PSYC 210 Lecture Notes - Lecture 16: Dissociative Identity Disorder, The Fugue, Substance Abuse
30 Apr 2018
School
Department
Course
Professor
What are the names of the different theories of the etiology of Dissociative
Identity Disorder? (select all that apply)
Psychological+model
A.
Sociocognitive*model
B.
Posttraumatic*model
C.
Stress+Response+model
D.
What is believed to precipitate DID symptom presentation?
Genetic+predisposition
A.
Substance+abuse
B.
Extreme*childhood*trauma*or*abuse
C.
Severely+elevated+social+anxiety
D.
Dissociative*disorders:+sudden+disruption+in+the+continuity+of+consciousness,+memory+
or+identity
Dissociation:+some+aspect+of+cognition+or+experience+becomes+inaccessible+to+
consciousness;+avoidance+response
Not+always+a+bad+thing
Ex:+if+you+get+in+a+fist+fight+and+get+hit,+you+won't+feel+them+as+
intensely+to+shut+down+pain+responses+because+it's+not+helpful+to+
feel+the+pain+in+the+middle+of+the+fight
§
Can+be+adaptive+or+necessary+at+times
§
○
In+the+disorder,+it's+when+the+normal+process+goes+too+far
○
•
Depersonalization/derealization*disorder:+alteration+in+the+experience+of+the+
self+and+reality
•
Dissociative*amnesia:+lack+of+conscious+access+to+memory,+typically+of+a+
stressful+experience
The+fugue+subtype+–more+severe
○
•
Dissociative*identity*disorder:+at+least+two+distinct+personalities+that+act+
independently+of+each+other
Used+to+be+called+multiple+personality+disorder
○
•
Dissociative+identity+disorder+(DID)
Two+or+more+distinct+and+fully+developed+personalities+(alters)
Each+has+unique+behaviors,+memories,+and+relationships
○
Can+have+different+handed-ness,+eye+sight,+allergies,+handwriting+
○
•
Memory+gaps+are+common+for+periods+of+time+when+alters+are+in+control
Other+symptoms:+headaches,+hallucinations,+self+harm,+suicide+attempts
○
Alters+may+not+know+other+alters+exist
○
•
Not+very+well+studied+because+it's+controversial+if+it+exists
Mostly+based+on+case+studies
○
•
Typical+onset+in+childhood
Rarely+diagnosed+until+adulthood
○
•
More+severe+than+other+dissociative+disorders
Recovery+may+be+less+complete
○
•
More+common+in+women+than+men•
Often+comorbid+with+PTSD,+MDD,+BPD,+substance+abuse,+and+phobias•
DSM-5+criteria+for+Dissociative+Identity+Disorder+(DID)
Disruption*of*identity characterized+by+two*or*more*distinct*personality*states,+
which+may+be+described+in+some+cultures+as+an+experience+of+possession
The+disruption+in+identity+involves+marked+discontinuity+in+sense+of+self+
and+sense+of+agency,+accompanied+by+related+alterations+in+affect,+
behavior,+consciousness,+memory,+perception,+cognition,+and/or+motor+
functioning
○
These+signs+and+symptoms+may+be+observed+by+others+or+reported+by+the+
individual
○
1.
Recurrent*gaps*in*the*recall of+everyday+events,+important+personal+
information,+and/or+traumatic+events+that+are+inconsistent+with+ordinary+
forgetting
2.
The+symptoms+cause+clinically*significant*distress*or*impairment in+social,+
occupational,+or+other+important+areas+of+functioning
In+children,+not+explained+by+imaginary+friends+or+fantasy+play
○
3.
The+disturbance+is not a+normal+part+of+a+broadly+accepted cultural*or*religious*
practice
4.
Symptoms+are+not*attributable to+the+physiological+effects+of+a+substance*or*
another*medical*condition
5.
