Chapter 8 Somatic Symptom and Dissociative Disorders PDF

9/8/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 8 SOMATIC SYMPTOM AND DISSOCIATIVE DISORDERS Copyright...

9/8/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 8 SOMATIC SYMPTOM AND DISSOCIATIVE DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-2 2 1  9/8/2024 LEARNING OBJECTIVES 8.1 Describe the similarities and differences between the two categories of somatic symptom and dissociative disorders and the various ways in which these conditions have been understood historically 8.2 Identify the features, causes and treatments of the primary disorders in the ‘somatic symptom and related disorders’ category 8.3 Identify the features, causes and treatments of the primary disorders in the ‘dissociative disorders’ category Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-3 3 Somatic Symptom and Dissociative Disorders Somatic symptom and related disorders: – Prominent somatic symptoms, preoccupation and worry about an illness and/or excessive help seeking behaviour Dissociative disorders: – The loss of the normal integration of identity, memory, perception, emotion, behaviour, consciousness, body representation and/or motor control Both involve some dissociation or disconnection between mental awareness and another part of the normally integrated mental system Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-4 4 2  9/8/2024 Somatic Symptom and Dissociative Disorders Separate chapters in the DSM. Why in the same book chapter? Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-5 5 Historic Approaches to these Disorders Historical Commonality - some somatic symptom and dissociative disorders are very strongly historically linked and may share common features. Some used to be categorized (in DSM-II) under one general heading, “hysterical neurosis”. The term “hysteria” (from the Greek “wandering uterus”) referred to physical symptoms without organic basis (somatic symptom disorders) or to dissociative experiences (alterations in consciousness, memory, or identity). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-6 6 3  9/8/2024 Historic Approaches to these Disorders Earliest researchers included Sigmund Freud, Joseph Breuer, Pierre Janet, Morton Prince, William James.  Both disorders may be disruptions in the normal controlling functions of consciousness.  Today some researchers (e.g., Nijenhuis) distinguish between somatoform dissociation and psychoform (i.e., psychological) dissociation. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-7 7 CHAPTER 8 SOMATIC SYMPTOM AND DISSOCIATIVE DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-8 8 4  9/8/2024 Somatic Symptom and Related Disorders Previously (in DSM) called Somatoform Disorders Fairly Substantial Changes in DSM-5 (and 5-TR) – Body Dysmorphic Disorder moved to OCD and Related Disorders. – Hypochondriasis, Somatisation Disorder renamed and majorly revised – Pain Disorder removed as separate diagnosis – Factitious Disorder added to this section – Psychological Factors affecting other medical conditions added to this section Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-9 9 Somatic Symptom and Related Disorders Psychological problems take a physiological form – ‘Soma’ means body Historically, the idea was that the bodily symptoms had no known physical cause. Now, in the DSM-5, persons “may or may not have a diagnosed medical condition”. Not intentionally produced or under voluntary control (except in the case of factitious disorder) Individuals may seek medical, not psychological, treatment. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-10 10 5  9/8/2024 DSM-5 Somatic Symptom and Related Disorders Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Factitious Disorder Psychological Factors affecting other medical conditions Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-11 11 DSM-5 Somatic Symptom and Related Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-12 12 6  9/8/2024 DSM-5 Somatic Symptom and Related Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-13 13 DSM-5 Somatic Symptom and Related Disorders With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-14 14 7  9/8/2024 DSM-5 Somatic Symptom and Related Disorders Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Factitious Disorder Psychological Factors affecting other medical conditions Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-15 15 Somatic Symptom Disorder DSM-5: one in which the individual experiences one or more debilitating somatic symptoms. These symptoms are accompanied by abnormal thoughts, feelings and behaviours. These abnormal reactions include persistent worry about symptoms and spending excessive time and energy over health concerns. What was previously called somatisation disorder (Briquet’s Syndrome) would fit into this category, but it involved the presence of several symptoms. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-16 16 8  9/8/2024 Somatic Symptom Disorder DSM-5-TR Criteria A. One or more somatic symptoms that are distressing or result in significant disruption of daily life. B. Excessive thoughts, feelings, or behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of the following. 1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms. 2. Persistently high level of anxiety about health or symptoms. 3. Excessive time and energy devoted to these symptoms or health concerns. C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-17 17 DSM-5 Somatic Symptom and Related Disorders Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Factitious Disorder Psychological Factors affecting other medical conditions Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-18 18 9  9/8/2024 Illness Anxiety Disorder Preoccupation with having or getting a serious illness Somatic symptoms are not prominent. High levels of health anxiety and excessive health-related behaviours are present. Close to what was called Hypochondriasis. The individual may worry about a particular disease/illness, or a number of different types If a medical condition is present, the level of preoccupation is excessive Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-19 19 Illness Anxiety Disorder: DSM-5-TR Criteria A. Preoccupation with having or acquiring a serious illness. B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate. C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status. D. The individual performs excessive health-related behaviours (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals). E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time. F. The preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder. Specify if: care seeking type or care-avoidant type. