipolar (mania), depression with psychotic features, borderline personality disorder, alcohol/drug dependence (can cause memory loss, etc.)

what is the etiology of DID ?

childhood trauma (though most don't develop DID)

what are the general rates of DID with child abuse history ?

98% have been abused, 83% are child sexual abuse cases, 67% are neglect or abandonment cases

what is ritualistic abuse ? how does it interact with DID ?

brutal form of abuse involving rituals over extended period of time + extremely painful, humiliating, and severe (aka complex PTSD);

often seen in DID patients' past

how does the behavioral perspective view DID ?

avoidance coping behaviors that are negatively reinforced by temporarily removing aversive psychological states

what is the behavioral repertoires ?

everyone has different repertoires (skill sets) under different contexts, which can be evoked even when they haven't been around for a period of time

how does the behavioral perspective apply behavioral repertoires to DID ?

DID tightly controlled repertoires, evolving them into alters > resurgence— reverting to behavioral repertoires that had reinforcing properties for individuals in past;

integrate behavioral repertoires so one "self" is experienced across situations

what DID treatment is known to fail ?

attempts to eliminate or destroy specific personalities in client

what is the primary goal in DID treatment ?

understanding and integrating into one consistent self

how does the psychodynamic perspective treat DID ?

uncover traumatic childhood experiences and teach client to tolerate them

why is DID controversial ?

questionable rarity (more or less rare than originally thought + diagnosis validity) — better diagnosis criteria, belief in DID's authenticity, or underreport of DID v. confirmation bias

what are difficulties of human memory ?

very fallible and unreliable; people don't remember everything + some events too painful to remember + can be manipulated or changed

what are repressed memory ?

freudian/psychoanalytic concept that a traumatic memory gets pushed into unconscious mind as remembering it is too threatening

is it possible to recover memories ?

yes, spontaneously or through therapy

what is false memory syndrome ?

high number of very vivid but false memories that patient believes to be real, often of abusive events in childhood

what are criticisms of recovered memories ?

highly detailed (memories tend not to be), therapists have agendas and look for confirming evidence of abuse histories (agrees = occurred; disagrees = denial)

what are the legal magnifications of recovered false memories ?

can be used to arrest, take custody, or sue alleged perpetrator, which can be extremely damaging to true causes

why do people fake memories ?

looking for answers, external or psychological support

what is malingering ?

intentional production of false or grossly exaggerated physical or psychological symptoms for a specific gain/external support (eg. financial, work, etc.);

common with antisocial personality disorder

what is fictitious disorder ?

intentional production/feigning of physical or psychological signs/symptoms to be in "sick role" (psychological support ?), but no external incentives are present (financial, legal);

munchausen's syndrome

What is factitious disorder imposed on another/by proxy ?

caregivers/others make up or produce physical illnesses in someone else (commonly in children)