Tiêu đề 08 AbPsy - Dissociative Disorders.pdf ✅

08 – Dissociative Disorders ABPSY | 2024 - 2025 | NOT FOR SALE OUTLINE 1. Dissociative Identity Disorder 2. Depersonalization/Derealization Disorder 3. Dissociative Amnesia DISSOCIATIVE IDENTITY DISORDER DEFINING DISSOCIATIVE IDENTITY DISORDER (DID) Dissociative Identity Disorder – presence of two or more distinct personality states (or experience of possession) and recurrent episodes of amnesia ● Individuals with DID commonly minimize the impact of their dissociative and posttraumatic symptoms ● Full disorder may first manifest at almost any age (from earliest childhood to late life) ● Children present primarily with overlap and interference among mental states ● Prevalence across genders was 1.6% for males and 1.4% for females DIAGNOSTIC CRITERIA A. 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 sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual. B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play. E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures). CAUSES / RISK FACTORS Environmental Risks ● Interpersonal physical and sexual abuse ● Other forms of traumatizing experiences, including childhood medical and surgical procedures, war, childhood prostitution, and terrorism Suicide Risk ● Multiple attempts are common, and other self-injurious behavior is frequent ● Assessment of suicide risk may be complicated if presenting identity is unaware that other dissociated identities do Course Modifiers ● Ongoing abuse ● Later-life retraumatization ● Comorbidity with mental disorders ● Severe medical illness ● Delay in appropriate treatment DIAGNOSTIC ISSUES Gender ● Females predominate in adult clinical settings only ● They also present more frequently with acute dissociative states ● Males commonly exhibit more criminal or violent behaviors ● Common triggers include combat, prison conditions, and physical/sexual assaults Culture ● Fragmented identities may take the form of possessing spirits, deities, demons, animals, or mythical figures ● Acculturation or prolonged intercultural contact may shape the characteristics of the other identities DIFFERENTIAL DIAGNOSIS AND COMORBIDITY Major Depressive Disorder ● Although some may experience depressed symptoms, depressed mood and cognitions fluctuate ● These depressed mood and conditions may be experienced in some identities but not others Bipolar II Disorder ● Shifts in mood is rapid in DID while mood changes are slower in Bipolar Disorders ● Depressed moods are also usually in conjunction with overt identities 1 | @studywithky
Posttraumatic Stress Disorder ● Clinician establish the presence or absence of dissociative symptoms that are not characteristic of acute stress disorder or PTSD DID PTSD Amnesias for many everyday events Dissociative flashbacks that may be followed by amnesia for the content of the flashback Disruptive intrusions by dissociated identity states into the individual's sense of self and agency Infrequent, full-blown changes among different identity states Amnesia for some aspects of trauma Dissociative flashbacks relating to traumatic event Symptoms of intrusion and avoidance, negative alterations in cognition and mood, and hyperarousal that are focused around the traumatic event Psychotic Disorder ● Certain symptoms in DID may be mistaken for psychotic hallucinations ● However, these symptoms are caused by alternate identities, do not have delusion explanations, and often describe symptoms in a personified way Comorbidity ● Posttraumatic Stress Disorder ● Depressive Disorders ● Trauma- and Stressor-Related Disorders ● Personality Disorders (avoidant and borderline) ● Somatic Symptom Disorder ● Eating Disorders ● Substance-Related Disorders ● Obsessive-Compulsive Disorder ● Sleep Disorders TREATMENT Psychological Treatments ● Patient must identify cues or triggers that provoke memories of trauma, dissociation, or both, and to neutralize them ● Patient must confront and relive the early trauma and gain control over the horrible events ● Therapist must help the patient visualize and relive aspects of the trauma until it is simply a terrible memory ● Hypnosis: to access unconscious memories and bring various alters into awareness DEPERSONALIZATION/DEREALIZATION DISORDER DEFINING DEPERSONALIZATION/DEREALIZATION DISORDER Depersonalization/Derealization Disorder – persistent depersonalization and/or derealization accompanied by intact reality testing ● Depersonalization:unreality or detachment from oneself ● Derealization: unreality or detachment from one’s surroundings ● The mean age at onset of depersonalization/derealization disorder is 16 years but can start in early or middle childhood DIAGNOSTIC CRITERIA A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both: 1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing). 