Dissociative Disorders (PDF)

Dissociative Disorders Ch.6 Overview Dissociative Disorders Depersonalization-derealization disorder (DPDR) How Theorists Explain These Disorders Two DID Documentaries Quick Review Questions (that are also on the Midterm) People with ________ are afraid of being in public places or sit...

Dissociative Disorders Ch.6 Overview Dissociative Disorders Depersonalization-derealization disorder (DPDR) How Theorists Explain These Disorders Two DID Documentaries Quick Review Questions (that are also on the Midterm) People with ________ are afraid of being in public places or situations where escape might be difficult or help unavailable, should they experience panic or become incapacitated. A. Panic Disorder B. Agoraphobia C. Social Phobia D. Specific Phobia In response to a threat, we perspire, breathe more quickly, get goose bumps, and feel nauseated. These responses are controlled by which nervous system? A. Somatic B. Peripheral C. Sympathetic D. Parasympathetic A persistent fear of a specific object is known as: A. Panic disorder B. Phobic disorder C. Generalized anxiety disorder D. Specific Phobia Rachel was just outside the parking garage of the World Trade Center when the explosion happened. At the time, he was terrified and had visions of the building falling on him. Ever since the bombing he has had periods of anxiety and sleeplessness. This is an example of a: A. Panic Disorder B. Phobic Disorder C. Generalized Anxiety Disorder D. Post Traumatic Stress Disorder Dissociative Disorders Dissociative Disorders The key to our identity—the sense of who we are and where we fit in our environment—is memory. 1. Dissociative disorders involve the loss of some part of an individual’s memory. 2. In such disorders, one part of the person’s memory typically seems dissociated, or separated, from the rest. 3. There are several kinds of dissociative disorders: dissociative amnesia, dissociative identity disorder, and depersonalization-derealization disorder. Dissociative Disorders 1. People with dissociative amnesia are unable to recall important information, usually of an upsetting nature, about their lives. 2. The loss of memory is much more extensive than typical forgetfulness: i. It is not caused by physical factors ii. Typically is triggered by a specific upsetting event. All forms of the disorder are similar in that the amnesia interferes mostly with a person’s memory for personal events and information. Memory for abstract or encyclopedic information usually remains intact. (Midterm Question: What is Dissociative Amnesia?) Dissociative Disorders Group of disorders triggered by traumatic events When changes in memory lack a clear physical cause (neurological abnormality) they are called dissociative disorders. ○ One part of the person's memory typically seems to be dissociated, or separated, from the rest. Kinds of dissociative disorders ○ Dissociative amnesia Dissociative fugue ○ Dissociative identity disorder (multiple personality disorder) Subpersonalities Alternate personalities Photo: A woman is overwhelmed by emotions as she leans against the wall of the Grenfell Tower, a London public housing development, the scene of a horrific 2017 fire that killed 72 residents. People who experience severe threats to their health and safety—as in fires—are particularly vulnerable to amnesia and other dissociative reactions. Fedai & Asoglu (2022) explained… “Research indicates that dissociative disorders are observed in 12–13.8% of the psychiatric patient population.10,11 However, DID is found in 1% of the general population.12 DID has an estimated lifetime prevalence of around 1.5%.13 This rate is similar to that of schizophrenia, and it is a public health problem that should receive attention” (pg. 3035). Characterizing Dissociative Disorders People from all age groups and racial, ethnic and socioeconomic backgrounds can experience a dissociative disorder. Up to 75% of people experience at least one depersonalization/derealization episode in their lives, with only 2% meeting the full criteria for chronic episodes. Women are more likely than men to be diagnosed with a dissociative disorder. Clouden’s Case Report (2020) Dissociative Amnesia and Dissociative Fugue in a 20-Year-Old Woman with Schizoaffective Disorder and Post-Traumatic Stress Disorder “Dissociative amnesia…clings to the heels of trauma and stressful events. The dissociation is the mind’s way of hiding the traumatic event from the individual’s consciousness. Dissociative amnesia is defined as the ‘inability to recall important autobiographical information’ ” (p. 1). Dissociative Amnesia 1. Dissociative amnesia may be: a. Localized—most common type i. loss of all memory of events occurring within a limited period of time b. Selective—loss of memory for some, but not all, events occurring within a period of time c. Generalized—loss of memory beginning with an event but extending back in time; may lose sense of identity; may fail to recognize family and friends d. Continuous—forgetting into the future; quite rare in cases of dissociative amnesia 2% of All Adults 1. Research suggests that at least 2% of all adults experience dissociative amnesia each year. i. Many cases seem to begin during serious threats to health and safety. ii. Childhood abuse, especially child sexual abuse, can trigger dissociative amnesia. Dissociative Fugue An extreme version of dissociative amnesia People not only forget their personal identities and details of their past, but also flee to an entirely different location May be brief (hours or days) or more severe Dissociative Fugue An extreme version of dissociative amnesia a. Fugue has its origins in the Latin word for flight. b. For some individuals, the fugue is brief—a matter of hours or days—and ends suddenly. c. For others, the fugue is more severe; people may travel far from home, take a new name and establish new relationships, and even a new line of work; some display new personality characteristics. d. The majority of people regain most or all of their memories and never have a recurrence. i. The story of 32 y/o Hannah Upps Mysterious Disappearance ii. How A Woman Lost Her Identity iii. St. Thomas honors missing teacher, The Virgin Island Daily News, 11.25.24 Dissociative Identity Disorder (DID) Dissociative Identity Disorder A person with dissociative identity disorder (DID), formerly called multiple personality disorder, develops two or more distinct personalities (subpersonalities). Each subpersonality has a unique set of memories, behaviors, thoughts, and emotions. Dissociative Identity Disorder (DID) At any given time, one of the subpersonalities dominates the person’s functioning. 