This document provides an overview of dissociative disorders, including:
- The history and evolution of concepts related to dissociative disorders from ancient theories to modern classifications.
- Current classifications of dissociative disorders in the DSM-5 and ICD-10.
- Epidemiological findings indicating dissociative symptoms and disorders are more common than previously thought.
- Various etiological theories for dissociative disorders including information processing models, trauma models, and neurobiological models related to attachment and brain regions like the orbitofrontal cortex.
we have tried to simplify the each step of psycho dynamic formulation with live example so that people especially the psychiatrist and psychologist learn and apply it in the clincal practise for betterment of patients.
DISORDER CONTENTOF THOUGHT -DELUSION
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN
Definition of delusion:
Delusions are categorized into four different groups
THERE ARE 2 TYPES OF DISORDERS OF THOUGHT CONTENT
1.DELUSION
2.OVERVALUED IDEAS
DISTINGUISED
DELUSION
OTHER MEMBERS OF THE CULTURE DONOT SHARE THE BELIEF.
NEED NOT BE ASSOCIATED WITH AFFECT.
FIRMLY SUSTAINED BELIEF.
CONVINCED THAT DELUSION IS REAL.
RECOGNIZED AS ABSURED.
CANNOT BE ACCEPTED.
OCCUR IN MENTALLY ILL PATIENTS.
OVERVALUED IDEAS
OTHER MEMBERS OF THE CULTURE SHARE THE BELIEF.
ASSOCIATED WITH VERY STRONG AFFECT.
NOT HELD FIRMLY.
ATLEAST SOME LEVEL OF DOUBT AS TO ITS TRUTHFULNESS.
NOT RECOGNIZED AS ABSURED.
ACCEPTABLE.
CAN OCCUR IN BOTH HEALTHY AND MENTALLY ILL PATIENTS.
KENDLER’S VECTORS FOR DELUSION:
five stages in the development of delusion(FISH & CONRAD)
FACTORS CONCERNED WITH GENERATION OF DELUSIONS
PATHPOPHYSIOLOGY OF DELUSIONS
PRIMARY DELUSIONS
SECONDARY DELUSIONS
SYSTEMATIZATION
DELUSIONS ON THE BASIS OF CONTENT OF DELUSIONS
THANK YOU
Depressive Disorders: An Overview of Full Spectrum. Dr. Ashok Kumar Batham.DrAshok Batham
Medical specialists outside the area of psychiatry and those who practice family medicine generally get fragmented information about mental depression. Therefore, an endeavour has been made to provide a complete overview of various depressive disorders, such as, Major Depressive Disorder (MDD), Persistent Depressive Disorder (PDD) or Dysthymia, Disruptive Mood Dysregulation Disorder (DMDD), Premenstrual Dysphoric Disorder (PMDD), Substance/Medication Induced Depressive Disorder, Depressive Disorder Due to Another Medical Condition, and other depressive disorders. DSM-5 diagnostic criteria of each of these disorders are given along with vignettes of diagnosis and treatment of the same are presented. Hopefully, this slide share will help non-psychiatrists to understand the complete spectrum of depressive disorders.
Antipsychiatry Movement arose as a zeitgeist of the 1960s anti-establishment movements. It has in a way contributed to the development of psychiatry by pointing out its short comings.
we have tried to simplify the each step of psycho dynamic formulation with live example so that people especially the psychiatrist and psychologist learn and apply it in the clincal practise for betterment of patients.
DISORDER CONTENTOF THOUGHT -DELUSION
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN
Definition of delusion:
Delusions are categorized into four different groups
THERE ARE 2 TYPES OF DISORDERS OF THOUGHT CONTENT
1.DELUSION
2.OVERVALUED IDEAS
DISTINGUISED
DELUSION
OTHER MEMBERS OF THE CULTURE DONOT SHARE THE BELIEF.
NEED NOT BE ASSOCIATED WITH AFFECT.
FIRMLY SUSTAINED BELIEF.
CONVINCED THAT DELUSION IS REAL.
RECOGNIZED AS ABSURED.
CANNOT BE ACCEPTED.
OCCUR IN MENTALLY ILL PATIENTS.
OVERVALUED IDEAS
OTHER MEMBERS OF THE CULTURE SHARE THE BELIEF.
ASSOCIATED WITH VERY STRONG AFFECT.
NOT HELD FIRMLY.
ATLEAST SOME LEVEL OF DOUBT AS TO ITS TRUTHFULNESS.
