7.2 Dissociative Disorders

DDD: Depersonalization, dissociation disorder

when depersonalization becomes so severe person cant function: detached from ones own thoughts, body. feels like theyre dreaming but has an understanding its reality

DDD diagnostic criteria: A

Depersonalization: fees detached from self: feeling like outside observer of ones thoughts, feelings, sensations, body, or actions: distorted sense of time, numb, unreal/absent self

Derealization: feels detached from surroundings: people, objets around them feel not really, foggy, dreamlike: lifeless, visually distorted

DDD diagnostic criteria: B C, D, E

b. reality is intact during D or D

c. significant distress or social, work impairment

d. not due to a substance

e. not better explained by another disorder

Dissociative, Depersonalizaton Disorder Prevelenace

under 1-3% of the population (0.8-2.8%)

Causes of DDD

often happens after trauamatic event like sexual assault

mean age of onset for DDD

16 yrs old

course of DDD

chronic course ofteing lasting 15 years

DDD commborid with anxiety, mood disorders

study showed half of participants had anxiety, mood disorder

Guralnick cognitive profile for those with DDD

showed that they had worse short term memory, poor attention span, perception of 3D objects

corresponds with visual (perceptual) distortion and issues absorbing information (mind emptiness)

DDD and brain functioning

those with DDD showed less emotional response, inhibiting expression

brain imaigng confirms issues with perception and emotional regulation

HPA axis also shows theres dysregulation

DDD treatment

prozac seemed neutral, psychological treatments not studied

Dissociative Amnesia

can’t recall personal information about a stressful/traumatic event

Generalized amnesia

when a person can’t remember anything about who they are. their identity, personal info. can be lifelong or extend from 6-months to yr ago

Diagnostic criteria for Dissociative Amnesia (ABCD)

can’t recall autobiographical info of the traumatic event and its beyond simply forgetting

(localized to one event/specific events)

B. symptoms cause clinically significant distress or impairment

C. can’t be due to substance

D. not better explained by another disorder

(specify if theres dissociative fugue state bewildered wandering, purposeful travel related to identity amnesia, or for important autobiographical info)

localized or selective amnesia

can’t recall specifc usually traumatic events, at specifc period.

Dissociative fugue

memory loss of an unexpected trip. leave and wind up in new place unsure of how they got there. (typically left an untolerable situation had to get out).

sometimes assumes a new identity or becomes confused about the old one

ends abruptly

Dissociative amnesia prevelance

rarely happens before adolesence, and usually happens in adulthood (rare to never happen before 50)

1.8-7% prev range The most prev dissociative disorder 2-7%

Amok

typically males have a fugue state where they kill animals or people brutally “running amok”

running on its own is more common in women

dissociative trance disorder

belief you are possessed by spirits. considered a disorder when under stress or dysfunctioning. undesriable state

happens in India, Nigeria (vinvursia), Thailand, etc

Dissociative Identity Disorder DID

up to 100 personalities or fragments of personalities living within one body and mind

alters

the different personalities of alter egos for someone with DID

Diagnositic critiera for DID: A, B,

a. at least 2 or more seperate personalities (some cultures may see this as possession)

disconnected from sense of self, and agency: change of affect, behaviour, memory, cognition, s/m functioning

b. has gaps in memory of everyday events, personal information, and/or traumatic events which. inconsistent with typical forgetting

Diagnositic critiera for DID: C, D, E

C. clinically significant distress, impairement in social, work, etc

D. “disturbance” not a normal part of cultural or religious practice

E. not attributable to a substance, medical condtion

DID which identity usually asks for treatment?

one of the host identities (not original), the origainal identity rarely asks for help

switch and characteristics (DID)

the change between alters. usually instaneous.

when changing alters, the person can physically change i.e. posture, facial expressions, facial wrinkles, physical disabilities (limp)

Can DID be faked?

hard to say. people with DID are very suggestible so maybe a therapist’s prev insights/suggestions led them to believe they had another personality, or it emerged during hypnotic state

Nicholoas Spoanos faking DID experiment

gave/didnt give college students option to use DID in defence of murder and those who had option faked DID 80%. those w/out knowledge less likely to fake

socio cognitive model

spanos suggested that DID symptoms could have come from therapist suggesting sociocognitive model (fragments of personality from trauma), that their behaivour could be explained by alters

interpersonality amnesia

not remembering the events experienced by another personality

what evidence is there that DID is not always fake (physical)

1. interpersonal amnesia is true, memories experienced by a different personality are only known by that same personality

2. objective tests were done, found that alters had different optical functions (micro-transitent-subimus) hard to fake

