PHSI 208 Lecture Notes - Posttraumatic Stress Disorder, Amobarbital, Hypnotic Susceptibility
dissociative amnesia: when a person is unable to recall important personal information, usually
after some stressful episode. The information is not permanently lost, but it cannot be retrieved during
the episode of amnesia.
rarely, the amnesia is for only selected events during a circumscribed period of distress, is
continuous from a traumatic event to the present, or is total, covering the person’s entire life.
The person’s behaviour during the period of amnesia is otherwise unremarkable, except that the
memory loss may bring some disorientation and purposeless wandering.
The amnesic episode may last several hours or as long as several years. It usually disappears as
suddenly as it came on, with complex recovery and only a small change of recurrence.
In degenerative brain diseases, memory fails more slowly over time, is not linked to life stress, and is
accompanied by other cognitive deficits, such as the inability to learn new information. Memory loss
following a brain injury caused by some trauma (eg an automobile accident) or substance abuse can
be easily linked to the trauma or the substance being abused.
Memory loss is more extensive in dissociative fugue than in dissociative amnesia. The person not
only becomes totall amnesic but suddenly leaves home and work and assumes a new identity.
Sometimes the person takes a new name, a new home, a new job, and even a new set of personality
More often, the fugue is of briefer duration. It consists for the most part of limited, but apparently
purposeful, travel, during which social contacts are minimal or absent.
Fugues typically occur after a person has experienced some sever stress, such as marital quarrels,
personal rejection, financial or occupational difficulties, war service, or a natural disaster. Recovery,
although it takes varying amounts of time is usually complete and the individual does not recollect
what took place during the flight from his or her usual haunts.
depersonalization disorder: unlike other dissociative disorders, involves no disturbance of
memory. In a depersonalization episde, which is typically triggered by stress, individuals rather
suddenly lose their sense of self. They have unusual sensory experiences, i.e. their limbs may seem
drastically changed in size or their voices may sounds strange to them.
They may have the impression that they are outside their bodies, viewing themselves from a
distance. Sometimes they feel mechanical, as though they and others are robots, or they move as
though in a world that has lost its reality.
Depersonalization episodes are associated with traumatic life events in general or specific events
involving sexual abuse.
The most common reaction was a sense of derealisation, with statements such as “I feel as if i am
floating away from reality”
Desomatization was also reported; “my body does not feel like it belongs”. Other symptoms; worries
about feeling isolated from people.
DISSOCIATIVE IDENTITY DISORDER:
Dissociative identity disorder: requires that a person have at least two separate ego states, or
alters – different modes of being and feeling and acting that exist independently of ach other and that
come forth and are in control at different times. There is usually one primary personality.
Gaps in memory occur in all cases and are produced because at least one alter has no contact with
The existence of different alters must also be chronic (long-lasting) and severe (causing considerable
disruption in one’s life)
Each alter must be quite complex, with its own behaviour patterns, memories and relationships; each
determines the nature and acts of the individual when it is in command.
Usually, the personalities are quite different, even opposites of one another. They may have different
handedness, wear glasses with different prescriptions, and have allergies t different substances.
DID presumably begins in childhood, but it is rarely diagnosed until adulthood, it is more extensive
than other dissociative disorders, and recovery may be less complete, the diagnoses is much more
common in women than men; suicidal tendencies, depression, recurring headaches and sexual abuse.
According to Liotti, a related possibility is that individuals suffering from DID have a disorganized
attachment style because they were exposed as young children to the frightening and chaotic
behaviour of their caregiver.
Controversies in the diagnosis of DID:
Compared with the American sample, the Canadian respondents were significantly more susceptible
about the scientific validity and diagnostic legitimacy of DID. There were no significant differences
between the views of English-speaking and French-speaking respondents.
psychoanalytically oriented psychiatrists were significantly more accepting of the validity of DID than
were biologically oriented psychiatrists.
re-emergence of the DID diagnosis in the past thirty years can be linked to:
•In DSM-III, the diagnostic criteria for DID were spelled out clearly for the first time.
•Could be that clinicians has always seen a similar number of cases but chose to report them only
when interest in DID grew.
•Cases of DID may have mistakenly been diagnosed as cases of schizophrenia. However the
symptoms of the two disorders are actually not very similar.
ETIOLOGY OF DISSOCIATIVE DISORDERS:
There are two major theories of DID.
One assumes that DID begins in childhood as a result of severe physical or sexual abuse. The abuses
causes dissociation and the formation of alters as a way of escaping the trauma.
It is further proposed that a diathesis present among those who do develop DID. One idea is that eing
high in hypnotisability facilitates the development of alters through self-hypnosis. Another proposed
diathesis is that people who develop DID are very prone to engage in fantasy.
The other DID theory considers the disorder to be an enactment of learned social roles. The alters
appear in adulthood, typically due to suggestions by a therapist.
A critical piece of evidence regarding the two theories is whether or not DID actually develops in
childhood as a result of abuse.
One study however has come close to providing clearer data regarding both childhood onset and
abuse in cases of DID.
Concluded that there really isn’t any proof for the claim that DID is caused by childhood trauma and
that DID cases in children are rarely reported.
THERAPIES FOR DISSOCIAIVE DISORDERS:
psychoanalytic treatment is perhaps more widespread as a choice of treatment for dissociative
disorders than for any other psychological problems. (The goal f lifting repression).
PTSD is the most commonly diagnosed co-morbid disorder with DID.
Treatment of DID:
hypnosis is used commonly in the treatment of DID. The general idea is that the recovery of
repressed painful memories will be facilitated by recreating the state entered into during the original
abuse, a hypothesis consistent with classic research on state-dependent learning.
The person is hypnotised with the help of drugs such as sodium amytal and encouraged to go back in
his or her mind to events in childhood – a technique called age regression. The hope is that accessing
these traumatic memories will allow the adult to realise that the ganders from childhood are not now
present and his or her current life need not be governed by these ghosts from the past.
Improvement in a DID patient’s anxiety and depression is sometimes effected through psychoactive
drugs such as tranquilizers and antidepressants, though without effect on the DID itself.
Series of agreed upon treatment guidelines focuses on: (1) safety, stabilization and symptom
reduction; (2) working directly and in depth with traumatic memories; and (3) identity integration and