HD3700 Prelim 2

dissociation

detachment from body, self, and surroundings

everyday dissociation

"zoning out" while driving

getting lost in a book, movie, creative activity

looking at a beautiful landscape or very familair landmark in real life

even deep daydreaming

what makes a dx of a dissociative disorder different

change or disturbances in identity, memory, or consciousness

type of dissociattype of dissociative disorderive disorder

depersonalization/derealization disorder

dissociative amnesia

dissociative identify disorder

depersonalization/derealization disorder dx criteria

the presence of persistent or recurrent experiences of depersonalization, derealization, or both

during the depersonalization or derealization experiences, reality testing remains intact

the sx cause clinically significant distress or impairment in social, occupational, or other areas of functioning

the disturbance is attributable to the physiological effects of a substance (eg a drug of abuse, medication) or another medical condition (eg seizure)

the disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder

depersonalization

experiences of unreality, detachment, or being an outside observer with respect to one's thought, feelings, sensations, body, or actions (eg perceptual alteration, distorted sense of time, unreal or abset self, emotional and/or physical numbing)

derealization

experiences of unreality or detachment with respect to surroundings (eg individual or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted)

depersonalization/derealization disorder prevalence

0.8-2.8%

depersonalization/derealization disorder average age of onset

~16 yrs

other factors of depersonalization/derealization disorder

tend to have relative weaknesses in processing speed, attention, and spatial reasoning

often preceded by periods of intense stress, depression, anxiety, or drug use

equally prevalent across men and women

dissociative amnesia criteria

A. an inability to recall imprtant autobiographical information, usually of a traumatice or stressful nature, that is inconsistent with ordinary forgetting.

(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)

B. the sx cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

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

D. the disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic sx disorder, or major or mild neurocognitive disorder

two types of amnesia may be experienced

localized

generalized

ppl are usualy unaware or only partially aware of their memory problems

localized amnesia

events during a specific span of time, usually the first few hrs after a distrubing event

generalized amnesia

no memory of life, incl identity or previously acquired knowledge (eg recent political events); ppl usually but not always--retain well-learned skills (like how to put in contact lenses)

specifier of dissociative amnesia

can be with or without dissociative fugue: apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information

how is dissociative amnesia different from amnesia in cognitive disorders?

d/t known medication disorder or physical cause

onset related to psychological trauma/estreme stress

exacerbated by stress

memory deficits primarily in autobiograpphical recall

reversible with hypnosis

improvement with sedative-hypnotics (ex: pharmacologically facilitated interviews)

varying extent and nature of the intrusion of the dissociated mental elements to consciousness

anility to learn new info is intact. ability to manipulate facts and neutral info is generally normal (for ex, finances, current events, etc)

disorientation to personal identity generally only occurs in late phase of illness

additional facts of dissociative amnesia

onset of sx is typically sudden

more prevalent in women

duration of memory loss can range from mins to decades

main risk is sever, acute, or chronic traumatization

when memory retunrs, suicidality is common -- indivs may experience a flood of unwanted memories

bhutan in the 1990s

reclassified Lhotshampas (Bhutanese citizens of Nepalese descent; one of three main ethnic groups in Bhutan) as "illegal immigrants"

many were persecuted and tortured by the gov

resulted in flight or expulsion of nearly 100,00 peopl

compared to under 5% in refugees who had not been tortured, ~20% of those who had experienced torture experienced dissociative amnesia

treatments of dissociative amnesia

there are presently no evidence-based treatments specific for the treatment of dissociative amnesia -- but people sometimes recover spontaneously on their own

ppl may also use therapy techniques designed for trauma and coping with stress

hannah upp's story of dissociative identity disorder

disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. the disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perceptions in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor function. these signs and sx may be observed by others or reported by the indiv

recurrent gaps in the recall of everyday events, important personal info, and/or traumatic events that are inconsistent with ordinary forgetting

the sx cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

the disturbance is not a normal part of a broadly accepted cultrual or religious practice (note: in children, the sx are not better explained by imaginary playmates or other fantasy play)

the sx are not attributable to the physiological effects of a substance (eg balckouts or chaotic behavior during alcohol intoxication) or another medical condition (eg complex partial seizures)