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-20 20 10  9/8/2024 DSM-5 Somatic Symptom and Related Disorders Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Factitious Disorder Psychological Factors affecting other medical conditions Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-21 21 Conversion Disorder “Functional Neurological Symptom Disorder” Symptoms of altered motor or sensory functioning Not consistent with any recognised medical condition. Causes significant distress and/or impairment. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-22 22 11  9/8/2024 Conversion Disorder: DSM-5-TR Criteria A. One or more symptoms of altered voluntary motor of sensory function. B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. C. The symptom or deficit is not better explained by another medical or mental disorder D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation. Can be: With weakness or paralysis, abnormal movement, swallowing symptoms, speech symptoms, attacks or seizures, anaesthesia or sensory loss, special sensory symptoms, or mixed symptoms. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-23 23 Conversion Disorder: Overview Overview and Defining Features – Physical malfunctioning – Lack physical or organic pathology – Malfunctioning often involves sensory-motor areas – Persons may show “la belle indifference” – Retain most normal functions, but lack awareness – Rule out malingering and factitious disorder (more later) Facts and Statistics – Rare condition, with a chronic intermittent course – Seen primarily in females – Onset usually in adolescence or earlier – May be less common now than in previous years Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-24 24 12  9/8/2024 Conversion Disorder: Aetiology and Treatment Aetiology – Freudian psychodynamic view is still popular – Focus on past trauma and conversion – Detachment from the trauma and negative reinforcement – Primary / secondary gain Treatment – Core strategy is attending to the trauma – Remove sources of secondary gain – Reduce supportive consequences of talk about symptoms Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-25 25 DSM-5 Somatic Symptom and Related Disorders Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Factitious Disorder Psychological Factors affecting other medical conditions Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-26 26 13  9/8/2024 Factitious Disorders Factitious disorder, imposed on the self: – Fabrication of psychological or medical symptoms – May involve induction of injury or disease in oneself or others and presenting of oneself or others as ill – This behaviour does not appear to have any obvious external reward – Has been known as ‘Munchausen’s syndrome’ Factitious disorder, imposed on another: – An individual induces illness in another – Has been known as ‘Munchausen’s by proxy’ Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-27 27 Factitious Disorders versus Malingering Malingering - “The intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such a avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs” (APA, 2022). Not a disorder but an antisocial behaviour that might be associated with antisocial personality disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-28 28 14  9/8/2024 Malingered Physical or Psychological Symptoms Typically to: Avoid responsibility or punishment (e.g., feign psychosis) Get money (e.g., insurance co., disability, or lawsuit - may be brain damage but could be anything) Get drugs (anxiety, ADHD, pain) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-29 29 Factitious Disorder Fabrication of psychological or medical symptoms May involve induction of injury or disease in oneself or others and present themselves or others as ill. External incentives for the behaviour (such as economic gain, avoiding legal responsibility, or improving physical well-being, as in Malingering) are absent. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-30 30 15  9/8/2024 Factitious Disorder - DSM-5 Criteria Factitious Disorder Imposed on Self A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. B. The individual presents himself or herself to others as ill, impaired, or injured. C. The deceptive behaviour is evident even in the absence of obvious external rewards. D. The behaviour is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-31 31 Factitious Disorder - DSM-5 Criteria Factitious Disorder Imposed on Another (previously Factitious Disorder by Proxy) A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception. B. The individual presents another individual (victim) to others as ill, impaired, or injured. C. The deceptive behaviour is evident even in the absence of obvious external rewards. D. The behaviour is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-32 32 16  9/8/2024 Factitious Disorder Presentation may Involve A factitious history. A feigned presentation (e.g., complaints of stomach pains or headaches). Self-inflicted patho-physiology (as in injecting noxious substances into body tissues to produce swellings). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-33 33 Factitious Disorder: Descriptive Data Epidemiological data virtually non-existent Estimates in psychiatric or medical settings range from quite low (.3%,.6%,.8%) to relatively common (6%). Often claimed to be more common among men, but that’s hard to substantiate. There may be subtypes that are related to gender Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-34 34 17  9/8/2024 Aetiology of Factitious Disorder “It is difficult to construct one theory that can explain the self- destructiveness of injecting oneself with parrot feces, the grandiosity of claiming to be an oceanographic physicist working with Jacques Cousteau, the passivity of submitting to 48 lumbar punctures, the skill to stop breathing to unconsciousness, and the wanderlust for 423 admissions” (Pankratz, 1981, p. 74). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-35 35 Proposed Motivations for Factitious Behaviour Need to be the centre of attention Longing to be cared for Maladaptive reaction to loss or separation Anger at physicians or displaced onto physicians (from families) Derived pleasure from deceiving others Achieving control in a life dominated by chaos Masochism as a response to guilt about angry or sexual feelings Re-enactments of abuse scenarios (attempt at mastery) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-36 36 18  9/8/2024 DSM-5 Somatic Symptom and Related Disorders Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Factitious Disorder Psychological Factors affecting other medical conditions Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-37 37 Psychological Factors affecting Other Medical Conditions - DSM-5-TR Criteria A. A medical symptom or condition (other than a mental disorder) is present. B. Psychological or behavioural factors adversely affect the medical condition in one of the following ways. 1. The factors have influenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition. 2. The factors interfere with the treatment of the medical condition (e.g., poor adherence). 3. The factors constitute additional well-established health risks for the individual. 4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention. C. The psychological and behavioural factors in Criterion B are not better explained by another mental disorder. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-38 38 19  9/8/2024 Psychological Factors Afecting Other Medical Conditions Factors might include: – Psychological distress – Interpersonal style – Coping styles – Maladaptive health behaviours Examples – Anxiety exacerbating asthma – Denial of need for treatment – Manipulating insulin to lose weight Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-39 39 CHAPTER 8 SOMATIC SYMPTOM AND DISSOCIATIVE DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-40 40 20  9/8/2024 A Definition Dissociation is The Opposite of Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-41 41 Dissociative Disorders Their defining feature is a disruption (disconnection) in the usually integrated (associated) functions of “consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior” (APA, 2022, p. 329). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-42 42 21  9/8/2024 DSM-5 Dissociative Disorders Depersonalisation/Derealisation Disorder Dissociative Amnesia Dissociative Identity Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-43 43 DSM-5 Dissociative Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-44 44 22  9/8/2024 The Dissociative Disorders With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-45 45 Dissociative Disorders: Previous Names  Dissociative Amnesia formerly Psychogenic Amnesia  Dissociative Fugue formerly Psychogenic Fugue  Dissociative Identity Disorder formerly Multiple Personality Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-46 46 23  9/8/2024 Dissociative Experiences Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-47 47 Dissociative Experiences Amnesia Depersonalisation Derealisation Identity Confusion Identity Alteration Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-48 48 24  9/8/2024 Dissociative Experiences Amnesia – A specific and significant block of time that has passed but that cannot be accounted for by memory Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-49 49 Dissociative Experiences Depersonalisation – Feeling of detachment from one’s self, e.g., a sense of being an outside observer of one’s self. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-50 50 25  9/8/2024 Dissociative Experiences Derealisation – Having a sense that one’s surroundings are unreal, strange, or unfamiliar Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-51 51 Dissociative Experiences Identity Confusion – Subjective feelings of uncertainty, puzzlement, or conflict regarding one’s own identity. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-52 52 26  9/8/2024 Dissociative Experiences Identity Alteration – The assumption of different identities (with objective behaviour indicating their presence) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-53 53 DSM-5 Dissociative Disorders Depersonalisation/Derealisation Disorder Dissociative Amnesia Dissociative Identity Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-54 54 27  9/8/2024 Depersonalisation/Derealisation Disorder Perception of self or surroundings is altered – Feelings of detachment or disconnection  Watching self from outside Floating above one’s body  Emotional numbing – Unusual sensory experiences  Limbs feel deformed or enlarged  Voice sounds different or distant Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-55 55 Depersonalisation/Derealisation Disorder: DSM-5-TR Criteria A. Persistent or recurrent episodes of depersonalisation, derealisation, or both. B. During the experience, reality testing remains intact. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other 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, PTSD, or another dissociative disorders. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 8-56 56 28  9/8/2024 Depersonalisation/Derealisation Disorder – Triggered by stress or traumatic event – A history of substance use sometimes – No psychosis or loss of memory – Relationship with anxiety unclear – Neurological explanations being explored – Typical onset in adolescence – Chronic course Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-57 57 Depersonalisation/Derealisation Disorder Relatively little is known regarding treatment – There are a few experimental medications, some of which seem to make symptoms worse. – Therapies may be similar as for panic disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-58 58 29  9/8/2024 DSM-5 Dissociative Disorders Depersonalisation/Derealisation Disorder Dissociative Amnesia Dissociative Identity Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-59 59 Dissociative Amnesia Inability to recall important personal information – Usually about a traumatic experience – Not ordinary forgetting – Not due to physical injury – May last hours or years Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-60 60 30  9/8/2024 Dissociative Amnesia: DSM-5-TR Criteria A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetfulness. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or medication) or a neurological or other medical condition (e.g., seizure disorder). D. The disturbance is not better explained by DID, PTSD or other disorders. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-61 61 Types of Dissociative Amnesia Localised – circumscribed period of time. Selective – bits and pieces. Generalised – entire life. Continuous – subsequent to event until present. Systematised – categories of information. With or without Fugue Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-62 62 31  9/8/2024 Dissociative Fugue Now considered a part of dissociative amnesia Amnesia plus flight – Latin fugere, “to flee” Sudden, unexpected travel with inability to recall one’s past – Assume new identity  May involve new name, job, personality characteristics – More often of brief duration – Remits spontaneously Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-63 63 Memory Deficits and Dissociation Distinguishing other causes of memory loss from dissociation: – Degenerative brain disorders  e.g., Alzheimer's Disease  Not linked to stress  Involves gradual decline over time  Accompanied by other cognitive deficits Inability to learn new information – Substance abuse  Linked to use of drug or alcohol Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-64 64 32  9/8/2024 Dissociative Amnesia and Fugue: Stats/Aetiology/Treatment Facts and Statistics - Dissociative Amnesia and Fugue – Usually begins or recognised in adulthood – Both may show rapid onset and dissipation – Both are seen more often in females Aetiology – Cognitive or physiological mechanisms not clear – Trauma and life stress can serve as triggers Treatment – Many get better without treatment – Many remember what they have forgotten – Helping remember viewed as controversial Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-65 65 DSM-5 Dissociative Disorders Depersonalisation/Derealisation Disorder Dissociative Amnesia Dissociative Identity Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-66 66 33  9/8/2024 Dissociative Identity Disorder (DID) Experience all the dissociative symptoms discussed (amnesia, depersonalisation, derealisation, identity confusion and alteration) Onset believed to be in childhood More severe than other dissociative disorders – Recovery may be less complete More common in women than men (probably) Often comorbid with: – PTSD, major depression, personality disorders, substance abuse, phobias Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-67 67 Dissociative Identity Disorder (DID) DSM-5-TR 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 disturbance in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behaviour, 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. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-68 68 34  9/8/2024 Dissociative Identity Disorder (DID) DSM-5 Criteria 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 (and in children the symptoms are not better explained by imaginary playmates of other fantasy play) E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behaviour during alcohol intoxication) or a medical condition. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-69 69 Dissociative Identity Disorder (DID) Epidemiology – Once believed to be very rare – Recent research suggests otherwise and similar to schizophrenia (i.e., around 1% prevalence) – Numerous possible reasons for increased reporting. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-70 70 35  9/8/2024 Aetiology of Dissociative Identity Disorder (DID): Two Major Theories Posttraumatic Model – DID results from severe trauma in childhood among people with a dissociative ability. Iatrogenic/sociocognitive/fantasy model – DID a form of role-play in suggestible, fantasy-prone individuals  Occurs in response to prompting by therapists or media  No conscious deception (i.e., not malingering or factitious) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-71 71 Aetiology of Dissociative Identity Disorder (DID): Two Major Theories Gleaves, D. H. (1996). The sociocognitive model of dissociative identity disorder: A reexamination of the evidence. Psychological Bulletin, 120, 42-59. Also Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardeña, E., Frewen, P. A., Carlson, E. B., & Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological Bulletin, 138, 550-588. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-72 72 36  9/8/2024 Trauma and DID 1) Vast majority (if not all) of persons report having experienced childhood trauma (which often can be verified). 2) Dissociative symptoms reliably associated with trauma. 3) Vast majority of DD patients also have diagnosable PTSD. 4) Some symptoms of PTSD are dissociative in nature. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-73 73 Treatment of Dissociative Identity Disorder (DID) Depends on “paradigm” of therapist. If proponent of the sociocognitive model, they ignore the symptoms. If proponent of the posttraumatic model, treatment is similar to that of PTSD, but taking into consideration the person’s fragmented sense of self and the initial need for stabilisation. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-74 74 37  9/8/2024 Treatment of Dissociative Identity Disorder (DID) Guidelines from the International Society for the Study of Trauma and Dissociation: 1) Establishing safety, stabilisation, and symptom reduction. 2) Confronting, working through, and integrating traumatic memories. 3) Identity integration and rehabilitation. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-75 75 Treatment of Dissociative Identity Disorder (DID) The Evidence for trauma-based approach – No RCTs – Large-scale uncontrolled studies – Clinician Surveys No meaningful evidence that treatment based on the iatrogenesis model is helpful. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-76 76 38  9/8/2024 Any Questions? If so, post them online Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 6-77 77 39