PSY206 Dissociative Disorders PDF

PSY206|Dissociative Disorders ψ Overview of Somatic Disorders and experienced a traumatic Dissociative Disorder event. “Somatic symptom and ○ It often arises from dissociative disorders used to...

PSY206|Dissociative Disorders ψ Overview of Somatic Disorders and experienced a traumatic Dissociative Disorder event. “Somatic symptom and ○ It often arises from dissociative disorders used to be childhood experiences of categorized as “hysterical abuse, neglect, neurosis.” abandonment, and Neurosis - as defined in trauma. psychoanalytic theory, suggested ○ Influence of social and a specific cause for certain cultural factors is strong in disorders. Specifically, neurotic dissociative disorders. disorders resulted from underlying Feelings of dissociation can be unconscious conflicts, anxiety that experienced into two types: resulted from those conflicts, and ★ Depersonalization - an the implementation of ego episode wherein a person’s defense mechanisms. perception alters so that ○ unconscious conflicts that they will temporarily lose stems from trauma their sense of reality, as if Hysterical - came to refer more they are in trance or dream generally to physical symptoms and they are watching without known organic cause or to themselves. dramatic or “histrionic” behavior ○ often part of a thought to be characteristic of broader set of women. dissociative disorders. ψ Dissociative Disorders ○ Key notes: out of extreme dissociation or dissociative body experience, experience. 3rd person Dissociative experience– like perspective. dreaming, detachment from ○ As if the external reality; people experience world is not real. occasional slight alterations, or ★ Derealization - A person’s detachments, in consciousness or sense of reality of the identity. external world is lost. Things characterized by involuntary may seem to change escape from reality characterized shape or size; people may by a disconnection between seem dead or mechanical. thoughts, identity, consciousness ○ an episode wherein and memory. your sense of reality ○ When a person dissociates is lost or distorted; from the reality out of contact with ○ Dissociation is normal in the environment; cases when a person feeling of alienation  PSY206|Dissociative Disorders to one’s Ø Depersonalization or environment; derealization occurs on its own dream-like (that is, it is not caused by drugs or experiences. another mental health disorder), ○ As if you are not and it persists or recurs. real. Ø The symptoms are very distressing to the person or make it 3 DISSOCIATIVE DISORDERS difficult for the person to function 1. Depersonalization-Derealization at home or at work. Disorder - involves a persistent or 2 weeks up to 1 month. recurring feeling of being Etiology/Reasons detached from one’s body or develops in people who have mental processes, like an outside experienced severe stress, observer of one's life including the following: (depersonalization), and/or a Ø Emotional abuse or neglect feeling of being detached from during childhood one's surroundings (derealization). Ø Physical abuse A person is experiencing Ø Experiencing or witnessing detachment with reality domestic violence and with oneself. Ø Having a severely impaired or Clinical Description mentally ill parent feelings of unreality are so severe Ø Unexpected death of a loved and frightening that they dominate one an individual’s life and prevent Symptoms can be triggered by normal functioning. severe stress (for example, due to feelings of depersonalization and relationships, finances, or work), derealization are part of several depression, anxiety, use of illicit disorders. But when severe drugs. However, in 25 to 50% of depersonalization and cases, the causes of stress are derealization are the primary relatively minor or cannot be problem, the individual meets identified. criteria for Treatment depersonalization-derealization Psychotherapy Disorder. Sometimes antianxiety medications marked by the presence of and antidepressants persistent and recurrent episodes Depersonalization/derealization of depersonalization, derealization, disorder may disappear without or both. treatment. Depersonalization/derealization People are treated only if the feelings are considered a disorder disorder persists, recurs, or causes when the following occur: distress.  PSY206|Dissociative Disorders The goal is to make a person be in recall important personal touch with reality (reason: would information. like to escape reality). memory loss is not Techniques that can help include the organically caused following: but rather due to Cognitive techniques can help stress and trauma. block obsessive thinking about the The forgetting is unreal state of being. selective for Behavioral techniques can help traumatic events or people become absorbed in tasks memories rather that distract them from the than generalized. depersonalization. Clinical Description Grounding techniques use the five lack of conscious access to senses (hearing, touch, smell, taste, memory, typically of a stressful and sight) to help people feel experience. The dissociative fugue more connected to themselves subtype involves loss of memory for and the world. For example, loud one’s entire past or identity. music is played or a piece of ice is Generalized Amnesia - People put in the hand. These sensations who are unable to remember are difficult to ignore, making anything, including who they are. It people aware of themselves in the may be lifelong or may extend present moment. from a period in the more recent Psychodynamic techniques focus past, such as 6 months or a year on helping people work through previously. intolerable conflicts, negative Far more common than general feelings, and experiences from amnesia is localized or selective which people feel they must amnesia, a failure to recall specific detach themselves. events, usually traumatic, that Moment-to-moment tracking and occur during a specific period. labeling of dissociation and affect seldom appears