10/24 Dissociative Disorders - Palmeri Flashcards Preview

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Flashcards in 10/24 Dissociative Disorders - Palmeri Deck (15):
1

dissociation

complex psychobiological process that exists as a continuum ranging from:

  • daydreaming, transient lapses in attention

to

  • pathological failure to integrate thoughts, feelings, memories, and actions into a coherent and unified sense of consciousness

 

disruption or discontinuity in integration of consciousnes, memory, identity, emotion, perception, body representation, motor control, behavior

2

dissociative sx

  • unbidden intrusions into awareness and behavior with accompanying losses of continuity in subjective experiences
  • while dissociating, inability to access info or control normal behavior or mental fx

usually occur in context of traumatic stressors as an attempt to maintain emotional equilibrium but end up in distress and dysfx

3

dissociative disorders

  1. dissociative amnesia
  2. depersonalization/derealization disorder
  3. dissociative identity disorder
  4. other specified dissociative disorder
    • chronic and recurrent syndromes of mixed sx
    • identity disturbance due to prolonged and intense coercive persuasion (i.e. brainwashing)
    • acute dissociative rxn due to stress
    • dissociative trance

 

recall: dissociation involves disturbances in...

  • memory 
  • perception
  • sense of self
  • consciousness
  • emotion
  • motor control/behavior

4

what fails to integrate in each dissociative disorder?

  1. dissociative amnesia : memory
  2. depersonalization/derealization : perception and motor control
  3. dissociative identity disorder : identity, sense of self, and consciousness

5

neurobio of dissociation

  • NMDA, 5HT, and endogenous opiod dysregulation
  • autonomic blunting
  • HPA baseline with incr tone AND blunted reactivity to stress
  • disruptions in sensory cortex (somatosensory, auditory, visual)

 

DID : decr hippocampal and amygdala volume

memory suppression : PFC, paralimbic, subcortical, and parietal involvement in memory suppression

hypoemotionality : frontal inhibition of limbic structures

6

psych disorders that commonly have dissociative sx

medical conditions related to dissociation

PTSD

psychosis

panic disorder

somatization or pain disorders

substance abuse

OCD

borderline personality disorder

 

partial complex seizures

temporal lobe disease

migraine

delirium

Alzheimer's endocrine disorders

sleep disorders

sensory deprivation

substance intox/withdrawals

7

common comorbidities with dissociative disorders

MDD

persistent depressive disorder

substance abuse/dependence

GAD

eating disorders

borderline personality disorder, OCD personality disorder, avoidant personality disorder

8

what might you pick up in diagnostic interview for dissociative disorders?

  • blackouts/time loss
  • disremembered behavior
  • fugues
  • unexplained possessions
  • changes in relationships (instability)
  • fluctuations in skills/habits/knowledge
  • fragmentary recall of personal history
  • passive influence (feeling that thoughts are not your own - are being influenced by someone else)
  • negative hallucinations (not seeing or hearing what people around you see/hear)
  • analgesia
  • depersonalization/derealization (not feeling like 'self'/environment distorted)

9

dissociative amnesia

 

what is it?

"with dissoc fugue"

 

levels of severity

  • inability to recall important autobio info - NOT FORGETTING
  • usually related to a trauma (repeated or severe trauma is a risk factor)
  • recurrent
  • comorbidities: borderline personality disorder, affective disorders, substance abuse, conversion

 

 

with dissociative fugue: apparently purposeful travel or bewindered wandering for ID/autobio info

  • memory changes may be more permanent

 

as a disorder, levels of severity:

  1. localized: failure to recall events during a circumscribed time
  2. selective: recall of some but not all of events in a circumscribed time
  3. generalized: complete loss of memory for one's personal identity; can occur as semantic loss (facts/environment) or procedural (skills)
  4. systemized: loss of memory for one category of knowledge (ex. family)
  5. continuous: loss of memories as each new even occurs

10

depersonalization/derealization disorder

depersonalization: lasting or recurring feeling of being detached from one's body, observer to ones thoughts/feelings/sensations

  • perceptual alterations
  • distorted sense of personal time
  • unreal/absent self
  • emotional/physical numbing

derealization: experiences of unreality or detachment is respect to surrounding environment

  • people/objects experienced as unreal, dreamlike, foggy, lifeless, visually distorted
  • macropsia/micropsia

 

high levels of distress (feel like going crazy)

often history of emotional abuse/neglect

onset: sudden, mean age 16 (only 5% after 25), sudden or gradual

course: can last days-years, can often be persistent (not remitting)

  • discrete/continuous/discrete→continuous

11

dissociative identity disorder

disruption of identity caused by two or more distinct personality states (sometimes described as possession)

  • marked discont in sense of self 
  • alterations in affect, behavior, consciousness, memory, perception, cognition, motor fx
  • recurrent gaps in memory/recall (not forgetting)

 

 

chronic, and most severe dissoc disorder

involves overwhelming trauma (physical/sexual abuse)

usually young women

multifactorial in devpt (OFC, hipocampus/parahippocampal gyrus, amygdala)

avg = 5-10 personalities

70% atttempt suicide

related to ongoing stressors

marked by

  • sudden alteration in sense of self and agency

AND

  • recurrent dissociative amnesia (gaps in remote memory of personal nature, lapses in dependable memory, discovery of evidence) w mixed awareness of lapses

12

identity disturbance due to prolonged an intense coercive persuasion

brainwashing/thought reform

13

acute dissociative disorders

occur less than a month after a trauma

resolve after 1 month mark

14

dissociative trance

  • not culturally acceptable
  • complete loss of awareness of environment with stereotyped behavior and LOC
    • look like awake

15

treatment for dissociative disorders

no controlled studies

most SYMPTOMS remit quickly (not disorders)

if remission does not occur...

  • behavioral (flooding, positive reward)
  • cognitive tx
  • psychodynamic psychotherapy
  • psycho education
  • psychopharmacology
  • stress management
  • hypnosis