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BHS 499-07 Memory and Amnesia Functional Disorders  of Memory
Functional Disorders (Hysteria) <ul><li>Functional disorders are not disorders of structure but of function. </li></ul><ul...
Sources of Symptoms (Psychodynamic View) <ul><li>Strangulated affect is converted into physical symptoms by the repressed ...
History of Hysteria <ul><li>In the mid-1800’s hysteria was considered either: </li></ul><ul><ul><li>Irritation of the fema...
Charcot shows colleagues a female hysteria patient at Salpetriere Hospital (Paris). Freud studied with Charcot in 1885.
History (Cont.) <ul><li>Symptoms included: </li></ul><ul><ul><li>Paralysis </li></ul></ul><ul><ul><li>Convulsions, contrac...
Janet’s View of Hysteria <ul><li>Symptoms arose from subconscious beliefs isolated and forgotten, thus disassociated from ...
Janet (Cont.) <ul><li>Memory pools may be associated with fixed ideas that motivate repeated actions. </li></ul><ul><ul><l...
Freud’s View of Hysteria <ul><li>Freud studied with Charcot and later wrote “Studies in Hysteria” with Breuer, based on th...
Freud’s Seduction Theory <ul><li>Repressed memories nearly always revealed seduction or sexual molestation by an adult. </...
Classifications of Hysteria <ul><li>Dissociative disorders </li></ul><ul><li>Posttraumatic stress disorder (PTSD) </li></u...
Dissociative Disorders <ul><li>Disruption of the usually integrated functions of memory, consciousness, identity or percep...
Dissociative Amnesia <ul><li>Impairment is reversible and usually reported retrospectively (in past tense). </li></ul><ul>...
Dissociative Fugue <ul><li>Sudden, unexpected travel away from one’s home or workplace with inability to recall the past. ...
Dissociative Identity Disorder (DID) <ul><li>Also called multiple personality disorder (MPD). </li></ul><ul><li>Presence o...
DID (Cont.) <ul><li>Frequent gaps in memory. </li></ul><ul><li>Amnesia may be asymmetrical: </li></ul><ul><ul><li>Passive ...
Depersonalization Disorder <ul><li>A feeling of detachment or estrangement from one’s self. </li></ul><ul><li>A person may...
An Identity View of Dissociation <ul><li>One function of consciousness is to construct a mind-space that includes: </li></...
Cultural Examples of Dissociation <ul><li>All cultures have some kind of spirit possession: </li></ul><ul><ul><li>Amok syn...
Social Construction of Dissociative States <ul><li>Spanos considers possession to be a social construct: </li></ul><ul><ul...
Physiological Theories of Dissociation <ul><li>Only a tiny percentage of individuals exposed to stressors or trauma show d...
Repetition-Compulsion <ul><li>PTSD is caused by close-calls rather than injury. </li></ul><ul><li>Repetition occurs in the...
PTSD (Cont.) <ul><li>Avoidance of reminders of the event can include amnesia for some aspect of the event. </li></ul><ul><...
Somatoform Disorders <ul><li>Unintentional symptoms of a medical disorder without a medical cause: </li></ul><ul><ul><li>S...
Conversion Disorder <ul><li>Pseudoneurological – related to voluntary motor or sensory function. </li></ul><ul><li>Symptom...
Conversion Disorder (Cont.) <ul><li>The symptom represents a symbolic resolution of an unconscious conflict. </li></ul><ul...
Sleep Disorders <ul><li>Dyssomnias – sleep problems. </li></ul><ul><li>Parasomnias – abnormal behavior associated with sle...
Sleepwalking Disorder (Somnambulism) <ul><li>Repeated episodes of complex motor behavior initiated during sleep, with limi...
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Chap 16

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Transcript of "Chap 16"

  1. 1. BHS 499-07 Memory and Amnesia Functional Disorders of Memory
  2. 2. Functional Disorders (Hysteria) <ul><li>Functional disorders are not disorders of structure but of function. </li></ul><ul><li>Such disorders are classified as hysteria by the DSM (Diagnostic & Statistical Manual). </li></ul><ul><li>They were the only disorders retaining a psychological explanation & etiology, rather than being defined by symptoms. </li></ul>
  3. 3. Sources of Symptoms (Psychodynamic View) <ul><li>Strangulated affect is converted into physical symptoms by the repressed memory – called conversion symptoms . </li></ul><ul><li>Symptoms disappear if the repressed emotion associated with an event is released – called abreaction . </li></ul><ul><li>Therapy is needed to overcome resistance to remembering and thereby relive the trauma. </li></ul>
  4. 4. History of Hysteria <ul><li>In the mid-1800’s hysteria was considered either: </li></ul><ul><ul><li>Irritation of the female sexual organs (floating womb) </li></ul></ul><ul><ul><li>Imaginary, play-acting by women </li></ul></ul><ul><li>Charcot rejected both explanations, calling it a neurosis also shown by men. </li></ul><ul><ul><li>Charcot thought it required hereditary brain degeneration. </li></ul></ul>
  5. 5. Charcot shows colleagues a female hysteria patient at Salpetriere Hospital (Paris). Freud studied with Charcot in 1885.
