dissociative disorders Flashcards
(22 cards)
what is dissociation
disruption of normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior
reasons dissociation may occur
response to trauma or drugs
allow mind to distance self from experiences that can’t be processed presently
culturally/religiously accepted phenomenon
prevalence of dissociation in “normal” people
60-65% of people have had some non-clinically significant dissociative experiences
non-pathological dissociations
everyday adaptation- states of selective attention or inattention
therapeutic- hypnosis, anesthesia
“daydream” or fantasy
dissociations in development
if child lacks object constancy, may have fantasy and imaginary friends, fluctuating sense of self good/badness, imagined inconstancy or rules, impaired sense of time
dissociation and trauma
much more common in traumatized people, but not in all people who have suffered trauma
part of a group of sx common to some victims of childhood physical, psychological, or sexual abuse
development of dissociative disorders
usually involves repetitive trauma from which escape is not possible, especially during a phase of life when dissociation is a frequently used adaptive defense
dissociation and co-morbid symptoms
often include anxiety, PTSD, low self-esteem, personality disorders, somatization, depression, chronic pain, interpersonal dysfunction, substance abuse, self-mutilation, suicidal ideation or action
Freudian explanation of dissociation
unconscious psychological strategy to cope with reality and maintain self image, protect mind from anxiety or environment
medical conditions in differential diagnosis for dissociation
neurological disorders, including TBI, CVA
delirium
partial complex seizures
substance use/abuse (ketamine, NO, EtOH, LSD, tiletamine, marijuana, dextromethorphan, PCP, salvia, muscimol, atropine, ibogaine)
substances on urine drug screen
amphetamines, opiates, cocaine, cannabis, barbiturates, benzos
psychiatric conditions in differential diagnosis for dissociation
PTSD, borderline personality disorder, mood disorders, psychosis, malingering/ factitious, substance abuse
dissociative amnesia criteria
1+ episodes of inability to recall important personal information (usually stressful in nature) beyond normal forgetfulness
- does not occur exclusively during other psychiatric disorders or d/t substance or other condition
- not disoriented, may be aware of amnesia, resolves quickly
epidemiology of dissociative amnesia
1% males, 2.6% females
sudden onset
risk factors: war, child abuse, natural disaster, prison/concentration camp, genocide
dissociative fugue criteria
sudden unexpected travel away from home or work with inability to recall past, confusion about identity or assumption of new identity
does not occur exclusively during dissociative identity disorder, not d/t substance or other condition
*form of dissociative amnesia in DSM5
depersonalization/ derealization disorder criteria
persistent/recurrent feelings of detachment from mental processes or body
reality testing remains intact
does not occur during other mental disorder, substance, or other condition
epidemiology of depersonalization/ derealization disorder
2% both sexes
mean onset: 16 yo
common in users of THC, LSD, ketamine, MDMA, salvia
often have immature coping mechanisms
dissociative identity disorder criteria
2+ distinct identities or personality states, at least 2 of which recurrently take control of person’s behavior
inability to recall important personal information beyond ordinary forgetfulness
epidemiology of dissociative identity disorder
1.6% males, 1.5% females in US
over 70% have attempted suicide
90% have hx of childhood abuse or neglect
high comorbidity w psych d/o and malingering
clues to dissociative identity disorder diagnosis
large gaps in memory
being recognized by strangers or called different names by them
finding unfamiliar objects in home
being unable to remember injuries on multiple occasions (w/o EtOH)
other specified dissociative disorders
identity disturbance - d/t prolonged and intense coercive persuasion/ brainwashing
acute dissociative reactions to stressful events
diagnosis and tx of dissociative disorders
no diagnostic tests available, dx based on serial interviews
tx: psychotherapy (supportive, insight-oriented, hypnosis), partial hospitalization, low-dose atypical anti-psychotics, SSRIs (depressive affects), BZDs for anxiety about previously split-off material
