Dissociative disorders PSYCH II Sec B


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Sec B, Psych II Final

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  • Several Images Contained in this Lecture Presentation Were Produced and Made Available From W. L. Carr at http://www.birdhouse.org/images/wcarr/wcgraph.htm
  • Several Images Contained in this Lecture Presentation Were Produced and Made Available From W. L. Carr at http://www.birdhouse.org/images/wcarr/wcgraph.htm
  • Dissociative disorders PSYCH II Sec B

    1. 1. Dissociative Disorders
    2. 2. <ul><li>Some people have the experience of driving a car and suddenly realizing that they don’t remember what happened during all or part of the trip. </li></ul><ul><li>Some people find that sometimes they are listening to someone talk and they suddenly realize that they did not hear part or all of what was just said. </li></ul>
    3. 3. <ul><li>Some people find that they have no memory for some important events in their lives (e.g. a wedding or graduation </li></ul><ul><li>Some people have the experience of finding themselves dressed in clothes that they don’t remember putting on. </li></ul><ul><li>Some people sometimes have the experience of feeling that other people, objects, and the world around them are not real. </li></ul>
    4. 4. <ul><li>loss of sense of having one </li></ul><ul><li>consciousness </li></ul><ul><li>Can arise as a self-defense </li></ul><ul><li>against trauma </li></ul>
    5. 5. <ul><li>Also delay the working through </li></ul><ul><li>needed to place the trauma in </li></ul><ul><li>perspective </li></ul><ul><li>Creates a situation in which </li></ul><ul><li>mental contents coexist in </li></ul><ul><li>parallel consciousness </li></ul>
    6. 6. <ul><li>Dissociative Amnesia </li></ul><ul><li>Dissociative Fugue </li></ul><ul><li>Dissociative Identity Disorder </li></ul><ul><li>Depersonalization Disorder </li></ul><ul><li>Dissociative Disorder, NOS </li></ul>
    7. 7. <ul><li>Inability to remember information, </li></ul><ul><li>usually related to a stressful or </li></ul><ul><li>traumatic event, that cannot be </li></ul><ul><li>explained by ordinary </li></ul><ul><li>forgetfulness, the ingestion of a </li></ul><ul><li>substance, or a </li></ul><ul><li>general medical condition. </li></ul><ul><li>limited to amnesia </li></ul><ul><li>Amnesia is the most common dissociative symptom </li></ul>Dissociative Amnesia
    8. 8. <ul><li>common form: amnesia for personal identity but intact memory of general information </li></ul><ul><li>Thought to be the most common dissociative disorder </li></ul><ul><li>Occur more often in women and in younger adults. </li></ul>
    9. 9. <ul><li>Most patients cannot retrieve painful memories of stressful and traumatic events. </li></ul><ul><li>Theory of state-dependent learning: Information learned or experienced during a particular behavior or in a particular physical setting is often recalled only, or more easily, while re-experiencing the original state. </li></ul>
    10. 10. <ul><li>In dissociative amnesia: memory of the traumatic event is laid down during the event, and the emotional state may be so extraordinary that it is hard for the affected person to remember information learned during that state. </li></ul><ul><li>Secondary defenses: repression and denial </li></ul>
    11. 11. <ul><li>CLINICAL FEATURES: </li></ul><ul><li>precipitating emotional trauma charged with painful emotions or psychological conflict </li></ul><ul><li>Onset of amnesia is abrupt – aware </li></ul><ul><li>Usually alert before and after amnesia occurred </li></ul><ul><li>Depression and anxiety are common precipitating factors. </li></ul><ul><li>Adaptive strategies: confabulation and self-monitoring. </li></ul>
    12. 12. <ul><li>DIFFERENTIAL DIAGNOSES: </li></ul><ul><li>Dementia and Delirium </li></ul><ul><li>Epilepsy </li></ul><ul><li>Transient Global Amnesia – anterograde amnesia </li></ul><ul><li>Dissociative fugue </li></ul><ul><li>Dissociative Identity Disorder </li></ul><ul><li>Sleepwalking </li></ul><ul><li>PTSD </li></ul><ul><li>Somatoform Disorder </li></ul><ul><li>Malingering </li></ul>
    13. 13. <ul><li>Abrupt termination; complete recovery </li></ul><ul><li>Drug-assisted interview – hypnosis </li></ul><ul><li>Psychotherapy – to help patient incorporate the memories into their conscious states. </li></ul>
    14. 14. <ul><li>Fugue – patients physically travel away from their customary homes or work situations and fail to remember important aspects of their previous identities., take on entirely new identity. </li></ul><ul><li>Old and new identity do not alternate </li></ul><ul><li>rare </li></ul>
    15. 15. <ul><li>Predisposing factor: heavy alcohol abuse, Mood disorders, Personality disorders, psychological stressors </li></ul><ul><li>Motivating factor: to withdraw from emotionally painful experiences </li></ul>
    16. 16. <ul><li>DIFFERENTIAL DIAGNOSES: </li></ul><ul><li>Dementia and Delirium </li></ul><ul><li>Epilepsy </li></ul><ul><li>Dissociative amnesia </li></ul><ul><li>Dissociative Identity Disorder </li></ul><ul><li>Sleepwalking </li></ul><ul><li>Organic: </li></ul><ul><ul><li>Hallucinogen </li></ul></ul><ul><ul><li>Alcohol blackouts </li></ul></ul><ul><li>Malingering </li></ul>