3. Galvanic skin reponse, EEG, fMRI shown to be different between alters

what evidence is there that DID is not always fake (pyschophysical)

-patients with DID wanted to hide symptoms while those malingering wanted to show off alters , fluid swtiches

is the self dissociable from our bodies?

despite what media shows, our personalities, our selves are connected to us physcially (our bodies)

does physical evidence prove DID is real

not necesarily, the test results may be different becuase the person is exbiiting a different emotional state. more research, proper test needs to be developed

(calm and ocllected vs impulsive and angry)

DID onset and gender prevelance

ratio of 9 women: 1 men

and onset is almost always in childhood:
can be as young as 4 years old but usually diagnosed found out later

DID course

chronic course lasting a lifetime without treatment.

but switching usually lessens as they age

when do new alters emerge?

can emerge in response to new life situation, to help them 

DID prevelance

canada and us: 2-6 % (inpatients)

higher than previously thought

DID commorbidity

those with DID usually have other psych diagnoses: substance use, depresion, bpd, etc) BPD esp has similar symptoms (some say it accounts for DID symptoms)

(one study 7 other disorders on avg)

most likely due to severe reaction to instense child abuse

DID mistaken as psychotic disorder

often mistaken as psychotic disorder because auidtory hallucinations are very common (however since it comes from inside its not psychotic thats outside)

voices often want orignal personality to do smth against their will. person aware its not real and tries to supress

DID culturally

found all over the world. often viewed as possesion

DID causes

horrific abuse in childhood (almost all)

(gleaves 100 cases found 97% physically, sexually abused more than hald incest0

(some reports could be fake)

not all trauma cuased by abuse: war zone

lack of support during after trauma impiled

general reason people develop DID

to escape or dissociate from the negative affect from extreme childhood trauama

lack of support during after trauma impiled: walter ross twin study

showed that most variance of dissociative experience comes form non-supportive environment

individual experience, personlaity factors the rest

what causes pathological dissociaton (i.e amnesia, depersonalizaion, etc)

extreme life stress. has to go through it currently. some dont get this no matter how stressful so need the vulnerability.

also while everyone under extreme stress dissociates in some way this is different from pathological verison

DID and PTSD

some think DID is a subtype of PTSD since similar etiology but stronger emphasis on dissociative symptoms. but different developmental window. DID has to be before 9 yrs or not likely to happen

Suggestibility

a personality trait. some are born more or less suggestible than others. majority arein the middle

DID and suggestibility (Mclewin and Muller)

those with DID have higher suggestibility.

more likely to have had imaginary friends andhaving imaging friends correlates with having higher suggesibility/hypnotizaiton

autohypnotic model and defence mechanisms

autohynotic model showed that those who were more suggestible were more likely to use dissociation as a defence mechanism against trauma

developing PTSD or DID based on sugeestiblity

those with higher suggestiblity using dissociation, fantasy as defnec mechanism for extreme trauama may end up with DID if they cant diferentiate from reality as they grow older.

while those who do differentiate are therorized to dev extreme PTSD instead

biological contribitons (conflicting)

biological vulnerablity for DID that is hard to pinpoint

variance and identifable causal factors are all environemntal

twin study shows suggestiblity is highly hereditable (half variance of dissociation to genetics) so the findings are inconsistent more research needed

• head injury/brain damage

• sleep deprivation worsens DID symptoms, cuases hallucinations

therapy DID real or false memories

some are not sure that DID trauamatic past was also carelelsly inffered by therapist since they assume there must be past trauma for DID. 

patients again are very suggestible memoeries are not entirely accrautely. espeically in. thepast. things that feel real are not necessarily true

the issue with false memoreis

evidence shows they can be reasonably created. can cause wrongful convicitons, family breakups etc

however the validity of memeories esp if forgotten due to dissociative amnesia lead to people getting away with crime, and no relief to current suffering\

need corroboration - CPA

treatment : dissociative disorder, fugure state

get better on their own with time (usually) remembering what theyve forgotten. revllolves around current life stress so therapy is good to prevent more episodes

when needed therapists will try to help them remeber with accounts of other people, etc until they can bring it into counsciousness

DID treatment

therapists can try to reinetgrate the frgamented personalities though often hopeless. long term therapy

5/20 success rate but Powell says it oculd be due to other factors

similar to PTSD

identify triggers for dissociation, memories of trauama

help them relive it to regain control

hyponisis helps binrg unconsiocus memories to light (little evidence sometimes helps)

antidepressent may be used (little evidence sometimes helps)