abpsych lesson 2

Dissociative disorders

are characterized by alterations in perceptions: a sense of detachment from one's own self, from the world, or from memories. It includes the following disorders

Depersonalization- Derealization Disorder

Dissociative Amnesia

Dissociative Identity Disorder

Dissociative disorders

Depersonalization

your perception alters so that you temporarily lose the sense of your own reality, as if you were in a dream and you were watching yourself

Depersonalization

Feeling like you are outside of the body looking on yourself from distance

Depersonalization

Difficulty recognizing and describing your emotions.

Depersonalization

Feeling your head is wrapped in cotton.

Depersonalization

Feeling physically numb

Depersonalization

Difficulty to own your memories as experiences happened to you

Depersonalization

Feeling detached from your body, sensations, feelings and mind.

Derealization

your sense of the reality of the external world is lost. Things may seem to change shape or size; people may seem dead or mechanical. The real world is distorted, muted, or not as it should be.

Derealization

Seeing other objects or people incorrectly. They may seem too large, small, or unusual in size or texture.

Derealization

Having a distorted perception of time: Time may either feel like it's speeding up or slowing down

Derealization

Feeling like sounds are distorted: Sounds may seem too loud, too soft, or otherwise different

Derealization

Strongly feeling like you're in a dream: It seems like you are in a dream-like state or trance, and it is markedly different from your normal reality

Derealization

Finding the outside world as lifeless, colorless, or unreal: The surroundings may look a different color, feel exaggerated, or seem fake

Rare depersonalization

derealization disorder can occur when feelings of unreality are so severe and frightening that they dominate an individual's life and prevent normal functioning.

Depersonalization (A)

Experiences of unreality, detach-ment, 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 (A)

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

B

During the depersonalization or derealization experi-ence, reality testing remains intact.

C

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D

The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medica-tion) or another medical condition (e.g., seizures).

Depersonalization-Derealization Disorder

People undergoing intense stress or experiencing a traumatic event are prone to experience these symptoms specially on childhood.

Depersonalization-Derealization Disorder

Feelings of depersonalization and derealization are part of several disorders specially the panic, anxiety disorders and acute stress disorders.

Depersonalization-Derealization Disorder

Surveys suggest that this disorder exists in approximately 0.8% to 2.8% of the population and cases are approximately equally split between men and women.

Depersonalization-Derealization Disorder

Mean age of onset was 16 years, and the coursetended to be chronic.

Depersonalization-Derealization Disorder

Psychological treatments have not been systematically studied. One evaluation of the drug Prozac did not show any treatment effect.

Dissociative Amnesia

is a condition in which a person cannot remember important information about their life

Dissociative Amnesia

this forgetting may be limited to certain specific areas may include much of the person's life history and/or identity

Dissociative Amnesia

is different from amnesia caused by medical problems, such as illnesses, strokes or brain injuries. In medically caused amnesia, recovering memories are rare and generally a slow and gradual process.

Dissociative Amnesia

are relatively short. Often, memories return suddenly and completely. Memory recovery may be triggered by something in the person's surroundings, or in therapy.

Localized

Generalized

Dissociative Fugue

Three types/patterns of Dissociative Amnesia:

Localized

Memory loss affects specific areas of knowledge or parts of a person's life, such as a certain period during childhood, or anything about a friend or coworker

Localized

Often the memory loss focuses on a specific trauma. For example, a crime victim may have no memory of being robbed at gunpoint, but can recall details from the rest of that day. Specific time

Generalized

Memory loss affects major parts of a person's life and/or identity, such as a being unable to recognize your name, job, family and friends. This is quite rare.

Dissociative Fugue

with fugue literally meaning "flight". In these curious cases, memory loss revolves around a specific incident-an unexpected trip (or trips).

fugue

flight

Dissociative Fugue

Usually they have left behind an intolerable situation. During these trips, a person sometimes assumes a new identity or at least becomes confused about the old identity.

Dissociative Fugue

Mostly, individuals just take off and later find themselves in a new place, unable to remember why or how they got there.

A. Dissociative Amnesia

An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.

B. Dissociative Amnesia

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

A. Dissociative Amnesia

Note: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.

C. Dissociative Amnesia

The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other drug of abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, or other neurological condition).

D. Dissociative Amnesia

The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder

Dissociative Fugue

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

Dissociative amnesia

has been linked to overwhelming stress, which may be caused by traumatic events such as war, abuse, accidents or disasters. The person may have suffered the trauma or just witnessed it.

Dissociative amnesia

It is rare; it affects about 1% of men and 2.6% of women in the general population

Dissociative amnesia

seldom appears before adolescence and usually occurs in adulthood

Dissociative amnesia

It is rare for dissociative amnesia to appear for the first time after an individual reaches the age of 50. Once dissociative disorders do appear, however, they may continue well into old age.

dissociative disorders

The best treatment approach depends on the person, the type of amnesia and how severe the symptoms are.