NOT RECOGNIZED AS ABSURED.
ACCEPTABLE.
CAN OCCUR IN BOTH HEALTHY AND MENTALLY ILL PATIENTS.
KENDLER’S VECTORS FOR DELUSION:
five stages in the development of delusion(FISH & CONRAD)
FACTORS CONCERNED WITH GENERATION OF DELUSIONS
PATHPOPHYSIOLOGY OF DELUSIONS
PRIMARY DELUSIONS
SECONDARY DELUSIONS
SYSTEMATIZATION
DELUSIONS ON THE BASIS OF CONTENT OF DELUSIONS
THANK YOU
Depressive Disorders: An Overview of Full Spectrum. Dr. Ashok Kumar Batham.DrAshok Batham
Medical specialists outside the area of psychiatry and those who practice family medicine generally get fragmented information about mental depression. Therefore, an endeavour has been made to provide a complete overview of various depressive disorders, such as, Major Depressive Disorder (MDD), Persistent Depressive Disorder (PDD) or Dysthymia, Disruptive Mood Dysregulation Disorder (DMDD), Premenstrual Dysphoric Disorder (PMDD), Substance/Medication Induced Depressive Disorder, Depressive Disorder Due to Another Medical Condition, and other depressive disorders. DSM-5 diagnostic criteria of each of these disorders are given along with vignettes of diagnosis and treatment of the same are presented. Hopefully, this slide share will help non-psychiatrists to understand the complete spectrum of depressive disorders.
Antipsychiatry Movement arose as a zeitgeist of the 1960s anti-establishment movements. It has in a way contributed to the development of psychiatry by pointing out its short comings.
Sberdays #4 / Антон Гуменский / Дебаты о влиянии технологий на человечествоSberdays
В рамках SBERDAYS* состоятся дебаты о влиянии технологий на человечество — Антон Гуменский (МГУ, МГИМО), Альберт Шарафутдинов (De:coding), Илья Соболь (Школа дизайна НИУ ВШЭ) и Андрей Потапов (Kosmos) обсудят, как сейчас обстоят дела с проникновением технологий в разные сферы жизни и какие возможные сценарии нас ждут в ближайшем будущем.
Эксперты:
— Илья Соболь, куратор специализации «Предметный дизайн/дизайн будущего» Школы дизайна НИУ ВШЭ. Основатель изобретательского бюро «Изобрюло». Эксперт по реализации проектов, мейкер. Relations designer или человек горизонтальных связей. Специалист в области персональных цифровых производственных технологий, 4-й промышленной революции.
— Андрей Потапов, сооснователь академии KOSMOS, трендспоттер, футурист, бизнес-консультант. Эксперт по новым технологиям в образовании. Один из создателей первого в России воркшопа по трендспоттингу.
— Антон Гуменский, исследователь медиа, преподаватель факультетов журналистики МГУ и МГИМО, приглашенный преподаватель МВШСЭН (Шанинки) РАНХиГС.
— Альберт Шарафутдинов, сооснователь аналитической лаборатории социальных исследований de:coding (Look At Media), сооснователь академии KOSMOS, аналитик, трендспоттер, бизнес-консультант, коуч. Эксперт по качественным исследованиям, популяризатор исследований будущего (future study), автор воркшопа по трендспоттингу.
Съемку и прямую трансляцию дебатов организует «Лекториум»
* о проекте Sberdays:
Sberdays — образовательные события для digital-специалистов от Сбербанка. Цель проекта — формирование сообщества активных участников IT-индустрии, популяризация и распространение актуальных знаний и опыта лучших экспертов. Важной задачей проекта является тестирование новых цифровых сервисов и продуктов Сбербанка, а также поиск свежих идей и решений. #sberdays #сбербанк
London iCAAD 2019 - Daniel Souery - A TRANSDIAGNOSTIC APPROACH FOR PSYCHIATRI...iCAADEvents
Diagnostic approaches applied in psychiatry are often criticized and deemed unsatisfactory because of their relative lack of reliability and validity. One reason for this complexity lies in the purely symptomatic approach to diagnosis. This approach also results in misdiagnosis, difficulties and high risk of aberrant therapeutic choices. The problem is also the source of great difficulty in differentiating the normal from the pathological in situations of emotional and psychological distress that should not be the subject of a psychiatric diagnosis.