1. Usually one of these subpersonalities, called the primary or host personality, appears more often than the others. 2. The transition from one subpersonality to the next, called switching, is usually sudden and may be dramatic. 3. Most cases are first diagnosed in late adolescence or early adulthood. 4. Typical onset is before age 5 Dissociative Identity Disorder (multiple personality disorder) ○ Sudden movement from one subpersonality to another (switching) is usually triggered by stress. ○ Women are diagnosed three times more often than men. How do subpersonalities interact? Average number subpersonalities is now thought to be 15 for women and 8 for men; Subpersonalities will often appear in groups of 2 or 3. There have been cases with more than 100 subpersonalities How do subpersonalities interact? The relationship between or among subpersonalities varies from case to case, though there are generally three kinds of relationships: Mutually amnesic relationships—subpersonalities have no awareness of one another. Mutually cognizant patterns—each subpersonality is aware of the other personalities. One-way amnesic relationships—most common pattern; some personalities are aware of others, but the awareness is not mutual. ○ Those who are aware, referred to as co-conscious subpersonalities, are “quiet observers.” How do subpersonalities differ? Subpersonalities often display dramatically different characteristics including identifying features, abilities and preferences, and physiological responses: Identifying features Subpersonalities may differ in features as basic as age, sex, race, and family history. Abilities and preferences Although semantic information is not usually affected by dissociative amnesia, it is often disturbed in dissociative identity disorder. Physiological Responses Researchers have discovered that subpersonalities may have physiological differences, such as: Differences in autonomic nervous system activity ○ blood pressure levels ○ evoked potentials ○ allergies Repressed Childhood Memories or False Memory Syndrome? Claims of recovery of childhood memories of abuse have declined in recent years. Repressed childhood sexual abuse memories emerge in various settings. Counterargument: Suggestibility ○ Memories may be flawed illusions or false images formed by a confused mind; created in laboratory. ○ Some people are more prone to false memories. ○ Details of child sexual abuse are often remembered. How common is DID? Traditionally, DID was believed to be rare. Some researchers even argue that many or all cases are unintentionally produced by practitioners. These arguments are supported by the fact that many cases of DID first come to attention only after a person is already in treatment. ○ This is not true of all cases. Clinicians’ Side-eye to Dissociative Identity Disorder? The number of people diagnosed with the disorder increased in the 1980s and 1990s and then declined in the twenty-first century. ○ Ex. Dissociative Identity Disorder: A Controversial Diagnosis, Gillig, 2009. Although the disorder still is uncommon, thousands of cases have been documented in the United States and Canada. Despite changes, many clinicians continue to question the legitimacy of this category.  Dissociative Disorders Checklist: Dissociative amnesia Dissociative identity disorder 1. Person cannot recall important 1. Person experiences a disruption to his or her identity, as reflected by life-related information, at least two separate personality typically traumatic or stressful states or experiences of information. The memory possession problem is more than simple 2. Person repeatedly experiences forgetting. memory gaps regarding daily events, key personal information, 2. Leads to significant distress or or traumatic events, beyond impairment ordinary forgetting 3. Leads to significant distress or 3. Symptoms are not caused by impairment a substance or medical 4. Symptoms are not caused by a condition substance or medical condition DID Documentaries (Warnings) When the Devil Knocks - Hillary’s story The Many Sides of Jane: Anon, 2019. Episode 1: Who Am I? (Many Sides of Jane), Films Media Group. 43.11 minutes. A disorder marked by the inability to recall important personal events and information is known as: A. Dissociative amnesia B. Alzheimer’s C. Cognitive dysfunction D. Frontal-temporal dementia What do you think? Should DID remain in the DSM? PsychWatch: Peculiarities of Memory Many memory peculiarities have been identified: ○ Absentmindedness ○ Déjà vu (already seen) ○ Jamais vu (never seen) ○ Tip-of-the-tongue phenomenon ○ Memory while under anesthesia ○ Memory for music ○ Visual memory How do theorists explain dissociative amnesia and dissociative identity disorder? ○ A variety of theories have been proposed to explain dissociative disorders. ○ Older explanations have not received much investigation. ○ Newer viewpoints, which highlight such factors as state-dependent learning and self-hypnosis, have captured the interest of clinical scientists. Theoretical Perspectives for Dissociative Disorders Psychodynamic perspective ○ Dissociative disorders are caused by repression, the most basic ego defense mechanism. People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness. ○ Dissociative amnesia and fugue are single episodes of massive repression. ○ DID results from a lifetime of excessive repression, motivated by very traumatic childhood events. Dissociative Disorders