History
Almost+no+identified+reports+of+DID+before+1800
Existence+and+well+documented+for+a+lot+of+other+disorders,+but+not+DID
○
Could+have+cultural+construction
○
•
Marked+increase+since+the+1970s
Media+popularization
The+three+faces+of+Eve,+Sybil
§
○
•
Didn't+appear+in+the+DSM+until+DSM-III+in+1980
Diagnostic+criteria+ and+growing+literature+ may+have+increased+detection+
and+recognition+of+symptoms
○
•
Etiology
Posttraumatic+model
DID+results+from+severe+psychological+and/or+sexual+abuse+in+childhood
Your+sense+of+personality+is+still+being+formed+in+childhood
○
More+plastic+or+malleable+at+that+age+
Creates+greater+possibility+for+the+split
§
○
•
Adaptive+response+to+extremely+traumatic+situations•
Socio-cognitive+model
DID+is+a+form+of+role-play+in+suggestible+individuals•
Occurs+in+response+to+prompting+by+therapists+or+media
Alters+tend+to+be+discovered+in+psychotherapy+treatment
○
Raises+question+of+if+it's+created+in+treatment+
○
In+any+psychotherapy,+you+take+someone's+narrative+and+reshape+it+
Consider+the+world+in+a+slightly+different+way
§
An+extreme+version+of+this+by+creating+new+personalities
§
○
•
No+conscious+deception•
Analogy+of+split+brain+patients
Split-brain+patients+have+undergone+surgery+to+cut+the+corpus+callosum,+
the+main+bundle+of+neuronal+fibers+connecting+the+two+sides+of+the+brain
○
Form+of+epilepsy+only+treated+by+severing+corpus+callosum+that+connects+
the+two+hemispheres
Seizures+went+away+but+the+right+and+left+hemispheres+couldn't+
communicate+directly
§
Used+to+study+lateralization+of+function+in+the+brain
§
By+covering+one+eye,+you+could+only+show+one+hemisphere+
information+and+see+what+happens
§
○
Left+hemisphere+focuses+on+language+and+ability+to+say+things
Can+read
§
○
Right+hemisphere+can+read+but+doesn't+talk
○
Could+selectively+send+a+message+to+either+the+right+or+left+brain
Show+left+hemisphere+a+sign+that+says+stand+up+now+and+they+did+so+
because+they+read+it
§
Show+right+hemisphere+a+sign+that+says+stand+up+and+they+stand+up+
and+they+made+up+a+reason
"I+thought+it+was+time+to+go,"+"I+wanted+to+get+a+sandwich"□
§
Shows*we*are*all*making*up*a*story*to*fit*the*data*given*to*us*all*
the*time
§
Left+hemisphere+didn't+know+that+it+didn't+know+it+didn’t+have+all+the+
information+needed+to+explain+behavior+and+found+a+reason+why
§
○
We+have+times+where+we+surprise+ourselves+
Say+something+you+didn't+expect
§
Don't+know+how+you+ended+up+places
§
○
Your+interpretations+of+that+is+that+I+did+something+unusual+for+me
If+the+situations+get+so+extreme+and+unpredictable,+you+can+start+to+
wonder+if+you+even+did+that+or+if+someone+else+was+there
§
The+normal+processes+of+which+we+make+sense+and+build+a+model+
what+we're+likely+to+do+and+who+we+are+and+how+in+extreme+
circumstances+that+may+start+to+break+down+a+little+ bit
§
○
•
Evidence+raised+in+theory+debate
DID+can+be+role-played
Hypnotized+students+prompted+to+reveal+ alters+did+so
§
○
DID+patients+show+only+partial+implicit+ memory+deficits
Alters+"share"+memories
§
○
Majority+of+DID+cases+are+diagnosed+by+a+small+number+of+clinicians
○
For+many,+symptoms+emerge+after+therapy+begins
○
•
Treatment
Most+treatments+involve:
Empathetic+and+supportive+therapist+who+guides+integration+of+alters+into+
one+fully+functioning+individual
○
Improvement+of+coping+skills
○
•
Psychodynamic+approach+adds:
Re-experience+ the+traumatic+event
Use+hypnosis+(might+actually+worsen+symptoms)
§
○
•
No+evidence+for+psychotherapy
Not+a+lot+of+evidence+that+treatment+is+effective
○
Best+thing+would+be+if+someone+can+recognize+and+live+with+the+alters
○
•
Dissociative*Disorders
Thursday,+ March+ 8,+2018
11:39+AM
What are the names of the different theories of the etiology of Dissociative
Identity Disorder? (select all that apply)
Psychological+modelA.
Sociocognitive*modelB.
Posttraumatic*modelC.
Stress+Response+modelD.
What is believed to precipitate DID symptom presentation?
Genetic+predispositionA.
Substance+abuseB.