Pandangan Ilmu Kedokteran Jiwa pada KESURUPAN Andri Andri
Kasus Kesurupan di Indonesia banyak dikaitkan dengan budaya. Presentasi ini mencoba melihat masalah kesurupan lebih kepada sudut pandang ilmiah. Presentasi ini disampaikan di Fakultas Psikologi Univ Mercubuana pada tanggal 23 Mei 2015
This presentation covers briefly about various psychiatric illnesses and their management through modern medicine. Various medications has been discussed with their functions. As there are advancements on a daily basis, the treatments are subjective to change. The ppt is only for educational purposes and it is not a recommendation or prescription. This presentation gives basic knowledge to the students of Yoga and Naturopathy about psychiatric medications.
This is a ppt explaining the symptoms and diagnostic criteria of schizophrenia, along with possible treatment methods. The information provided is based entirey on DSM-5.
How do psychological disorders impact a person’s life? sneharathod39
Psychology is the examination of the conscious and unconscious mind and human behavior. A professional researcher involved in this specialty is called a psychologist. As per the WHO (world health organization), all over 450 million people currently suffer and affect by such conditions, placing mental illness or disorders among the leading causes of ill health and disability worldwide.
A total 8 type psychology disorders describe by professional scientists such as:
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
4. • Dissociation is a common defense/reaction to stressful or
traumatic situations. Severe isolated traumas or repeated
traumas may result in a person developing a dissociative
disorder.
• A dissociative disorder impairs the normal state of awareness
and limits or alters one’s sense of identity, memory or
consciousness. Once considered rare, recent research
indicates that dissociative symptoms are as common as
anxiety and depression.
5. • The concept of dissociative or conversion disorder has been
described since antiquity.
• These disorders have been previously classified as ‘hysteria’,
based on Egyptian theory of wandering uterus.
• The term dissociation has its origin in the constituent parts of
the term: dis-association, which means disconnecting or
lowering the strength of associated connections.
6. • The common theme shared by dissociative disorders is a
partial or complete loss of normal integration between
memories of the past, awareness of identity and immediate
sensations and control of body movements.
• This group of illness also lacks the evidence of proximate
organic illness or pathophysiological disturbance, and the
symptoms correspond to the ideas of the patient about how
parts of body or mind malfunction or fail to function.
Isaac & Chand, 2006; Bob, 2003
8. • The ancient “wandering womb” hypothesis and also humoral
theory remained prominent until the middle of the
eighteenth century.
• “Master organ theories” emerged in the 1700s and referred to
the idea that master organs such as uterus, digestive system
or nerves influenced the brain and resulted in nervous
symptoms.
9. • During the 1800s, the spinal irritation doctrine was expanded
into reflex theory, which asserted that every organ in the body
could reflexively influence every other organ.
• Charcot conceptualized hysteria as an inherited disease of the
nervous system, caused by lesions of the nervous centers.
10. • These lesions were called “functional” because they were
presumed to exist but couldn’t be localized by the techniques
of that time.
• Two of Charcot’s most important successors, Babinski and
Janet, took divergent views.
11. • Babinski describes that hysteria was caused by suggestion and
could be removed by persuasion or counter suggestion.
• Pierre Janet established the concept of “dissociation” to
describe the disruption of normal mental synthesis between
ideas, acts and sensory and motor functions as seen in
patients with hysterical symptoms (Gordon, 1984).
12. • In his theory of dissociation, Janet referred to
mental/behavioural/affective states as “psychological
automatisms”.
• The psychological automatism was an elementary system of
the mind, a complex act tuned to external and internal
conditions, preceeded by an idea, and accompanied by an
emotion.
13. • Janet argued that psychological automatisms could be split off
from consciousness under conditions of terror or severe
stress, illness or fatigue, and function outside awareness of
voluntary control (Van der Kolk, 1989).
• Neo-dissociation theory of Hilgard -1977, theory assumes that
the mind is organized as a system of mental structures, which
monitor and control experience, thought, and action in
different domains.
14. • In principle, each of the structures can process inputs and
outputs independently of the others, although under ordinary
circumstances each structure is in communication with the
others, and several different structures might compete for a
single input or output channel.
• Freud’s psychoanalytic understanding dominated twentieth-
century understanding of conversion symptoms.
15. • During the later part of 1890s, Freud followed Janet’s
dissociation trauma hypothesis and, in his observation of
eighteen hysterical patients, proposed childhood sexual
trauma as the origin of their symptoms.
• Later, he coined the term “conversion” to describe the process
by which unacceptable mental contents were transformed
into somatic symptoms.