Support for psychodynamic perspective ○ Most of the support for this model is largely drawn from case histories, which report brutal childhood experiences. ○ Yet only a small fraction of abused children develop this disorder. ○ Some individuals with DID do not seem to have experiences of abuse Psychodynamic Therapists ○ Psychodynamic therapists guide patients to search their unconscious and bring forgotten experiences into consciousness. ○ In hypnotic therapy, patients are hypnotized and guided to recall forgotten events. ○ In drug therapy, intravenous injections of barbiturates are sometimes used to help patients regain lost memories. Also referred to as “truth serums.” Benzodiazepines may also be used to help patients regain their memories If people learn something when they are in a particular situation or state of mind, they are likely to remember it best when they are in again in that same condition. This link between state and recall is called “state-dependent learning” (Comer & Comer, 2021). State-dependent learning: Cognitive Behavioral View Link between state and recall Learning can also be associated with mood states. This model has been demonstrated with substances and mood, may be linked to arousal levels. ○ Arousal is an important part of learning and memory. Dissociative Disorders State-dependent learning ○ Learning becomes associated with the conditions under which it occurred, so that it is best remembered under the same conditions. Each thought, memory, and skill is tied exclusively to a particular state of arousal, ○ People who are prone to develop dissociative disorders have state-to-memory links that are unusually rigid and narrow. Self-hypnosis As A Cause ○ Dissociative amnesia Parallel between hypnotic amnesia and dissociative disorders People may hypnotize themselves to forget unpleasant events; fugue occurs when all memories of person’s past and identity are forgotten. ○ Dissociative identity disorders Children who experience early abuse or horrifying events may escape threat by self-hypnosis (mental separation through wish to become other person). A way to forget traumatic events How do therapists help individuals with dissociative identity disorder? ○ Unlike victims of dissociative amnesia or fugue, people with DID do not typically recover without treatment. Treatment for this pattern, like the disorder itself, is complex and difficult. Dissociative Amnesia vs DID People with dissociative amnesia often recover on their own. Only sometimes do their memory problems linger and require treatment. People with dissociative identity disorder (DID) usually require treatment to regain their lost memories and develop an integrated personality. Differences In Treatment Treatments for dissociative amnesia tend to be more successful than those for DID. The leading treatments for these disorders are psychodynamic therapy, hypnotic therapy, and drug therapy. Psychodynamic therapists guide patients to their unconsciousness and bring forgotten experiences into consciousness. How do therapists help with Dissociative Identity Disorder? Therapists usually try to help clients: Recognize fully the nature of their disorder (bonding with primary personality) (In the documentary, When the Devil Knocks–Hilary attempts this in her sessions with the therapist) Hypnosis, group and family therapy Recover the gaps in their memory Psychodynamic therapy, hypnotherapy, drug therapy Integrate their subpersonalities into one functional personality Fusion, ongoing therapy to maintain a complete personality Depersonalization- derealization disorder (DPDR) The central symptom is persistent and recurrent episodes of depersonalization and/or derealization: Depersonalization - a change in one’s experience of the self in which one’s mental functioning or body feels unreal or detached Derealization - the sense that one’s surroundings are unreal or detached Depersonalization-derealization disorder ○ DSM-5-TR categorizes this as a dissociative disorder, but not as one characterized by the memory difficulties found in the other dissociative disorders. ○ Central symptom is persistent and recurrent episodes of depersonalization and/or derealization. Effects around 2% of population, most often adolescents and young adults, rarely in people over 40 Triggered by extreme fatigue, physical pain, intense stress, substance abuse recovery; survivors of life-threatening situations Starts suddenly and can be long lasting Few theories have been offered to explain this disorder Dissociative Disorders Depersonalization Derealization ○ Feeling separation from ○ Feeling external world is own body unreal and strange ○ Seeing self from inside out; doubling ○ Changing object shape or ○ Having mechanical, size dreamlike, dizzy feelings ○ May see other people as ○ Awareness that perceptions robots are distorted Depersonalization-derealization disorder ○ Transient depersonalization and derealization experiences Relatively common, while depersonalization-derealization disorder is not ○ Depersonalization-derealization disorder symptoms Persistent or recurrent Cause considerable distress May impair social relationships and job performance Getting a Handle on Trauma and Stress Researchers now better understand the relationship between trauma, stress, and psychological dysfunction. ○ Effective treatment programs: Combine biological, cognitive-behavioral, family, and group interventions ○ Research and treatments for dissociative disorders have not advanced as quickly. Getting a Handle on Trauma and Stress ○ The current interest and research into trauma and stress has led to clinicians and researchers to overdiagnose PTSD and reach conclusions that may be too extreme. ○ There are some who are concerned that a resurgent interest in dissociative disorders may result in similar overreach in this diagnostic area. Questions, Comments, & What’s Next Case Study : Victor due tonight, January 30th Anxiety and Phobias Paper due this Sunday, February 2, 2025 by 11:59 PM Next week - Chapter 7, Depressive and Bipolar Disorders See you next week!