Extreme*childhood*trauma*or*abuseC.
Severely+elevated+social+anxietyD.
Dissociative*disorders:+sudden+disruption+in+the+continuity+of+consciousness,+memory+
or+identity
Dissociation:+some+aspect+of+cognition+or+experience+becomes+inaccessible+to+
consciousness;+avoidance+response
Not+always+a+bad+thing
Ex:+if+you+get+in+a+fist+fight+and+get+hit,+you+won't+feel+them+as+
intensely+to+shut+down+pain+responses+because+it's+not+helpful+to+
feel+the+pain+in+the+middle+of+the+fight
§
Can+be+adaptive+or+necessary+at+times
§
○
In+the+disorder,+it's+when+the+normal+process+goes+too+far
○
•
Depersonalization/derealization*disorder:+alteration+in+the+experience+of+the+
self+and+reality
•
Dissociative*amnesia:+lack+of+conscious+access+to+memory,+typically+of+a+
stressful+experience
The+fugue+subtype+–more+severe
○
•
Dissociative*identity*disorder:+at+least+two+distinct+personalities+that+act+
independently+of+each+other
Used+to+be+called+multiple+personality+disorder
○
•
Dissociative+identity+disorder+(DID)
Two+or+more+distinct+and+fully+developed+personalities+(alters)
Each+has+unique+behaviors,+memories,+and+relationships
○
Can+have+different+handed-ness,+eye+sight,+allergies,+handwriting+
○
•
Memory+gaps+are+common+for+periods+of+time+when+alters+are+in+control
Other+symptoms:+headaches,+hallucinations,+self+harm,+suicide+attempts
○
Alters+may+not+know+other+alters+exist
○
•
Not+very+well+studied+because+it's+controversial+if+it+exists
Mostly+based+on+case+studies
○
•
Typical+onset+in+childhood
Rarely+diagnosed+until+adulthood
○
•
More+severe+than+other+dissociative+disorders
Recovery+may+be+less+complete
○
•
More+common+in+women+than+men
•
Often+comorbid+with+PTSD,+MDD,+BPD,+substance+abuse,+and+phobias
•
DSM-5+criteria+for+Dissociative+Identity+Disorder+(DID)
Disruption*of*identity characterized+by+two*or*more*distinct*personality*states,+
which+may+be+described+in+some+cultures+as+an+experience+of+possession
The+disruption+in+identity+involves+marked+discontinuity+in+sense+of+self+
and+sense+of+agency,+accompanied+by+related+alterations+in+affect,+
behavior,+consciousness,+memory,+perception,+cognition,+and/or+motor+
functioning
○
These+signs+and+symptoms+may+be+observed+by+others+or+reported+by+the+
individual
○
1.
Recurrent*gaps*in*the*recall of+everyday+events,+important+personal+
information,+and/or+traumatic+events+that+are+inconsistent+with+ordinary+
forgetting
2.
The+symptoms+cause+clinically*significant*distress*or*impairment in+social,+
occupational,+or+other+important+areas+of+functioning
In+children,+not+explained+by+imaginary+friends+or+fantasy+play
○
3.
The+disturbance+is not a+normal+part+of+a+broadly+accepted cultural*or*religious*
practice
4.
Symptoms+are+not*attributable to+the+physiological+effects+of+a+substance*or*
another*medical*condition
5.