16. • Whereas both the classical dissociation theory of Janet (1889)
and the Neo-dissociation theory of Hilgard (1977) assume that
the normal unity of consciousness is disrupted by an amnesia-
like process, Woody and Bowers (1994) have offered an
alternative view that many mental and behavioral functions
are performed unconsciously and automatically to begin with,
by specialized cognitive modules.
• Thus, some degree of dissociation is the natural state.
18. • Classification of Dissociative disorders is somewhat different
in the two major classificatory systems.
DSM-5
• dissociative amnesia,
• dissociative identity disorder,
• depersonalization disorder,
• other specified dissociative disorder and
• unspecified dissociative disorder.
19. But in ICD 10, dissociative disorders include
• dissociative amnesia
• dissociative fugue,
• dissociative stupor,
• trance and possession disorder,
• dissociative disorders of movement and sensation.
• mixed dissociative disorders (i.e., Ganser’s syndrome ,
multiple personality disorder, transient dissociative disorder
occurring in childhood and adolescence and other specified
dissociative disorders).
20. CHANGES IN DSM-5
• Major changes in dissociative disorders in DSM-5 include the
following:
1) de-realization is included in the name and symptom structure
of what previously was called depersonalization disorder and is
now called depersonalization/de-realization disorder.
2) dissociative fugue is now a specifier of dissociative amnesia
rather than a separate diagnosis.
21. • 3) the criteria for dissociative identity disorder have been
changed to indicate that symptoms of disruption of identity
may be reported as well as observed, and that gaps in the
recall of events may occur for everyday and not just traumatic
events.
22. • In sum, both classification systems agree that dissociation
relates to the (autobiographical) memory system,
consciousness and the domain of personal identity.
• However, the ICD-10 acknowledges that it also may involve
the sensory and motor systems, leading to symptoms which
are subsumed under the term of conversion.
23. • In contrast, the DSM-5 restricts dissociation to the level of
psychic functions and systems.
• Consequently, conversion disorders are one among the
somatoform disorders in the DSM-5, while the ICD-10 claims
that dissociative and conversion disorders represent one
category that is independent from the somatoform disorders.
25. • The first systematic general population study of the
prevalence of dissociative disorder was done by Ross et al
(1990).
• They found dissociative amnesia in 6%, dissociative identity
disorder in 1.3%, depersonalization disorder in 2.8% and
dissociative disorder NOS in 0.2% in a random sample of 1055
adults from Canada.
• Reported rates of dissociative disorder of movement and
sensation (conversion disorder) have varied widely, ranging
from 11/100,000 to 500/100,000 in general population
samples.
26. • Dissociative amnesia,has been reported in approximately 1.8
to 6 percent of general population samples, with 7.3 percent
of a general population sample of Turkish women meeting
diagnostic criteria for dissociative amnesia.
• A survey of a random sample of 1,000 adults in the rural
South found a 1-year prevalence of 19 percent for
depersonalization and 14 percent for de-realization.
27. • Studies of general medical/surgical inpatients have identified
conversion symptom rates ranging between 1% and 14% (APA,
2000)
• Samples of psychiatric inpatients, outpatients, and substance
abuse patients in North America, Europe, and Asia have found
that between 5 and 30 percent of patients could be diagnosed
with a dissociative disorder when screened.
28. • Overall, the prevalence of dissociative disorders in inpatient
and outpatient psychiatric settings seems to be around 10%,
while approximately half of them (5%) has DID, the most
severe type of dissociative disorders.
(Epidemiology of Dissociative Disorders: An Overview Epidemiology Research International Volume 2011)
29. • The majority of patients were diagnosed with dissociative
motor disorder (43.3% outpatients, 37.7% inpatients),
followed by dissociative convulsions (23% outpatients, 27.8%
inpatients)
• Female preponderance was seen across all sub-types of
dissociative disorder except dissociative fugue.
Dissociative disorders in a psychiatric institute in India--a selected review and patterns over a decade
31. INFORMATION PROCESSING THEORIES
• In early 1970s, Hilgard -“Neodissociation theory”.
• This theory conceptualizes the mental apparatus as consisting
of a hierarchy of connected cognitive structures that monitor,
organize and control thought and action.
• According to this theory, certain conditions can disrupt the
links between structures, resulting in a reduction either of
normal voluntary control over subordinate structures or in
awareness of a body process controlled by a given structure.
32. • Brown hypothesizes that conversion symptoms reflect the
selection of inappropriate cognitive representation by low
level attention.