  6. 6. History (Cont.) <ul><li>Symptoms included: </li></ul><ul><ul><li>Paralysis </li></ul></ul><ul><ul><li>Convulsions, contractures (muscles won’t relax), seizures – arc de cercle (arching back in rigid posture) </li></ul></ul><ul><ul><li>Somnambulism (sleepwalking) </li></ul></ul><ul><ul><li>Hallucinations </li></ul></ul><ul><ul><li>loss of speech, sensation or memory </li></ul></ul><ul><li>Charcot recognized parallels between hysteria and hypnosis and found he could remove symptoms using hypnosis. </li></ul>
  7. 7. Janet’s View of Hysteria <ul><li>Symptoms arose from subconscious beliefs isolated and forgotten, thus disassociated from consciousness. </li></ul><ul><li>Memory pools are normally disconnected but become connected through mental effort. </li></ul><ul><ul><li>Traumatic shock disrupts the mental effort needed to associate memory pools. </li></ul></ul>
  8. 8. Janet (Cont.) <ul><li>Memory pools may be associated with fixed ideas that motivate repeated actions. </li></ul><ul><ul><li>These are seen in fugue states or sleepwalking or the emotions seen in multiple personality disorder’s alternative selves. </li></ul></ul>
  9. 9. Freud’s View of Hysteria <ul><li>Freud studied with Charcot and later wrote “Studies in Hysteria” with Breuer, based on the case study of Anna O. </li></ul><ul><li>He thought “hysterics suffer mainly from reminiscences”: </li></ul><ul><ul><li>Traumatic memories are pathogenic (disease-creating) </li></ul></ul><ul><ul><li>Banishment of memories requires repression </li></ul></ul><ul><ul><li>Affect is damned up or strangled. </li></ul></ul>
  10. 10. Freud’s Seduction Theory <ul><li>Repressed memories nearly always revealed seduction or sexual molestation by an adult. </li></ul><ul><li>The patient doesn’t know what is repressed so the therapist must overcome resistance to uncover it. </li></ul><ul><li>Later, Freud decided that fantasies, impulses and wishes caused repression. </li></ul>
  11. 11. Classifications of Hysteria <ul><li>Dissociative disorders </li></ul><ul><li>Posttraumatic stress disorder (PTSD) </li></ul><ul><li>Somatoform disorders </li></ul><ul><li>Sleep disorders </li></ul>
  12. 12. Dissociative Disorders <ul><li>Disruption of the usually integrated functions of memory, consciousness, identity or perception of the environment. </li></ul><ul><li>These include: </li></ul><ul><ul><li>Dissociative amnesia </li></ul></ul><ul><ul><li>Dissociative fugue </li></ul></ul><ul><ul><li>Dissociative identity disorder (DID, also MPD) </li></ul></ul><ul><ul><li>Depersonalization disorder </li></ul></ul>
  13. 13. Dissociative Amnesia <ul><li>Impairment is reversible and usually reported retrospectively (in past tense). </li></ul><ul><li>Types of disturbance: </li></ul><ul><ul><li>Localized – affects a few hours around a traumatic event. </li></ul></ul><ul><ul><li>Selective – affects some but not all events during a period of time, or some categories. </li></ul></ul><ul><ul><li>Generalized – affects entire past. </li></ul></ul><ul><ul><li>Continuous – a specific time up to the present </li></ul></ul>
  14. 14. Dissociative Fugue <ul><li>Sudden, unexpected travel away from one’s home or workplace with inability to recall the past. </li></ul><ul><li>The person may assume a new identity or be confused about his or her identity. </li></ul><ul><li>Wandering may be motivated by a fixed idea (repetition compulsion). </li></ul><ul><li>Return to pre-fugue state brings amnesia </li></ul>
  15. 15. Dissociative Identity Disorder (DID) <ul><li>Also called multiple personality disorder (MPD). </li></ul><ul><li>Presence of two or more distinct identities or personality states with memory loss across states. </li></ul><ul><li>Failure to integrate identity, memory and personality. </li></ul><ul><li>Primary personality is passive, guilty, dependent, depressed. Alternates may be hostile, aggressive, controlling. </li></ul>
  16. 16. DID (Cont.) <ul><li>Frequent gaps in memory. </li></ul><ul><li>Amnesia may be asymmetrical: </li></ul><ul><ul><li>Passive identities have more constricted memories. </li></ul></ul><ul><ul><li>Active or protector identities have more complete memories. </li></ul></ul><ul><li>Transitions triggered by stress. </li></ul><ul><li>May result from sexual abuse, results in a pattern of disruptive behavior in childhood continuing into adulthood. </li></ul>
  17. 17. Depersonalization Disorder <ul><li>A feeling of detachment or estrangement from one’s self. </li></ul><ul><li>A person may feel like an observer of their own mental processes or body. </li></ul><ul><li>Includes sensory anesthesia, lack of affect, a feeling of lack of control of one’s actions. </li></ul><ul><li>Voluntarily induced in religious and trance experiences. </li></ul>
