Dissociative Amnesia and Fugue

Dissociative Amnesia

• Characterized by a sudden inability to recall important personal information, beyond normal forgetfulness
• Typically involves the inability to recall information of a traumatic or stressful nature
• Memory loss that is too extensive to be explained by normal forgetting

Forms of Dissociative Amnesia

• Localized: Amnesia for a specific event or period
• Selective: Amnesia for some parts of an event
• Generalized: Amnesia for the entire life history

Dissociative Fugue

• A specifier involving sudden, unexpected travel
• Associated with an inability to recall one's past
• Accompanied by confusion about personal identity or assumption of a new identity

Additional Diagnostic Criteria

• Causes significant distress or impairment
• Not attributable to other conditions such as substance use, neurological issues, or psychological conditions
• Psychogenic in nature

Differential Diagnosis

• Should be distinguished from PTSD, acute stress disorder, somatic symptom disorder, and borderline/histrionic personality disorders
• Ruled out when due to medical conditions like seizures, head injuries, or substance use

Comorbidities

• May co-occur with dissociative disorders, PTSD, acute stress disorder, somatic symptom disorders, and certain personality disorders like borderline and histrionic

Causes and Treatment

• Psychological trauma serves as a common precipitating factor
• Theoretical models often emphasize trauma-related memory repression
• Treatment commonly involves trauma-focused psychotherapy

Depersonalization/Derealization Disorder

• Involves the sustained presence of depersonalization or derealization

Depersonalization

• Characterized by experiences of unreality, detachment, or being an outside observer of oneself
• Involves unusual sensory experiences like body part distortion or an echoey voice
• May include watching oneself from outside or a floating sensation

Derealization

• Characterized by experiences of unreality or detachment from surroundings
• World feels dream-like, strange, and unreal
• Objects may appear distorted in shape or size

Additional Symptoms & Facts

• Reality testing remains intact
• Symptoms are persistent or recurrent
• Not better explained by drugs, medical conditions, or other psychological disorders
• Typically emerges in adolescence, and may follow a chronic course

Differential Diagnosis & Comorbidities

• It's crucial to rule out substance-induced symptoms, other dissociative disorders, and psychosis
• Key difference from psychosis is preserved reality testing
• Can be comorbid with anxiety and major depressive disorder
• Often triggered by stress

Dissociative Identity Disorder (DID)

• Formerly called multiple personality disorder
• Characterized by presence of two or more distinct personalities within one individual

Disruptions of Identity Reflected

• Cognition
• Behavior
• Affect
• Memory
• Perception
• Consciousness
• Sensory-motor functioning

DID Signs and Symptoms

• Recurrent gaps in memory for everyday events, personal info, or traumatic events
• Not a normal part of cultural or religious practice
• Not due to drugs, medical conditions, or fantasy play in children
• Causes significant distress or impairment

Differential Diagnosis and Demographics

• Must differentiate from other dissociative disorders, psychotic disorders, seizure disorders, PTSD, and borderline personality disorder
• More common in women than men
• Often not diagnosed until adulthood
• Symptoms usually begin in childhood
• Patients experience a less complete rate of recovery, and DID is more severe than other dissociative disorders

DID Comorbidities, Causes and Treatment

• Comorbidities include PTSD, major depressive disorder, borderline personality disorder, substance use disorders, and somatic symptom disorders
• Posttraumatic Model: DID results from severe childhood trauma, often sexual or physical abuse
• Sociocognitive Model: DID is iatrogenic, developing via suggestion, media, and therapist influence, but no conscious deception is involved.
• Integration of alters into a unified self is a goal, also improved coping skills. Most treatments included supportive therapy and processing traumatic memories (often through hypnosis, age regression, psychoanalysis)
• Empathic and supportive therapeutic relationships are crucial, as is it may worsen symptoms or encourage role-playing of alters.

Somatic Symptom Disorder

• Diagnosis defined by excessive concern and help-seeking regarding physical symptoms
• At least one distressing or disruptive somatic symptom
• Excessive thoughts, feelings, or behaviors related to health concerns, with at least two of: health-related anxiety, disproportionate concerns about seriousness, and excessive time and energy devoted to symptoms
• Symptoms must be persistent for at least 6 months
• Must rule out medical causes and other mental disorders, and not be due to malingering or factitious disorder

Somatic Symptom Disorder Facts

• Onset typically in early adulthood
• Often chronic
• More common in women
• Comorbidities include mood, anxiety, and depression disorders
• Anterior insula and anterior cingulate hyperactivity
• Cognitive-Behavioral: Attention to bodily sensations, catastrophic interpretations, and reinforcement via attention/sick role
• Treatments: Cognitive Behavioral Therapy and Antidepressants such asTricyclics (e.g., Imipramine)

Illness Anxiety Disorder

• Involves unwarranted fears about a serious illness in the absence of any significant somatic symptoms

Symptoms

• Preoccupation with having/acquiring serious illness
• High health anxiety
• Maladaptive behaviors (e.g., checking) or avoidance
• Few or no somatic symptoms

Differentiation

• It is differentiated from somatic symptom disorder by having few/no somatic symptoms

Additional Illness Anxiety Disorder Points

• Onset in early to middle adulthood
• Often chronic
• Comorbidities include anxiety and depressive disorders
• Shares similar cognitive-behavioral factors as somatic symptom disorder
• No distinct brain or genetic information provided
• Treatment is similar to somatic symptom disorder, with CBT and antidepressants often used

Conversion Disorder

• Neurological symptom(s) that cannot be explained by medical disease or culturally sanctioned behavior

Conversion Disorder Presentation

• One or more neurological symptoms (e.g., paralysis, seizures) with no medical explanation
• Symptoms that are inconsistent with known medical conditions
• Causes distress or impairment

Facts for Conversion Disorder

• Must rule out genuine neurological disorders, as symptoms are often anatomically inconsistent
• Typically emerges in adolescence or early adulthood
• More common in women
• Prevalence is less than 1%
• Often follows stress
• More prevalent in rural areas, low SES, and non-Western cultures
• Comorbidities include major depressive disorder, substance abuse, and personality disorders
• Has historically psychoanalytic with no empirical support, also involving cultural and social factors

Factitious Disorder

• Involves falsification of psychological or physical symptoms

Characteristics of Factitious Disorder

• Falsification of physical/psychological symptoms
• Behavior occurs without obvious external rewards
• Can be imposed on self or another (e.g., Munchausen by proxy)
• Must be distinguished from malingering (intentional with external gain)

Malingering

• Intentionally faking psychological or somatic symptoms to gain from those symptoms
• Involves intentional production of false or exaggerated symptoms
• Motivated by external incentives (e.g., avoiding work, obtaining drugs)
• Distinguished from factitious disorder by the presence of external rewards
• Not applicable (intentional behavior)