• This selection takes place during the creation of primary
representations that are understood to underlie both the
activation of thought and active schemata, and the subjective
experience and control of action.
33. DISCRETE BEHAVIOURAL STATE MODEL
• Putnam put forward this model in late 1980s.
• He postulates “states” to be the fundamental unit of
organization of consciousness.
• The concept of state/mental state is defined as “a
constellation of certain patterns of physiological variables
and/or patterns of behaviour which seem to repeat
themselves and which appear to be relatively stable”.
34. • Discrete mental-behavioural states can be detected in new
born infants.
• When a transition of state occurs, the new state is reflected in
the quantitative and qualitative variables that define it.
• According to his model, dissociative disorders are
characterized by the individual’s consciousness being
organized into a series of discrete mental-behavioural states
characterized by specific affects, body images, modes of
cognition, perceptions, memories and behaviour.
35. • Unlike most adults, in individuals prone to dissociation, the
transitions between the individual’s states remain abrupt and
discontinuous.
• This can occur either as a result of severe childhood trauma
that has disrupted the normal developmental process of
smoothing out transitions between states, or in response to
conditions of severe stress, terror, severe illness or fatigue
36. DISSOCIATION AS A RESPONSE TO TRAUMA
• Since 1980s, research has elucidated multiple lines of
evidence linking dissociative disorder with antecedent
trauma.
• Several hundred peer-reviewed studies have found
significantly high levels of dissociation in traumatized groups
in comparison with the non-traumatized clinical and the
general population.
Van der Hart et al, 2004
37. • Sar et al (2004) found childhood physical trauma in 44.7% and
childhood sexual abuse in 26.3% in a sample of 38 patients
with conversion disorder.
• Maaranen et al (2004) reported a strong association of
childhood adverse experiences in people with somatoform
dissociation. Stone et al (2004) reported a higher incidence of
parental divorce in patients with pseudoseizures.
38. TAXON MODEL
• Taxon items represent statistically derived clusters of
symptoms experienced by those with a dissociative illness.
• It assumes that pathological dissociation such as dissociative
identity disorder represents a different type of taxon of
psychological organization.
• This is a contrast to earlier belief that dissociation occurs as a
continuum from normal to pathological (Isaac & Chand, 2006;
Loweinstein & Putnam, 2005).
39. • The taxon model implies a significantly different
developmental scenario than the continuum model, as well as
a different approach to treatment.
• In a continuum model of dissociation, a positive treatment
response would be conceptualized as moving a dissociative
individual more toward the normal dissociation segment of
the continuum.
• By contrast, a positive treatment outcome in a taxon model
implies changing an individual’s type from the dissociative to
the nondissociative category.
40. HYPNOTIC MODEL
• This model hypothesizes that a traumatized individual uses his
or her innate hypnotic capacity to induce autohypnosis as a
defense against overwhelming or repetitive traumatic
experiences.
• With continued use, the autohypnotic state is transformed
into an independent alter personality state.
• Several lines of evidence are said to support the autohypnotic
theory.
41. • The first is that dissociative, especially dissociative identity
disorder patients are highly hypnotizable.
• Second, many of the clinical phenomena associated with
pathological dissociation, such as trance states, age
regression, auditory hallucinations and amnesias, can be
produced in normal individuals with hypnosis.
• Finally, a pair of studies suggested that childhood trauma
might increase hypnotizability .
(Loweinstein & Putnam, 2005).
42. SOMATIC MARKER HYPOTHESIS
• This hypothesis was proposed by Damasio (2000).
• He developed a neurobiological model of consciousness and
proposed that conversion reactions may reflect transient but
radical changes in body maps, the neural representation of
body states.
• The spinothalamic pathway conveys afferent interoceptive
information from all tissues of the body and body state is
mapped continuously at different brain levels (i.e., brainstem
nuclei, hypothalamus, thalamus, anterior cingulated cortex
and somatosensory cortices).
43. • Somatic marker hypothesis defines “feelings” as subjective
perception of body state and feelings can emerge due to
actual stimulation of emotion triggering sites.
44. IATROGENIC AND SOCIOCOGNITIVE MODEL
• Some authorities believe that dissociative identity disorder
and dissociative amnesia are not authentic psychiatric
disorders but rather the product of suggestion on susceptible
individuals that leads them to believe that they have a
dissociative disorder and to enact the role of a person with
multiple selves or amnesia for childhood maltreatment.
• This has been called the iatrogenic or sociocognitive model.