2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted). B. During the depersonalization or derealization experiences, reality testing remains intact. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures). E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder. CAUSES / RISK FACTORS Temperamental Risks ● Characterized by harm-avoidant temperament, immature defenses, and both disconnection and overconnection schemata ● Immature defenses such as idealization/devaluation, projection and acting out result in denial of reality and poor adaptation 2 | @studywithky
● Cognitive Disconnection Schemata: reflect defectiveness and emotional inhibition and subsume themes of abuse, neglect, and deprivation ● Overconnection Schemata: involve impaired autonomy with themes of dependency, vulnerability, and incompetence Environmental Risks ● The most common proximal precipitants are ○ Severe stress (interpersonal, financial, occupational) ○ Depression and anxiety (particularly panic attacks) ○ Illicit drug use (tetrahydrocannabinol, hallucinogens, ketamine, MDMA, salvia, marijuana) ● Emotional abuse and emotional neglect have been most strongly and consistently associated with the disorder ● Other stressors can include physical abuse witnessing domestic violence, growing up with a seriously impaired, mentally ill parent, or unexpected death or suicide of a family member or close friend ● Sexual abuse is a much less common antecedent but can be encountered DIFFERENTIAL DIAGNOSIS AND COMORBIDITY Anxiety Disorder ● Depersonalization/derealization symptoms may occur during panic attacks ● Depersonalization/derealization disorder should not be diagnosed when the symptoms occur only during panic attacks that are part of panic disorder, social anxiety disorder, or specific phobia ● Diagnosis of depersonalization/derealization disorder can be made if ○ The depersonalization/derealization component of the presentation is very prominent from the start, clearly exceeding in duration and intensity the occurrence of actual panic attacks ○ The depersonalization/derealization continues after panic disorder has remitted or has been successfully treated Substance/Medical-Induced Disorder ● If the symptoms persist for some time in the absence of any further substance or medication use, the diagnosis of depersonalization/derealization disorder applies Psychotic Disorder ● Presence of intact reality testing specifically regarding the depersonalization/derealization symptoms is essential to differentiating Comorbidity ● High for unipolar depressive disorder and for any anxiety disorder ● Comorbidity with posttraumatic stress disorder was low ● The three most commonly co-occurring personality disorders were avoidant, borderline, and obsessive-compulsive TREATMENT Psychological Treatments ● Psychological treatments similar to those for panic disorder may be helpful ● Stresses associated with onset of disorder should be addressed DISSOCIATIVE AMNESIA DEFINING DISSOCIATIVE AMNESIA Dissociative Amnesia – inability to recall autobiographical information which may be generalized, localized, or selective, and may or may not involve dissociative fugue ● Individuals tend to be frequently unaware/partially aware of their memory problems ● Some may report depersonalization and auto-hypnotic symptoms ● Common in women (2.6%) than men (1.0%) Types of Amnesia ● Localized Amnesia: failure to recall events during a circumscribed period of time; most common ● Selective Amnesia: can recall selected events but not others ● Generalized Amnesia: complete loss of memory for one's life history; rarest form ○ Has an acute onset ○ Causes disorientation that may lead them to wander purposelessly ○ In this case, they may require the attention of the police or psychiatric emergency services ○ Common among combat veterans, sexual assault victims, and individuals experiencing extreme emotional stress or conflict ● Systematized Amnesia: loss of memory in a specific category of information (ex. Identity, person, childhood abuse) ● Continuous Amnesia: loss of memory in each new event as it occurs ● Global Amnesia: cannot recall both past and present; total memory loss Memory Disorders ● Anosognosia: no memories of his own illness ● Confabulation: filling in memory gaps with imaginary experiences 3 | @studywithky