First Aid Psych 10-1 Dissociative Disorders

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1. Dissociative Disorder are defined by?

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a. Loss of memory (amnesia), identity, or sense of self (the normal integration of thoughts, behaviours, perceptions, feelings, and memory into a unique identity.

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2. DSM inclusions of Dissociative disorders include (just to prep)?

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a. Dissociative amnesia
b. Dissociative fugue
c. Dissociative identity disorder (multiple personality)
d. Depersonalization disorder
e. Dissociative disorder NOS.

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3. Dissociative Amnesia?

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a. The diagnosis of dissociative amnesia requires that amnesia be the only dissociative sx present.
b. Pts w/this disorder very often retain new memory formation and can have large periods of time that are forgotten.

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4. Dissociative amnesia pearl- what are pts w/dissociative amnesia able to remember?

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a. Pts w/dissociative amnesia are often unable to recall common personal information but able to remember obscure details.
b. This is the opposite tot eh type of memory loss usually found in dementia.

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5. Note: Features of dissociative disorders, such as amnesia and feelings of detachment can come on gradually or suddenly, and they can be temporary or chronic.

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5. Note: Features of dissociative disorders, such as amnesia and feelings of detachment can come on gradually or suddenly, and they can be temporary or chronic.

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6. When are dissociative responses common?

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a. In traumatic and stressful events.

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7. DSM diagnosis of Dissociative Amnesia?

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a. At least 1 episode of inability to recall important personal information, usually involving a traumatic or stressful event.
b. The amnesia cannot be explained by ordinary forgetfulness.
c. The symptoms cause significant distress or impairment in daily functioning and cannot be explained by another disorder, including traumatic brain injury, medical condition, or substance use.

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8. What is the most common dissociative disorder?

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a. Dissociative amnesia.
b. More common in women than men.
c. More common in younger than older adults.

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9. What does dissociative amnesia have ↑ comorbidity with?

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a. Major depression and anxiety disorders.

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10. Course and prognosis of dissociative amnesia?

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a. Many acute cases abruptly return to normal after minutes to days.
b. Recurrences are uncommon.

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11. Tx of dissociative amnesia?

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a. Most important is the establishment of the pt’s safety.
b. Psychotherapy is the mainstay of tx.
c. No specific psychopharm is approved for amnesia, but specific sx can be targeted.
d. Hypnosis or administration of sodium amobarbital or lorazepam (Ativan) during the interview have been used historically and may be useful to help some pts talk more freely.

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12. Is loss of identity (such as dissociative fugue) seen in transient global amnesia?

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a. Not typically.
b. A pt with transient global amnesia will have difficulty recalling recent events, while memory for more temporally distance events, including his or her identity, and remain intact.

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13. What does dissociative amnesia refer to w/respect to a person’s memory?

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a. A disruption in the continuity of a person’s memory.
b. Pts with dissociative amnesia usually report gap(s) in the recollection of a particular event.
c. The memory forgotten is usually a traumatic one, such as being raped.

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14. Flashbacks w/dissociative amnesia?

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a. Pts suffering from dissociative amnesia can experience periods of flashbacks, nightmares, or behavioural re-enactments.

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15. Abreaction?

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a. Is the strong reaction pts often get when retrieving traumatic memories.

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16. Dissociative Fugue DSM?

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a. Sudden, unexpected travel away from home or work plus inability to recall one’s past.
b. Confusion about personal identity or assumption of new identity
c. Not due to dissociative identity disorder or the physiological effects of substance or medical disorder.
d. Sx can cause impairment in social or occupational functioning.

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17. Predisposing factors to dissociative fugue?

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a. Heavy alcohol use, major depression, hx of head trauma, and epilepsy.

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18. What is the onset of dissociative fugue often caused by?

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a. Onset associated w/stressful life event (dissociative fugue is often viewed as a response to a life stressor or personal conflict.

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19. Course prognosis of dissociative fugue?

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a. The fugue usually lasts a few hrs to several days but may lat longer.
b. After the episode, the pt will assume his or her old identity w/out ever remembering the time of the fugue.

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20. Tx of dissociative fugue?

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a. Similar to that of dissociative amnesia.

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21. How does dissociative fugue differ from dissociative amnesia w/respect to insight?

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a. Unlike dissociative amnesia, pts w/dissociative fugue are not aware that they have forgotten anything.

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22. Hint: Fugue: Think about a Fugitive who runs away and forms a new identity.

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22. Hint: Fugue: Think about a Fugitive who runs away and forms a new identity.

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23. Dissociative Identity Disorder DSM?

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a. Presence of 2 or more distinct identities.
b. At least 2 of the identities recurrently take control of the person’s behaviour.
c. Inability to recall personal information of one personality when the other is dominant.
d. Not due to substance/medical.

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24. Prevalence of Dissociative Identity Disorder in men vs. women?

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a. Women account for up to 90% of pts.
b. Most pts have experienced prior trauma, especially childhood physical or sexual abuse.

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25. Average age of onset of Dissociative Identity Disorder?

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a. 6 yo. Avg age of diagnosis is 30.

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26. Course and prognosis of Dissociative Identity Disorder?

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a. Usually chronic, w/incomplete recovery
b. Worst prognosis of all dissociative disorders
c. Pts w/an earlier onset have a poorer prognosis.

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27. Tx of Dissociative Identity Disorder?

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a. Hypnosis, drug-assisted interviewing, and insight-oriented psychotherapy.
b. Pharmacotherapy as needed if comorbid disorder develops (such as major depression).

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28. What 3 conditions may symptoms of dissociative identity disorder have similar features to?

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a. Borderline personality disorder, psychosis, or malingering.