• However, no empirical studies have been performed in clinical
population to attempt to examine the sociocognitive model or
related ideas.
46. DISORGANIZED ATTACHMENT AND THE ORBITOFRONTAL CORTEX
AS THE BASIS FOR THE DEVELOPMENT OF DISSOCIATIVE
IDENTITY DISORDER
• One particularly promising theory posits that, in addition to
traumagenic origins, infant disorganized attachment may be a
significant contributor to the development of DID.
• Neuroimaging studies have identified areas of the brain, the
orbitofrontal cortex in particular, that function differently in
DID patients, thus providing a neurobiological basis for the
disorder.
47. • One study compared rCBF of DID patients while they were in
their host personality with normal controls and observed
lower rCBF in the orbitofrontal cortex (OFC) of the DID
subjects.
• The orbitofrontal cortex is thought to be involved in decision-
making. Thus, Sar hypothesizes that the decreased
functioning of the OFC results in impulsivity and that the
switch to an alter personality may represent a drastic
expression of impulsive behavior caused by cognitive and
emotional conflicts.
48. • A more adequate description, provided by Rhawn Joseph, is
that the OFC is the “senior executive of the emotional brain.
• This system is also involved in the regulation of the body state
and reflects changes taking place in that state (Luria, 1980).
• Antonio Damasio posits in his model of consciousness that the
development of a notion of self arises from the brain’s second
order mapping of the relation between “objects” and the
organism.
49. • Within this model of consciousness, the OFC, with its
functions in both emotional processing of sensory information
as well as homeostasis and the mapping of the body, would
seem to be a critical component in the generation of a self.
• Thus, it is quite plausible that an abnormally functioning OFC
could lead to the generation of multiple selves.
50. • Attachment theory posits that an infant’s development of
attachment to its caregiver, usually its parent(s), plays a large
role in the development of its personality and later social
behaviors.
• Liotti builds upon the work of Main and Hesse by
hypothesizing that the conflicting models of self that are
developed within an infant with disorganized attachment
create the risk for the later development of DID.
51. • The conflicting attachment experiences endured by an infant
with disorganized attachment would lead to irregular
development of the OFC, which would mirror the
development of the conflicting models of self.
American Psychiatric Association, STAT!Ref, and Teton Data Systems. Diagnostic and Statistical Manual of
Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association, 2000
52. NEUROPHYSIOLOGY STUDIES
• HRV, EEG and (functional) MRI are sensitive methods to
detect physiological changes related to dissociation and
dissociative disorders such as FNSS.
• The majority of the identified studies concerned the
physiological characteristics of hypnosis; relatively few
investigations on dissociation related FNSS were identified.
General findings were increased parasympathetic functioning
during hypnosis (as measured by HRV), and lower HRV in
patients with FNSS
53. • Flor-Henry et al (1990) documented two cases of multiple
personality disorder with bilateral frontal and left temporal
dysfunction on neuropsychological test batteries and relative
activation of the left hemisphere across all cerebral regions in
EEG analysis
54. • Allen & Movius (2000) documented four cases of multiple
personality disorder evaluated by ERP during a memory
assessment task, in which words learned by one identity were
then presented to a second identity.
• All patients, when tested as second personality, produced ERP
and behavioural evidence consistent with recognition of
material learned by the first identities.
55. NEUROCHEMICAL STUDIES
• Delahanty et al (2003) found that peritraumatic dissociation
was correlated with 15 hour urine epinephrine level in 59
motor vehicle accident patients. Such a correlation was not
found for norepinephrine.
• Simeon et al (2003) found strong negative correlation
between urinary norepinephrine and depersonalization scores
in patients with depersonalization disorder.
56. • The authors concluded that although dissociation
accompanied by anxiety was associated with heightened
noradrenergic tone, there was a marked basic norepinephrine
decline with increasing severity of dissociation.
• Chambers et al (1999) found that high doses of ketamine
produced slowed perception of time, tunnel vision,
derealization and depersonalization in trauma victims.
57. • Pretreatment with a benzodiazepine or lamotrigine reduced
but didn’t entirely eliminate the effects of ketamine.
• It suggests that NMDA glutamate receptors play a central role
in dissociative symptoms
58. NEUROIMAGING
• key findings in neuroimaging studies of dissociative disorder
are volume reduction of amygdala and hippocampus,
nondominant hemisphere lesions in dissociative seizure.
• There is increase as well as decrease in contralateral
hemisphere activity in motor conversion disorder.
