A. DISSOCIATIVE DISORDERS

Question 1

Define dissociative disorder.

Answer 1

loss in usual integrated function of conciousness, memory, identity, emotions, motor control and/or perception.

Question 2

Dissociative Identity Disorder
Define/characterize Dissociative Identity disorder.

Answer 2

-presence of more than one personality state as a result of a fragmented state of self.
- feature of other dissociative disorders ( e.g amnesia, de-personalization and de-realization)
- predominantly develops in victims of significant chronic/ childhood trauma.

Question 3

Classify Dissociative disorders. (DDDOU)

Answer 3

1. Dissociative Identity disorder
2. Dissociative amnesia
3. De-personalization/De-realization
4. Other specified dissociative disorders
5. Unspecified dissociative disorders

Question 4

What is the Hallmark of dissociative identity disorder?

Answer 4

Presence of two or more personalities/ experience of possession.

Note
When one personality exerts its effects, the others are turned off.

Question 5

Name the two forms of Personality state manifestations.

Answer 5

1. Possessive form
2. Non-possessive form

Question 6

Describe possessive form of DID

Answer 6

manifests as behaviors under the control of a ‘‘spirit’’ or supernatural being
highly overt alternate personality

Question 7

Describe the non-possessive form of DID

Answer 7

subtle discontinuity which persist for a long period of time

Question 8

What is Dissociative fugue?

Answer 8

a state of amnesia where one ends up in an unexpected place with no memory of how they got there.

Note
-Amnesia is DID is not only limited to traumatic/stressful events.

Question 9

The diagnostic criteria of Dissociative Identity disorder (DID).

Answer 9

A - disruptionof identity manifested as 2 or more distinct personalities states dominating at different times.

B - extensive memory lapse in autobiography information, daily occurrences and/or traumatic events.

C - Not due to the effect of substance or another medical condition

D - The condition causes significant distress/impairment in social or occupational functioning.

Question 10

Description of criterion A of Dissociative Identity disorder

Answer 10

• sense of alteration/discontinuity of sense of self
• de–personalization
• may experience perception of voices
• may report their body not feeling like its thier’s

Question 11

Brief description of criterion B of Dissociative Identity disorder

Answer 11

• patient reports with Dissociative amnesia which may manifest in three ways:
  1. Gaps in remote memory of personal life events
  2. Lapse in dependable memory (e.g a well learned skill)
  3. Discovery of evidence of their daily actions that they don’t recollect doing (e.g finding an unexplained object in their possessions)

Question 12

Epidemiology of DID

Answer 12

• rare (<1%)
• greater in women
• high evidence of comorbid PTSD, major depressive disorder, eating disorder and BPD
  >70% of patients attempt suicide or other frequent attempts of self-mutilation

Question 13

What is the treatment for Dissociative identity disorder?

Answer 13

Standard tx - psychotherapy
(with focus on safety, stabilization and sx reduction)
Pharmacotherapy - SSRI’s (target the comorbid depression/PTSD sx)
- Prazosin - target nightmares
- Naltrexone - reduce self-mutilation

Question 14

Dissociative Amnesia
Define DA.

Answer 14

Dissociative amnesia is the inability to recall important information usually of traumatic/stressful nature, that is not explained by ordinary forgetfulness.

Question 15

How do you distinguish dissociative amnesia from any other conditon that results in amnesia?

Answer 15

In Dissociative Amnesia, procedural memory is preserved

Question 16

Comment on the Epidemiology of Dissociative amnesia.

Answer 16

• Greater in women
• approximately 1-3% of the general population
• occurs against the backdrop of a physical/psycho-social stressor.

Question 17

Name the Types of Dissociative amnesia.

Answer 17

Localized
Generalized
Continuous
Systematized
Selective

Question 18

Describe Briefly
Localized dissociative Amnesia

Answer 18

failure to recall events during a defined period of time
(most common)

Question 19

Selective DA

Answer 19

individual recalls some but not all events during a defined period of time.

Question 20

Generalized DA

Answer 20

Complete loss of one’s life story

May lose Semantic memory (previous knowledge about the world)
May lose Procedural memory (access to a well learned knowledge/skill)

Question 21

Continuous DA

Answer 21

forget all new events as they occur.

Question 22

Systematized DA

Answer 22

exhibit loss of memory for a specific category of information

Question 23

Comment on the Epidemiology of Dissociative Amnesia

Answer 23

• greater in females
• Lifetime prevalence - 6-7%