before (the outward expression of adolescence and usually occurs in emotions and thoughts) teaches adulthood. people to recognize and identify Is the most prevalent of all their feelings of dissociation. Such dissociative disorders. recognition helps some people. A subtype of dissociative amnesia This technique also helps people is referred to as dissociative fugue focus on what is actually with fugue literally meaning happening in the moment. “flight”. When an individual suddenly and unexpectedly travels 2. Dissociative Amnesia - is amnesia away from home or a customary (memory loss) caused by trauma or place of daily activities and is stress, resulting in an inability to unable to recall some or all of his or  PSY206|Dissociative Disorders her past; symptoms also include ○ May involve motivated either confusion about personal forgetting of traumatic identity or assumption of a new events. identity; no other signs of mental ○ Poor storage of information disorder are present, and the during traumatic events fugue state can last from hours to due to overarousal. months; fugue states usually end ○ Avoidance of emotions rather abruptly, and the individual during traumatic events, as returns home, recalling most, if not well as emotional reactions all, of what happened. to the events afterward. In these curious cases, ○ Dissociation during memory loss revolves traumatic events. around a specific Extreme life stress in the present. incident—an unexpected trip (or trips). Mostly, Treatment individuals just take off and The first goal of treatment for later find themselves in a dissociative amnesia is to relieve new place, unable to symptoms and control any remember why or how they problem behaviour. Treatment got there. Usually they have then aims to help the person safely left behind an intolerable express and process painful situation. During these trips, memories, develop new coping a person sometimes and life skills, restore functioning, assumes a new identity or and improve relationships. The best at least becomes confused treatment approach depends on about the old identity. the individual and the severity of When the state is undesirable and his or her symptoms. Treatments considered pathological by may include the following: members of the culture, ○ Psychotherapy: designed particularly if the trance involves a to encourage perception of being possessed by communication of conflicts an evil spirit or another person, the and increase insight into individual would be diagnosed problems. with an “other specified ○ Cognitive therapy: focuses dissociative disorder (dissociative on changing dysfunctional trance)” thinking patterns and the resulting feelings and Etiology behaviours. Typically occurs following traumatic events: 3. Dissociative Identity Disorder - formerly called multiple personality  PSY206|Dissociative Disorders disorder, two or more identities ○ The transition from one alternate being in control within personality to another. the same person. These identities may have speech, Clinical Description temperamental, and behavioral may adopt as many as 100 new patterns that are different from identities, all simultaneously those normally associated with the coexisting, although the average person. Also, the person cannot number is closer to 15. recall information that would defining feature of this disorder is ordinarily be readily remembered, that certain aspects of the person’s such as everyday events, identity are dissociated. important personal information, onset is almost always in childhood, and/or traumatic or stressful often as young as 4 years of age, events. although it is usually approximately the existence of different 7 years after the appearance of personalities or identities symptoms before the disorder is that are simultaneously identified. coexisting in one person. disorder tends to last a lifetime in There is also a presence of the absence of treatment. dissociative amnesia when frequency of switching decreases each time an identity alters. with age. TERMS Etiology Alters - is the shorthand term for the Childhood abuse and trauma different identities or personalities in Rooted in a natural tendency to DID. escape or “dissociate” from the Host Personalities- 1) person who unremitting negative affect becomes the patient and asks for associated with severe abuse. treatment; 2) usually attempt to Individual experience and hold various fragments of identity personality factors also contributed together but end up being to dissociative experiences. overwhelmed; 3) usually develops Suggestibility later than other personalities. ○ Self-hypnosis – individuals Switch - is instantaneous (although can dissociate from most of in movies and on television it is the world around them and often drawn out for dramatic “suggest” to themselves effect); physical transformations that, for example, they may occur; Posture, facial won’t feel pain in one of expressions, patterns of facial their hands. wrinkling, and even physical ○ Autohypnotic model - disabilities may emerge. people who are suggestible may be able to use  PSY206|Dissociative Disorders dissociation as a defense against extreme trauma. According to this model, when the trauma becomes unbearable, the person’s very identity splits into multiple dissociated identities. Treatment Supportive care, including medications as needed for associated symptoms. Psychotherapy is the main treatment used to integrate the different identities. Guided imagery; (involves thinking of a certain goal to help cope with health problems; most often used as a relaxation technique. It involves sitting or lying quietly and imagining yourself in a favorite peaceful setting such as a beach, meadow, or forest) and hypnosis. The goal of treatment for dissociative identity disorder is usually to integrate the personalities into a single personality. However, integration is not always possible. In these situations, the goal is to achieve a harmonious interaction among the personalities that allows more normal functioning.