• In one study, patients with depersonalization disorder had
higher activity in somatosensory association areas
Simeon et al 2000
59. • In another study, functional MRI was used to examine brain
activation in PTSD patients in a dissociative state while
reexperiencing traumatic memories; greater activation was
found in the temporal, inferior, and medial frontal regions and
in occipital, parietal, anterior cingulate, and medial prefrontal
cortical regions.
Lanius RA, Brain activation during script-driven imagery induced dissociative responses in PTSD: a
functional magnetic resonance imaging investigation. Biol Psychiatry. 2002
60. • Administration of ketamine, an antagonist of N-methyl-D-
aspartic acid (NMDA) receptors, which are highly
concentrated in the hippocampus, resulted in dissociative
symptoms in healthy subjects, including feelings of being out
of body and of time standing still, perceptions of body
distortions, and amnesia.
• On the basis of these findings, it was hypothesized that stress,
acting through NMDA receptors in the hippocampus, may
mediate symptoms of dissociation.
Glutamate and post-traumatic stress disorder: toward a psychobiology of dissociation. Semin Clin
Neuropsychiatry. 1999
61. DISSOCIATION SCALES AND DIAGNOSTIC INTERVIEWS
Symptom screening measures
• Dissociative experience scale (DES) is one of the best known
among general dissociation screening scales.
• Developed by Bernstein & Putnam (1986), Dissociative
Experiences Scale (DES) is a 28-item self-report instrument.
• It is a visual analog scale where the respondent has to slash a
line to indicate a score anywhere from 0 to 100 for each item.
62. • Another good screening measure is the 20-item Somatoform
Dissociative Questionnaire (SDQ-20) developed by Nijenhuis
et al (1996).
• The scale taps many of the somatosensory and dissociative
symptoms including motor inhibitions, loss of function,
anaesthesia and analgesia, pain and problems with vision,
hearing and smell.
• The scale has good reliability and validity for discriminating
dissociative disorder patients.
63. Diagnostic interviews
• Two DSM-based structured interviews have been developed
for the formal diagnosis of dissociative disorders-
1. The Structured Clinical Interview for DSM-IV Dissociative
Disorders, Revised ( SCID-D-R; Steinberg et al, 1994)
2. The Dissociative Disorder Interview Schedule (DDIS; Ross et
al, 1989).
64. • The SCID-D-R is a semi-structured clinician administered
interview that assesses the presence and severity of amnesia,
identity confusion and alteration, depersonalization and
derealization.
• The DDIS is a clinical diagnostic instrument which inquires
about a wide range of phenomena in addition to dissociative
symptoms, including child abuse history, major depression,
somatic complaints, substance abuse and paranoid
experiences
66. DISSOCIATIVE AMNESIA
• There are two major clinical presentations of dissociative
amnesia-
• The classic presentation is an overt, florid dramatic clinical
disturbance in which an individual is found without memory
for identity or life history.
• Less extreme forms of amnesia, such as acute amnesia for
recent traumatic circumstances, such as combat or rape, also
fall into this category.
67. • In the non-classical presentation, chronic, recurrent or
persistent dissociative amnesia, or a combination of these, is
most likely.
• Commonly, patients with nonclassic presentation of amnesia
do not reveal the presence of dissociative symptoms unless
directly asked about those.
68. subtypes
• Localized -inability to recall events related to a circumscribed period
of time.
• Selective -ability to remember some, but not all, of the events
during a circumscribed period of time.
• Continuous-failure to recall successive events as they occur
• Generalized-failure to recall whole life of the patient.
• Systematized-amnesia for certain categories of memory such as all
memories relating to one’s family or a particular person.
69. • It is important to distinguish dissociative amnesia from
organic amnesia.
• Though there is no single test or examination that can
differentiate these two, in organic amnesia, the memory loss
for personal information is embedded in a far more extensive
set of cognitive, language, attentional, behavioural and
memory problems.
• Loss of memory for personal identity is usually not found in
organic amnesia without evidence of a marked disturbance in
many domains of cognitive function.
70. DISSOCIATIVE FUGUE
• Classically, three types of fugue have been described:
(1) fugue with awareness of loss of personal identity
(2) fugue with change of personal identity
(3) fugue with retrograde amnesia.
• During a fugue, patients often appear without psychopathology
and do not attract attention.
• After the termination of a fugue, the patient may experience
perplexity, trance-like behaviour, depersonalization, derealization,
and conversion symptoms, in addition to amnesia.
