dissociative disorders basic headings

DISSOCIATIVE DISORDERS

-DR. DEEPIKA SINGH-JR1, DEPT OF PSYCHIATRY,-GSMC & KEMH

Dissociation:

“Disruption in the integrated functions of consciousnessmemory identityperception of the environment”

(DSM-IV)

HISTORY

EPIDEMIOLOGY:

Dissociative & conversion disorder constitutes 7.3 to 13% of all psychiatric cases.

Conversion > dissociation

Women > men

CLASSIFICATION

DSM IV TR includes: Dissociative amnesia Dissociative fugue Dissociative identity disorder Depersonalization disorder Dissociative disorder NOS

ICD 10 Classification includes:

1. DISSOCIATIVE AMNESIA

2. DISSOCIATIVE FUGUE

3. DISSOCIATIVE STUPOR

4. DISSOCIATIVE TRANCE & POSSESSION

5. DISSOCIATIVE D/Os OF MOVEMENT & SENSATION

6. OTHER DISSOCIATIVE D/Os

Conversion disorder

In ICD 10 it is further classified as:

1) Dissociative motor disorder

2) Dissociative anesthesia & sensory loss

3) Dissociative convulsions

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DISSOCIATIVE DISORDER

Dissociative Amnesia DSM IV

1 or more episodes of inability to recall

important personal information (traumatic or stressful, that is too extensive to be explained by ordinary forgetfulness)

Disturbance does not occur during any other dissociative d/o & not due to direct effects of a substance or GMC

Symptoms cause clinically significant distress or impaired social or occupational ,etc functioning

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Types of amnesia:

Localized amnesiaSelective/ Systematized amnesiaGeneralized amnesiaContinuous amnesia

Dissociative fugue

Amnesia plus flightLatin fugere, “to flee”

Sudden, unexpected travel with inability to recall one’s pastAssume new identity

May involve new name, job, personality characteristics

More often of brief durationRemits spontaneously

Dissociative Fugue DSM IV

Sudden unexpected travel away from home or ones customary place of work, with inability to recall one’s past.

Confusion about personal identity or assumes new identity (partial or complete)

Not due to another dd d/o or direct effects of substances or GMC

Causes significant distress or impairment in imp areas of functioning

Dissociative identity disorder

DSM-IV-TR criteriaPresence of two or more

personalities (alters)At least two of the alters

recurrently take control of behavior

Inability of at least one of the alters to recall important personal information

END

Epidemiology

No identified reports of DID or dissociative amnesia before 1800 (Pope et al., 2006).

Major increases in rates since 1970s DSM-III (1980)

Diagnostic criteria more explicit Appearance of DID in popular culture

Sybil, 1973 Book and movie received much

attention

Trance & possesion d/o

Dissociative stupor

It is characterised by an absence or marked dimunition of voluntary movements & speech in the presence of normal or relatively preserved conscious awareness.

Depersonalization

A. Persistent or recurrent experiences of feeling detached from & as if one is an outside observer of, one’s mental processes or body (e.g. like feeling like one is in a dream)

B. During the episode, reality testing remains intact

C. Causes significant distress or impairment in social, occupational functioning

D. Not due to another mental d/o, ,dissociative d/o, substances or GMC (temp lobe epilepsy)

Dissociaive d/o nos

Dissociative symptoms are predominant, but the clinical picture does not meet full criteria for a dissociative d/o

1. Ganser’s syndrome; Prisoners with personality d/os giving approximate answers to questions-eg. 2+2=5 or talking past the point usually with other symptoms like amnesia, perceptual disturbances .

Dissociative d/o nos

Mass hysteria Combat hysteria Dissociative trance d/o-in certain

cultures

References

References

1. CTP 2. SYNOPSIS OF

PSYCHIATRY 3. NEERAJ AHUJA PG

TEXTBOOK OF PSYCHIATRY

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