    17. 17. <ul><li>Brief course; recovery spontaneous and rapid; recurrences possible </li></ul><ul><li>Drug-assisted interview – hypnosis </li></ul><ul><li>Expressive-supportive psychodynamic psychotherapy – mixture of abreaction of the past trauma and integration of the trauma into a cohesive self that o longer requires fragmentation to deal with the trauma. </li></ul>
    18. 18. <ul><li>Multiple Personality Disorder </li></ul><ul><li>Chronic‘; cause typically involves a traumatic event, usually childhood physical or sexual abuse </li></ul><ul><li>Considered the most serious type of dissociative disorders </li></ul><ul><li>Two or more distinct personalities </li></ul>
    19. 19. <ul><li>.5 – 3% in general psychiatric admissions </li></ul><ul><li>5:1 to 9:1 F:M </li></ul><ul><li>Mean age at diagnosis: 30 </li></ul><ul><li>Cause is unknown </li></ul><ul><li>Causative factors: </li></ul><ul><ul><li>Traumatic life event </li></ul></ul><ul><ul><li>Vulnerability </li></ul></ul><ul><ul><li>Environmental </li></ul></ul><ul><ul><li>Absence of external support </li></ul></ul>
    20. 20. <ul><li>Transition of alters often sudden and dramatic </li></ul><ul><li>Generally amnestic about other states </li></ul><ul><li>Host personality is the one who comes for treatment and carries legal name </li></ul>
    21. 21. <ul><li>DIFFERENTIAL DIAGNOSES: </li></ul><ul><li>Complex Partial Epilepsy </li></ul><ul><li>Dissociative amnesia </li></ul><ul><li>Dissociative Identity Disorder </li></ul><ul><li>Schizophrenia </li></ul><ul><li>Borderline Personality Disorder </li></ul><ul><li>Malingering </li></ul>
    22. 22. <ul><li>Forensic Issues </li></ul><ul><ul><li>Dissociative defendants do not have control over, or are not conscious of, their alter personalities therefore cannot be held responsible for their actions. </li></ul></ul><ul><ul><li>Cannot recall the actions of their alter personalities and therefore cannot participate in their own defense. </li></ul></ul><ul><ul><li>Diagnosis makes it impossible for a defendant to conform to the law or know what is right from wrong. </li></ul></ul>
    23. 23. Depersonalization VS Derealization: Depersonalization is the feeling that the body or the personal self is strange or unreal; Derealization is the perception of objects in the external world as strange and unreal
    24. 24. <ul><li>Persistent or recurrent alteration in the perception of the self to the extent that a person’s sense of his or her own reality is temporarily lost. </li></ul><ul><li>Transient experiences of depersonalization and derealization are the third most commonly reported psychiatric symptoms </li></ul>
    25. 25. <ul><li>common after life-threatening experiences, with or without serious bodily injury. </li></ul><ul><li>two to four times more in women than in men </li></ul><ul><li>Serotonergic involvement: </li></ul><ul><ul><li>association of depersonalization with migraines and marijuana </li></ul></ul><ul><ul><li>response to selective serotonin reuptake inhibitor (SSRI) drugs </li></ul></ul><ul><ul><li>increase in depersonalization symptoms seen with the depletion of L-tryptophan </li></ul></ul>
    26. 26. <ul><li>Its really weird. Its sort of like I’m here, but I’m really not here and that I kind f stepped out of myself, like a ghost… I feel really light, you know. I feel kind of empty and light, like Im going to float away </li></ul>
    27. 27. <ul><li>It just doesn’t seem real. Everything to me doesn’t seem real, my body included….. I was looking in the mirror and all of a sudden it just felt as if the image in the mirror is looking back out upon myself. </li></ul>
    28. 28. <ul><li>You just feel like you’re never being yourself; you’re not thinking normally as you do. You just feel strange….. I need to concentrate on things a lot more…. I feel as if most persons have their brain on automatic. </li></ul>
    29. 29. <ul><li>bodily changes </li></ul><ul><li>duality of self as observer and actor </li></ul><ul><li>being cut off from others </li></ul><ul><li>being cut off from one's own emotions. </li></ul><ul><li>episodic, relapsing and remitting, or chronic course </li></ul><ul><li>Mean age of onset is thought to be in late adolescence or early adulthood in most cases. </li></ul>
    30. 30. <ul><li>Treatment: </li></ul><ul><li>Stress management strategies, distraction techniques, reduction of sensory stimulation, relaxation training, and physical exercise </li></ul><ul><li>SSRI </li></ul>
    31. 31. <ul><li>Dissociative trance disorder - temporary, marked alteration in the state of consciousness or by loss of the customary sense of personal identity without the replacement by an alternate sense of identity </li></ul><ul><li>Brainwashing </li></ul><ul><li>Recovered Memory Syndrome - If the event recalled never really happened but the person believes it to be true and reacts accordingly </li></ul>
    32. 32. PSYCH MOVIES <ul><li>Don't Say a Word </li></ul><ul><li>Identity    </li></ul><ul><li>Primal Fear </li></ul><ul><li>Sybil </li></ul><ul><li>The Three Faces of Eve </li></ul><ul><li>                                                                                                                       </li></ul>