71. DISSOCIATIVE IDENTITY DISORDER
• Dissociative identity disorder is characterized by two or more
distinctive identities or personalities; at least two of these
identity states recurrently taking control of the person’s
behaviour and inability to recall important personal
information that is too extensive to be explained by ordinary
forgetfulness (APA, 1994).
• The different identities, referred to as alters, may exhibit
differences in speech, mannerisms, attitudes, thoughts, and
gender orientation
72. • Most patients have personalities that are named, but there
may be those who are nameless or whose appellations are
not proper names.
• The classic host personality, which usually (over 50% of the
time) presents for treatment, nearly always bear the legal
name and is depressed, anxious, somewhat neurasthenic,
compulsively good, masochistic, conscience-striken,
constricted hedonically and suffers both psychophysiological
symptoms and time loss or time distortion.
73. DEPERSONALIZATION DISORDER
• Patients experiencing depersonalization often have great
difficulty expressing what they are feeling.
• There are a number of distinct components to the experience
of depersonalization.
• These include a sense of bodily changes, a sense of being cut
off from others, and a sense of being cut off from one’s own
emotions. Despite the outward appearance of lack of distress,
depersonalization disorder patients are enduring an intensely
unpleasant, and often disabling, subjective experience.
74. Serotonergic involvement
• Association of depersonalization with migraines and
marijauna , response to selective serotonin reuptake
inhibitors drugs,increased depersonalization symptom seen
with depletion of tryptophan.
• Neurochemical findings have suggested possible involvement
of serotonergic, endogenous opioid and glutamatergic NMDA
pathways.
Depersonalisation disorder: a contemporary overview,Simeon D
75. • On the other hand, de-realization , is the sense that the world
appears strange, foreign, or dream-like.
• It is conceptualized as a dissociative alteration in the
perception of the environment.
• Objects may appear as if viewed from a great distance and as
if they are two dimensional, without depth or substance.
76. • Objects feel strange to the touch,Colours deem and lose their
vitality.
• The faces of others change, becoming unfamiliar or
frightening.
• The world and all action and behaviour lose meaning and
purpose.
77. SEVERAL MODELS HAVE BEEN PROPOSED TO EXPLAIN
DEPERSONALIZATION DISORDER.
A SCHEMATIC INTEGRATION OF THESE MODEL
78. DISSOCIATIVE DISORDER OF MOVEMENT AND
SENSATION (CONVERSION DISORDER)
• In these disorders, motor symptoms or deficits usually include
impaired coordination, tremor or flaccidity, difficulty
swallowing or a sensation of lump in the throat, aphonia and
urinary retention.
• Sensory symptoms or deficits include loss of touch or pain
sensation, hyperesthesia and paresthesia, double vision,
blindness, deafness and hallucination.
79. • Dissociative seizure can be distinguished from true seizure by
its occurrence in almost always awake condition, longer
duration, lack of stereotyped movements, variable and bizarre
motor activity, partial preservation of awareness, pelvic
thrusting movements, side to side head movement, emotional
display, closed eyes with resistance to passive opening,
responsiveness to painful stimuli, absence of postictal
confusion, normal postictal EEG and normal serum prolactin
level after seizure.
Bowman & Markand, 2005
80. OTHER SPECIFIED DISSOCIATIVE DISORDER
• This category is included for disorders in which the
predominant feature is a dissociative symptom (i.e., a
disruption in the usually integrated functions of
consciousness, memory, identity, or perception of the
environment) that does not meet the criteria for any specific
dissociative disorder.
• It includes –
1.Chronic and recurrent syndromes of mixed dissociative
symptoms
81. 2.Identity disturbance due to prolonged and intense coercive
persuasion.
3.Acute dissociative reactions to stressful events
4.Dissociative trance-manifest by temporary marked alteration
in the state of consciousness or by a loss of customary sense of
personal identity but without the replacement by an alternate
sense of identity.
82. REFERENCES
• Kaplan & sadock’s comprehensive textbook of psychiatry,ninth edition
• Kaplan & sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry,
10th edition
• Glutamate and post-traumatic stress disorder: toward a psychobiology of
dissociation. semin clin neuropsychiatry. 1999
• Lanius ra, brain activation during script-driven imagery induced dissociative
responses in ptsd: a functional magnetic resonance imaging investigation. biol
psychiatry. 2002
• Epidemiology of dissociative disorders: an overview,epidemiology research
international volume 2011)