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Dissociative Disorders.docx

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University of Ottawa
Mark Coates

Chapter ­ Dissociative Disorders Dissociative Disorders • Disruption of the usual functions of consciousness, memory, identity, or perception • Not all dissociation is pathological (daydreaming, time passing while driving) • DSM-IV-TR diagnoses: – Dissociative amnesia – Dissociative fugue – Dissociative identity disorder – Depersonalization disorder – Dissociative NOS Dissociative Amnesia • A. The predominant disturbance is one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness. • Formerly called “Psychogenic Amnesia” • Inability to recall personal information – Not due to neurological changes or ordinary forgetfulness – Usually occurs following a traumatic event – Memory for non-personal information is usually intact – Memory usually returns within a few days, but can be chronic • Most important to rule out its not a brain problem • Would be able to remember whos the president and non personal info • Would have trouble remembering things about themselves • Most of the time the memories will return • Might remember forget, remember forget • If they do forget it forever its called chronic dissociative amnesia • Subtypes: – Localized – specific time period – Selective – parts of the trauma but not others – Generalized – all personal information from past – Continuous – all personal information from a certain point in the past – Systematized – certain categories of information • Prevalence of dissociative amnesia is unknown • Local: one period of time the person has no memories for – usually involving the trauma • Selective: remembering some bits of the trama but not all – Something bad happened at this house but i dont remember what it is – I know this person hurt me but i dont know how • Generalized: all information from the present back is forgotten – Dont have any past – Will only remember world events • Continous: same idea but starts at a certain point – Ex: everything before 2005 is forgotten • Systematized: certain things they cant remember – Ex: cant remember any bdays they had – Usually bc they trauma involved bdays th • No evidence that this disorder existed before the 18 century Dissociative Fugue • A. The predominant disturbance is sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past. • B. Confusion about personal identity or assumption of a new identity (partial or complete). • Most are able to function quite well • Sometimes are found to be fleeing an intolerable situation • Usually resolves after a few days or weeks • Dissociative amnesia with travel – cross national borders without any idea how they got there • Leave and go someone else and dont remember anyting • Take on a new ideanty bc they have no idea who they are • Might forget that they have family, etc • Dont understand that they dont know who they are , just find it confusing • Could make up a whole new life story • Onset is before they leave, after a trauma, fleeing for it • Assumption of identity happens a little later • One minute they are themselves and one minute they are someone else • Ex: girl had a stressful situation and dissapeared, a few days later was found in vegas, called the police and said she was kidnapped – came back to reality • Very rare for this to last very long • Several cultures recognize disorders that include “running” • Pibloktoq • Grisi siknis • Amok • Prevalence of dissociative fugue is known to increase during times of stress, such as war or natural disaster • Lifetime prevalence of 0.2% • Not culturally bound condition • Very very rare • Many go undiagnosed • Say you needed a vacation Depersonalization Disorder • A. Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream). • B. During the depersonalization experience, reality testing remains intact. • Feeling of being an “automaton”, watching self in a movie, or being outside own body • Perceived lack of control over motor behaviour, speech, affective responses • Reality testing is intact – Patient knows that they are not actually an automaton • Im not the one in control of my body, watching yourself – can experience this in a panic attack • B: person knows that its not real but it feels like you are actually out of your body • Derealization is also common in depersonalization disorder – Feeling of disconnection with or unreality of the outside world • Depersonalization experiences are extremely common – Up to 50% of people will experience an episode at some point in their life – 1/3 of people exposed to life-threatening danger – Lifetime prevalence of
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