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Dissociate identity disorder Flashcards

1
Q

learning objectives

A
  1. Understand what DID is.
  2. Explain how objective brain imaging data can inform the debate
    on the aetiology of DID.
  3. Describe how structural brain imaging can aid an earlier
    diagnosis and therefore has clinical relevance.
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2
Q

what is the estimated lifetime prevalence of dissociative identity disorder

A

1.5%

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3
Q

what is the estimated lifetime prevalence of schizophrenia

A

0.25 to 0.64%

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4
Q

how is DID characterised

A

two or more distinct identity states and memory gaps beyond what is explained by normal forgetfulness

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5
Q

describe identity states

A

identity states have their own perception, reaction and thinking about the environment and the self coinciding with fluctuating states of conciousness and changing access to autobiographical memory

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6
Q

what are the two main types of identity states

A

trauma related identity state (TIS) and neutral identity state (NIS)

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7
Q

what are the features of TIS

A

emotional part of personality (EP)
trauma-aware state
accesses and emotionally responds to traumatic memories; fixated
disoriented in place, time and identity
major lack of personification and presentification
child like behaviour
subjective sense of age
retracted field of conciousness
low level of conciousness

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8
Q

what are the features of NIS

A

apparently normal personality (ANP)
trauma avoidant state
lack of personification and presentification of the traumatic past and associated TIS
retracted field of conciousness (wider than TIS)
higher level of conciousness than TIS but lower than normals

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9
Q

what is the theoretical framework of DID

A

primary and secondary structural dissociation

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10
Q

what is primary structural dissociation

A

one ANP/NIS and one EP/TIS

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11
Q

ANP/NIS

A

action systems for functioning in daily life and survival of species

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12
Q

EP/TIS

A

action systems for defence from major threat - survival of the individual

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13
Q

what does overlap between ANP/NIS and EP/TIS indicate

A

shared access to implicit and explicit memory

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14
Q

what is secondary structural dissociation

A

one ANP/NIS and more than one EP/TIS or more than one ANP/NIS and more than one EP/TIS

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15
Q

what is a system

A

a collective internal group of distinct identities (alters) that share one body and mind

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16
Q

what is the target of pharmacological treatment

A

mx of comorbid symptoms such as depression, anxiety, sleep disturbance etc.

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17
Q

what is first line treatment for DID

A

phase oriented psychotherapy

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18
Q

what is phase 1 psychotherapy

A

establishing safety, stabilisation and symptom reduction

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19
Q

what is phase 2 psychotherapy

A

confronting, working through and integrating traumatic memories

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20
Q

what is phase 3 psychotherapy

A

identity re(integration) and re(habilitation)