  18. 18. An Identity View of Dissociation <ul><li>One function of consciousness is to construct a mind-space that includes: </li></ul><ul><ul><li>Space and time </li></ul></ul><ul><ul><li>Abstractions of meaning (gist) and making sense of what happens </li></ul></ul><ul><ul><li>A self, an imagined or idealized self, self-monitoring </li></ul></ul><ul><ul><li>Narratization (autobiography, hierarchical organization of life events). </li></ul></ul>
  19. 19. Cultural Examples of Dissociation <ul><li>All cultures have some kind of spirit possession: </li></ul><ul><ul><li>Amok syndrome </li></ul></ul><ul><ul><li>Historical examples of demonic possession </li></ul></ul><ul><ul><li>Current religious and spiritual possession </li></ul></ul><ul><li>Amnesia is often associated with such possessions. </li></ul>
  20. 20. Social Construction of Dissociative States <ul><li>Spanos considers possession to be a social construct: </li></ul><ul><ul><li>Society provides special status and historical factors affect its manifestation. </li></ul></ul><ul><ul><li>The possessed role is learned. </li></ul></ul><ul><ul><li>There are benefits to performing the possessed role and it is frequently acted by the powerless. </li></ul></ul><ul><li>DID may be a socially constructed role. </li></ul>
  21. 21. Physiological Theories of Dissociation <ul><li>Only a tiny percentage of individuals exposed to stressors or trauma show dissociative symptoms. </li></ul><ul><li>True cases of DID can be distinguished from socially constructed cases through childhood behavior. </li></ul><ul><li>True cases of DID, fugue or other amnesias usually show histories of early childhood brain injury or recent damage. </li></ul>
  22. 22. Repetition-Compulsion <ul><li>PTSD is caused by close-calls rather than injury. </li></ul><ul><li>Repetition occurs in the form of intrusive memory. </li></ul><ul><li>Normally anxiety protects us from fright but with an unexpected shock there is no chance for anxiety. </li></ul><ul><li>Repetition creates retrospective anxiety which builds defenses after the event. </li></ul>
  23. 23. PTSD (Cont.) <ul><li>Avoidance of reminders of the event can include amnesia for some aspect of the event. </li></ul><ul><ul><li>Reexperiencing includes dreams and intrusive recollections. </li></ul></ul><ul><li>Dreams and recollections are not factual but recreations of idealized or feared features of an event. </li></ul><ul><ul><li>Content changes during therapy. </li></ul></ul>
  24. 24. Somatoform Disorders <ul><li>Unintentional symptoms of a medical disorder without a medical cause: </li></ul><ul><ul><li>Somatization disorder – multiple symptoms (formerly just called hysteria) </li></ul></ul><ul><ul><li>Conversion disorder – voluntary motor or sensory dysfunction with psychological cause. </li></ul></ul><ul><ul><li>Hypochondriasis – fear of illness. </li></ul></ul><ul><ul><li>Pain disorder – pain whose onset, severity and maintenance have a psychological cause. </li></ul></ul>
  25. 25. Conversion Disorder <ul><li>Pseudoneurological – related to voluntary motor or sensory function. </li></ul><ul><li>Symptoms include impaired coordination or balance, paralysis, weakness, difficulty swallowing or lump in throat, double vision, blindness or deafness, seizures. </li></ul><ul><li>The more medically naïve the person, the more implausible the symptoms. </li></ul>
  26. 26. Conversion Disorder (Cont.) <ul><li>The symptom represents a symbolic resolution of an unconscious conflict. </li></ul><ul><li>Primary gain is keeping the conflict out of awareness. </li></ul><ul><li>Secondary gain is external benefits and relief from responsibilities. </li></ul><ul><li>Neurological conditions such as MS can be misdiagnosed as conversion disorder. </li></ul>
  27. 27. Sleep Disorders <ul><li>Dyssomnias – sleep problems. </li></ul><ul><li>Parasomnias – abnormal behavior associated with sleep. </li></ul><ul><li>Nightmares and sleep terrors – nightmares are not memories, sleep terrors usually cannot be remembered. </li></ul><ul><li>Hypnagogic hallucinations – occur at sleep onset, vivid, accompanied by wakefulness. </li></ul>
  28. 28. Sleepwalking Disorder (Somnambulism) <ul><li>Repeated episodes of complex motor behavior initiated during sleep, with limited recall upon waking. </li></ul><ul><li>Difficulty being awakened, with confusion upon awakening. </li></ul><ul><li>As with fugue, the person may attempt to carry out a fixed idea. </li></ul>
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