Dissociative Disorders

Unless otherwise indicated, answers are from DSM-IV-TR or First and

TasmanAs of 1Sep07

Memory types

Q. What are the two basic memory types?

Memory types

Ans. There are different terms used.

declarative and procedural

explicit and implicit

episodic and semantic

We will use declarative and procedural in these screens.

Memory – dissociative disorders

Q. Which type of memory is lost in dissociative disorders?

Memory - dissociative

Ans. Declarative. The patient still has the memory, for example, to drive a car even though they may not remember their name.

Classification

Q. Besides NOS category, what are the four dissociative disorders?

Classification

Ans.

1. Dissociative amnesia

2. Dissociative fugue

3. Dissociative identity disorder

4. Depersonalization disorder

[also, dissociative trance disorder is in the DSM appendix of disorders in need of research.]

Dissociative amnesia - basic

Q. Basic features of dissociative amnesia?

Dissociative amnesia - basic

Ans. An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.

Dissociative amnesia prevalence

Q. There is a controversy as to the prevalence of this disorder. State the controversy.

Prevalence

Ans. The increase of reported cases is attributed by some to greater clinician awareness. Others claim that the increase is the result of greater suggestibility.

Dissociative amnesia course

Q. What is the course?

Dissociative amnesia course

Ans. Some eventually get total recall, others have none.

Treatment of dissociative amnesia

Q. What is the treatment of dissociative amnesia?

Treatment of dissociative amnesia

Ans.

Place in safe environment

Hypnosis, e.g., age regression

Or

supportive psychotherapy of integrating memories into consciousness

Dissociative fugue - basic

Q. What is the basic feature to this disorder?

Dissociative fugue - basic

Ans. A sudden, unexpected travel away from one’s customary place of daily activities, with inability to recall some or all of one’s past.

Fugue’s prevalence

Q. What is fugue’s prevalence?

Fugue’s prevalence

Ans. 0.2% of the general population.

Fugue’s course

Q. What is the course?

Fugue’s course

Ans. May last for hours to months. Recovery is rapid, but refractory amnesia may persist.

Treatment of fugues

Q. What is the treatment of fugues?

Treatment of fugues

Ans.

First and Tasman prefer hypnosis.

Some examiners may also like to use medication-facilitated [e.g., Amytal] interviews.

Supportive psychotherapy is also used.

Dissociative identity disorder [DID] - basic

Q. What is the basic findings in DID?

DID - basic

Ans. The pt has two or more distinct identities or personality states that recurrently take control of behavior.

DID - prevalence

Q. What is the prevalence?

DID - prevalence

Ans. Controversial as some believe the increase is the result of clinician suggestion.

DID - course

Q. What is the course?

DID - course

Ans. Average time between onset and dx is 6-7 years, and course is episodic or continuous. Episodic is associated with untoward events.

DID treatment

Q. What is the treatment of DID?

DID treatment

Ans. Supportive, extensive, psychotherapy directed at integrating the personalities. In doing so, addressing past traumas may become key; but any suggestions as to trauma is seen as iatrogenic by some. Also used as adjuncts:

hypnosis

SSRIs when dysphoria is part of the presentation

Depersonalization disorder - basic

Q. Basic feature of depersonalization disorder?

Depersonalization - basic

Ans. Episodes of feeling detachment or estrangement from one’s self.

“Laboratory” findings

Q. DSM-IV suggests what laboratory finding in folks with depersonalization?

“Laboratory” findings

Ans. Display high hypnotizability.

Depersonalization – prevalence

Q. What is the prevalence?

Depersonalization - prevalence

Ans. About half of all adults have had such an experience, usually precipitated by severe stress.

Depersonalization - course

Q. What is the age of onset and subsequent course?

Depersonalization - course

Ans. Mean age of onset is 16 and course is usually chronic, exacerbating in association with actual or perceived stress.

Depersonalization - treatment

Q. What is the treatment?

Depersonalization - treatment

Ans. Medications for the co-morbid condition may suffice. Anxiolytics may work, but watch for side effect of depersonalization that may actually increase with these meds. Hypnosis is another option.

Dissociative trance disorder - basic

Q. Basic feature of this disorder?

BEING IN THE DSM APPENDIX MAKES THIS A VERY UNLIKELY EXAM TOPIC.

Dissociative trance disorder - basic

Ans. Patient has an involuntary state of trance causes significant distress and is not part of the individual’s cultural practice.

Trance - treatment

Q. What is the treatment?

Trance treatment

Ans. First and Tasman suggest adhering to the approach used in the pt’s cultural, e.g., “negotiating a change” in the pt’s “social circumstances.”