Dissociative Disorders Unless otherwise indicated, answers are from DSM-IV-TR or First and Tasman As...
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Transcript of Dissociative Disorders Unless otherwise indicated, answers are from DSM-IV-TR or First and Tasman As...
Dissociative Disorders
Unless otherwise indicated, answers are from DSM-IV-TR or First and
TasmanAs of 1Sep07
Memory types
Ans. There are different terms used.
declarative and procedural
explicit and implicit
episodic and semantic
We will use declarative and procedural in these screens.
Memory - dissociative
Ans. Declarative. The patient still has the memory, for example, to drive a car even though they may not remember their name.
Classification
Ans.
1. Dissociative amnesia
2. Dissociative fugue
3. Dissociative identity disorder
4. Depersonalization disorder
[also, dissociative trance disorder is in the DSM appendix of disorders in need of research.]
Dissociative amnesia - basic
Ans. An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.
Dissociative amnesia prevalence
Q. There is a controversy as to the prevalence of this disorder. State the controversy.
Prevalence
Ans. The increase of reported cases is attributed by some to greater clinician awareness. Others claim that the increase is the result of greater suggestibility.
Treatment of dissociative amnesia
Ans.
Place in safe environment
Hypnosis, e.g., age regression
Or
supportive psychotherapy of integrating memories into consciousness
Dissociative fugue - basic
Ans. A sudden, unexpected travel away from one’s customary place of daily activities, with inability to recall some or all of one’s past.
Fugue’s course
Ans. May last for hours to months. Recovery is rapid, but refractory amnesia may persist.
Treatment of fugues
Ans.
First and Tasman prefer hypnosis.
Some examiners may also like to use medication-facilitated [e.g., Amytal] interviews.
Supportive psychotherapy is also used.
DID - basic
Ans. The pt has two or more distinct identities or personality states that recurrently take control of behavior.
DID - prevalence
Ans. Controversial as some believe the increase is the result of clinician suggestion.
DID - course
Ans. Average time between onset and dx is 6-7 years, and course is episodic or continuous. Episodic is associated with untoward events.
DID treatment
Ans. Supportive, extensive, psychotherapy directed at integrating the personalities. In doing so, addressing past traumas may become key; but any suggestions as to trauma is seen as iatrogenic by some. Also used as adjuncts:
hypnosis
SSRIs when dysphoria is part of the presentation
Depersonalization - prevalence
Ans. About half of all adults have had such an experience, usually precipitated by severe stress.
Depersonalization - course
Ans. Mean age of onset is 16 and course is usually chronic, exacerbating in association with actual or perceived stress.
Depersonalization - treatment
Ans. Medications for the co-morbid condition may suffice. Anxiolytics may work, but watch for side effect of depersonalization that may actually increase with these meds. Hypnosis is another option.
Dissociative trance disorder - basic
Q. Basic feature of this disorder?
BEING IN THE DSM APPENDIX MAKES THIS A VERY UNLIKELY EXAM TOPIC.
Dissociative trance disorder - basic
Ans. Patient has an involuntary state of trance causes significant distress and is not part of the individual’s cultural practice.