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21
Q

which imaging methods can be used to inform aetiology

A

PET

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22
Q

Matthew et al. (1985) PET

A

hyperperfusion in the right temporal lobe accompanying identity switch

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23
Q

what is a possible neurostructural biomarker for DID

A

temporal regions

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24
Q

what are the two models of dissociation

A

trauma related
non trauma related

25
what is the trauma-related model of dissociation
States that DID constitutes a severe form of PTSD originating from severe and chronic trauma
26
What is the non trauma related model?
States that DID originates from suggestion or role playing and is facilitated by a high level of suggestibility or fantasy proneness
27
the trauma model includes which theory
the theory of structural dissociation of the personality (TSDP)
28
what does the creative experiences questionnaire measure
fantasy-proneness/ suggestibility
28
the non trauma model includes whcih theoretic model
sociocognitive model, the iatrogenic model and is referred to as the fantasy model
29
Reinders et al. (2003) one brain, two selves
specific changes in medial prefrontal cortex and posterior association cortices consistent with ability to generate at least two distinct mental states of self awareness
30
31
reinders et al. (2006) Psychobiological characteristics of dissociative identity disorder: a symptom provocation study (PET)
exposure to neutral and trauma related memory script tested subjective rating, cardiovascular response and regional cerebral blood flow psychobiological differences found between dissociative identity states
32
Schlumpf et al. (2013)
brain responses to affective stimuli differed between personality states in DID, which could not be simulated by healthy controls.
33
Schlumpf et al. (2014)
resting state imging showed personality-state dependent differences in DID are different from simulated personality-state dependent differences in HC
34
imaging evidence is supportive of which model of DID
trauma model
35
prevalence of dissociative subtype of PTSD
12-30%
36
dissociative PTSD (dPTSD)
exposure to personal trauma transcripts associated with high rates of dissociative symptoms
37
what are the opposing subtypes of PTSD
hyperarousal subtype vs dissociative subtype
38
what are the characteristics of dissociative PTSD
overmodulation of affect
39
what are the characteristics of hyperarousal PTSD
undermodulation of affect rexeperiencing dissociation mediated by a failure of prefrontal inhibition in limbic regions
40
which brain areas are associated with regulation and emotional arousal
rostral anterior cingulate and medial prefrontal cortex
41
which brain areas are associated with awareness of bodily states
right anterior insula and amygdala
42
hyperarousal PTSD is associated with what pattern of activiation
increased activation in the amygdala and right anterior insula and decreased activation in the rostral anterior cingulate and medial prefrontal cortex
43
dissociative ptsd is associated with what pattern of activiation
decreased activation in the right anterior insula and amygdala and increased activation in the medial prefrontal cortex and rostral anterior cingulate
44
which ptsd subtype is similar to TIS
hyperarousal ptsd subtype
45
which ptsd subtype is similar to NIS
dissociative subtype
46
what does brain morphometry show us
similar cortical gray matter abnormalities in women with ptsd and DID differences in subcortical grey matter abnormalities in women with ptsd only
47
what is the correlation between dissociation and the left inferior patietal region
patients with did-ptsd have smaller left inferior parietal regions than patients with ptsd only
48
cortical gray matter in did/ptsd vs controls
patients with did and ptsd compared to controls have smaller cortical grey matter in frontal, temporal and insular cortices
49
did vs ptsd self report
did patients report higher dissociative symptoms and traumatising events
50
structural brain differences in did vs ptsd
cortical differences in inferior parietal region larger dorsal-striatum smaller hippocampus
51
most common neuroanatomical finding in individuals with hx of childhood adversity
smaller hippocampal volume
52
what is the relationship between hippocampal volume and childhood adversity
smaller global and subfield hippocampal volumes are related to a history of childhood trauma in PTSD and DID patients
53
relative **decrease** in regional grey matter in DID is found where
* bilateral middle, superior and dorsolateral frontal gyrus * left medial and right orbito-frontal gyrus * bilateral anterior cingulate gyrus * bilateral middle temporal gyrus and right inferior temporal gyrus * bilateral fusiform gyrus * left inferior parietal lobule and supramarginal gyrus * bilateral superior occipital gyrus | reinders et al. 2019
53
what is data driven pattern recognition
the automatic discovery of patterns of statistical regularity in imaging data | reinders et al. 2019
54
relative **increase** in regional grey matter is found where
* left superior frontal gyrus * left medial parietal lobule * bilateral cerebellum | reinders et al. 2019
55
relative decrease in white matter volume is seen in which brain regions
bilateral inferior fronto-occipital tract left corticospinal tract right superior and left inferior longitudinal fasciculus right inferior, bilateral middle and superior frontal regions bilateral temporal, cerebellar and lateral occipital regions left amygdala–hippocampal junction left (anterior) cingulate | reinders et al. 2019
56
# true or false peope with DID can be distinguished from healthy controls at an individual level with good sensitivity and specificity
true | reinders et al. 2019
57
# true or false long lasting trauma results in widespread patterns of affected grey matter only | reinders et al. 2019
false - white and grey matter changes seen | reinders et al. 2019

Neuropsychiatric disorders (30 decks)

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