Psychotherapy,

Cognitive-behavioral therapy,

Family therapy,

Clinical hypnosis

dissociative disorders Treatment most likely includes some combination of the following methods:

dissociative disorders

There is no medication to treat dissociative disorders specifically but some prescribing an antianxiety or antidepression.

Dissociative Identity Disorder (DID)

formerly known as Multiple Personality Disorder

Dissociative Identity Disorder (DID)

may adopt as many as 100 new identities, all simultaneously co-existing, although the average number is closer to 15.

Dissociative Identity Disorder (DID)

In some cases, the identities are complete, each with its own behavior, tone of voice, and physical gestures.

Dissociative Identity Disorder (DID)

But in many cases, only a few characteristics are distinct, because the identities are only partially independent, so it is not true that there are "multiple" complete personalities.

Alters

is the shorthand term for the different identities or personalities in DID.

Switch

the transition from one personality to another. Usually, the switch is instantaneous (although in movies and on television it is often drawn out for dramatic effect).

Switch

Physical transformations may occur during switches. Posture, facial expressions, patterns of facial wrinkling, and even physical disabilities may emerge.

A. Dissociative Identity Disorder

Disruption of identity characterized by two or more dis tinct personality states, which may be described in some cultures as experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cogni tion, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

B. Dissociative Identity Disorder

Recurrent gaps in the recall of everyday events, im-portant personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

C. Dissociative Identity Disorder

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. Dissociative Identity Disorder

The disturbance is not a normal part of a broadly ac-cepted cultural or religious practice. Note: In children, the symptoms are not attributable to imaginary play-mates or other fantasy play.

E. Dissociative Identity Disorder

The symptoms attributable to the physiologi cal effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g... complex partial seizures).

alter personalities

the average number of _________ is reported by clinicians as closer to 15

Dissociative Identity Disorder (DID)

the ratio of females to males is as high as 9:1, although these data are based on accumulated case studies rather than survey research.

4

7

The onset is almost always in childhood, often as young as ___ years of age, although it is usually approximately ___ years after the appearance of symptoms before the disorder is identified.

treatment

Once established, the disorder tends to last a lifetime in the absence of _____

Different personalities

may emerge in response to new life situations.

Dissociative Identity Disorder (DID)

have simultaneous psychological disorders that may include anxiety, substance abuse, depression, and personality disorders.

Dissociative Identity Disorder (DID)

is often misdiagnosed as a psychotic disorder. But the voices in DID are reported by patients as coming from inside their heads, not outside as in psychotic disorders.

Causes

Almost every patient presenting with this disorder reports to their mental health professional being horribly, often unspeakably, abused as a child.

Causes

97%

67%

Most surveys report a high rate of childhood trauma in cases of DID. Putnam and colleagues (2006) examined 100 cases and found that ____ of the patients had experienced significant trauma, usually sexual or physical abuse. _____ reported incest

Causes

97%

95%

Ross and colleagues reported that, of ____ cases, ___ reported physical or sexual abuse. Some were tortured with matches, steam irons, razor blades, or glass

Causes

Not all the trauma is caused by abuse. A young girl in a war zone who saw both her parents blown to bits in a minefield. In a heart-wrenching response, she tried to piece the bodies back together, bit by bit.

Causes

428

A lack of social support during or after the abuse also seems implicated. A study of ____ adolescent twins demonstrated that a surprisingly major portion of the cause of dissociative experience could be attributed to a chaotic, non-supportive family environment

Causes

There is almost certainly a biological vulnerability to DID, but it is difficult to pinpoint. For example, in the large twin study none of the variance or identifiable causal factors was attributable to heredity: All of it was environmental.

Causes

6%

50%

It is reported that approximately ____ of patients with temporal lobe epilepsy reported "out of body" experiences. About _____ of another series of patients with temporal lobe epilepsy displayed some kinds of dissociative symptoms

Causes

Head injury

and resulting brain damage may induce amnesia or other types of dissociative experience. But these conditions are usually easily diagnosed because they are generalized and irreversible and are associated with an identifiable head trauma.

Causes

Finally, strong evidence exists that sleep deprivation produces dissociative symptoms such as marked hallucinatory activity. In fact, the symptoms of individuals with DID seem to worsen when they feel tired.

Treatment

With the person's very identity shattered into many elements, reintegrating the personality might seem hopeless.

Treatment

Although no controlled research has been reported on the effects of treatment, there are some documented successes of attempts to reintegrate identities through long-term psychotherapy

Treatment

Hypnosis is often used to access unconscious memories and bring various alters into awareness

Treatment

It is possible that reemerging memories of trauma may trigger further dissociation. The therapist must be on guard against this happening. Trust is important to any therapeutic relationship, but it is essential in the treatment of DID.