History
Almost+no+identified+reports+of+DID+before+1800
Existence+and+well+documented+for+a+lot+of+other+disorders,+but+not+DID
○
Could+have+cultural+construction
○
•
Marked+increase+since+the+1970s
Media+popularization
The+three+faces+of+Eve,+Sybil
§
○
•
Didn't+appear+in+the+DSM+until+DSM-III+in+1980
Diagnostic+criteria+ and+growing+literature+ may+have+increased+detection+
and+recognition+of+symptoms
○
•
Etiology
Posttraumatic+model
DID+results+from+severe+psychological+and/or+sexual+abuse+in+childhood
Your+sense+of+personality+is+still+being+formed+in+childhood
○
More+plastic+or+malleable+at+that+age+
Creates+greater+possibility+for+the+split
§
○
•
Adaptive+response+to+extremely+traumatic+situations•
Socio-cognitive+model
DID+is+a+form+of+role-play+in+suggestible+individuals•
Occurs+in+response+to+prompting+by+therapists+or+media
Alters+tend+to+be+discovered+in+psychotherapy+treatment
○
Raises+question+of+if+it's+created+in+treatment+
○
In+any+psychotherapy,+you+take+someone's+narrative+and+reshape+it+
Consider+the+world+in+a+slightly+different+way
§
An+extreme+version+of+this+by+creating+new+personalities
§
○
•
No+conscious+deception•
Analogy+of+split+brain+patients
Split-brain+patients+have+undergone+surgery+to+cut+the+corpus+callosum,+
the+main+bundle+of+neuronal+fibers+connecting+the+two+sides+of+the+brain
○
Form+of+epilepsy+only+treated+by+severing+corpus+callosum+that+connects+
the+two+hemispheres
Seizures+went+away+but+the+right+and+left+hemispheres+couldn't+
communicate+directly
§
Used+to+study+lateralization+of+function+in+the+brain
§
By+covering+one+eye,+you+could+only+show+one+hemisphere+
information+and+see+what+happens
§
○
Left+hemisphere+focuses+on+language+and+ability+to+say+things
Can+read
§
○
Right+hemisphere+can+read+but+doesn't+talk
○
Could+selectively+send+a+message+to+either+the+right+or+left+brain
Show+left+hemisphere+a+sign+that+says+stand+up+now+and+they+did+so+
because+they+read+it
§
Show+right+hemisphere+a+sign+that+says+stand+up+and+they+stand+up+
and+they+made+up+a+reason
"I+thought+it+was+time+to+go,"+"I+wanted+to+get+a+sandwich"□
§
Shows*we*are*all*making*up*a*story*to*fit*the*data*given*to*us*all*
the*time
§
Left+hemisphere+didn't+know+that+it+didn't+know+it+didn’t+have+all+the+
information+needed+to+explain+behavior+and+found+a+reason+why
§
○
We+have+times+where+we+surprise+ourselves+
Say+something+you+didn't+expect
§
Don't+know+how+you+ended+up+places
§
○
Your+interpretations+of+that+is+that+I+did+something+unusual+for+me
If+the+situations+get+so+extreme+and+unpredictable,+you+can+start+to+
wonder+if+you+even+did+that+or+if+someone+else+was+there
§
The+normal+processes+of+which+we+make+sense+and+build+a+model+
what+we're+likely+to+do+and+who+we+are+and+how+in+extreme+
circumstances+that+may+start+to+break+down+a+little+ bit
§
○
•
Evidence+raised+in+theory+debate
DID+can+be+role-played
Hypnotized+students+prompted+to+reveal+ alters+did+so
§
○
DID+patients+show+only+partial+implicit+ memory+deficits
Alters+"share"+memories
§
○
Majority+of+DID+cases+are+diagnosed+by+a+small+number+of+clinicians
○
For+many,+symptoms+emerge+after+therapy+begins
○
•
Treatment
Most+treatments+involve:
Empathetic+and+supportive+therapist+who+guides+integration+of+alters+into+
one+fully+functioning+individual
○
Improvement+of+coping+skills
○
•
Psychodynamic+approach+adds:
Re-experience+ the+traumatic+event
Use+hypnosis+(might+actually+worsen+symptoms)
§
○
•
No+evidence+for+psychotherapy
Not+a+lot+of+evidence+that+treatment+is+effective
○
Best+thing+would+be+if+someone+can+recognize+and+live+with+the+alters
○
•
Dissociative*Disorders
Thursday,+ March+ 8,+2018 11:39+AM
Document Summary
What are the names of the different theories of the etiology of dissociative. Dissociative disorders: sudden disruption in the continuity of consciousness, memory or identity. Dissociation: some aspect of cognition or experience becomes inaccessible to consciousness; avoidance response. Ex: if you get in a fist fight and get hit, you won"t feel them as intensely to shut down pain responses because it"s not helpful to feel the pain in the middle of the fight. In the disorder, it"s when the normal process goes too far. Depersonalization/derealization disorder: alteration in the experience of the self and reality. Dissociative amnesia: lack of conscious access to memory, typically of a stressful experience. Dissociative identity disorder: at least two distinct personalities that act independently of each other. Two or more distinct and fully developed personalities (alters) Can have different handed-ness, eye sight, allergies, handwriting. Memory gaps are common for periods of time when alters are in control.
