Dissociative Disorders

Download Report

Transcript Dissociative Disorders

Dissociative Disorders
At the most basic level …
• Disorders dealing with disruptions or
interruptions of typical consciousness
• Patients lose track of who, where, and why
with respect to identity and self-awareness
• Also, profound memory deficits
• Assumed to arise from stressful experiences
but don’t involve typical anxiety symptoms
• A process in which some or all of our mental
processes are separated from the main stream
of consciousness, or
• When our actions lose their connection with
the rest of our personality
Dissociative Disorders - Overview
• Three types recognized in DSM 5
• All involve caused by dissociation which leads
to some aspects of cognition, memory, or
experience to be inaccessible consciously
• Consciousness fails to perform its essential
task, the seamless integration of our thoughts,
emotions, motivations, and other aspects into
our experience
On the other hand …
• Mild forms of dissociation are everyday
• Automatization – to perform a task without
conscious awareness
• You suddenly find yourself in your driveway
without any memory of your trip
• But for these disorders, the dissociation is
much more severe
• Both the behavioral and psychodynamic
theorists think that these severe levels of
disconnectedness arise from an avoidance
• Protects person from experiencing significant
fear and/or anxiety
• Soldiers involved in intense military survival
training report many brief instances
A lot we don’t know
• Lots of uncertainty
• We just don’t know much about these
• Worse yet, there are major disputes regarding
risk factors and treatment
• Another reason arises from their scarcity
• One in a thousand?
• Even less?
Is it just repression?
• Psychodynamic theorists have an easy
• Some people, when placed under great stress,
repress (purposefully forget) experiences,
traumatic events, even their identity
• But much evidence shows that trauma causes
enhanced memory of the essential features of
the threat
Dissociative Amnesia
• The inability to recall important personal
information, usually concerning a bad
• This problem cannot be explained by ordinary
• These memories are unavailable during the
amnesia episode
• But they can be retrieved once it episode
• Now a subtype of Dissociative Amnesia
• Rare but fascinating
• More severe than typical dissociative
• Can involve limited but seemingly purposeful
• Recovery usually complete except for what
happened under fugue state
Memory Distinctions
• Dissociative Amnesia involves, by definition,
problems with memory
• But while explicit memory (memories we
express in words) is disrupted ….
• Implicit memory (memories based on
experiences without conscious awareness) is
• Depersonalization – a disconnection from
your mental processes or body
• You feel like a robot, like you have been lifted
from your body and are observing yourself
• Derealization – a disconnection from your
• Nothing is real, everyone is a robot, the
“world” of the Matrix
• Does not involve memory problems
• Usually begins in adolescence and then
• Comorbidity is common, 2/3s experience
depression and anxiety
• Childhood trauma is often found
Dissociative Identity Disorder (DID)
• DSM 5
1) at least two separate personalities (alters)
2) they have unique personalities, including
differing and distinct:
a) cognition
b) behavior
c) emotions
d) memories, etc.
More DID criteria
3) these alters may be seen by others , or
reported by the patient
4) gaps in memory that are beyond simple
5) condition must be chronic
6) can’t be explained by cultural influences,
drugs or religious beliefs.
Differing personalities
Eye glasses prescriptions
• More women than men
• Begins as kids but generally not diagnosed til
early adulthood
• More severe than other Dissociative disorders
• Tougher and longer for treatment
• Often found with PTSD, major depressive
disorder and somatic
• Often physiological symptoms
Why are some skeptical?
Startling increases in diagnosis
No cases prior to 1800
Few between 1920 and the 70’s
Huge uptick after Sybil and The Three Faces of
Eve in the mid-70’s
• But very few cases in China and other places
• Are some therapists merely finding what they
were looking for?
Posttraumatic model
• Some people are predisposed to dissociation
• If they experience severe childhood trauma
• Alters develop to cope with the trauma
• But the condition is so rare, there are no
Are some just role-playing?
• Maybe some people just jump into the
culturally composed role of the “Multiple
Personality Patient”
• This is prompted by the work of therapists
who suggest the existences of the alters then
use hypnosis to “confirm” that they are real
• Well publicized media reports provide a
Support for “role playing”
• Some traumatized have considerable
experience with fantasy lives
• They may deeply wish they were someone
• They are also eager to please their therapist
• Many therapeutic techniques do reward
patients for revealing alters
• People can readily invent alternate
Are the alters really distinct?
• Clever studies demonstrate that alters share
implicit memories
• In another study it was established that alters
also share explicit memories
• The uniqueness of each alter seems more
apparent than real
Reliability ?
• A disproportionate number of DID diagnoses
come from a small number of clinicians
• In Switzerland, 66% of diagnoses came from
10% of psychiatrists
• In some clinics, DID is never indicated
Does DID develop in treatment?
• Usually, evidence of DID only develops during
therapy – patients had no awareness of alters
• Were they suggested by overeager clinicians?
• But a study of murders found some DID
symptoms (trances, differing handwriting) in
• All therapists take a gentle, empathetic
• Goal – to function as a completely integrated
• This is done by teaching strategies to
effectively deal with stress
• Meds don’t influence the presence of the
Psychodynamics & DID treatment
• Most popular therapeutic approach
• But still very few
• Great efforts to reverse the effects of
• Since DID are highly hypnotizable, it is used to
go back to the childhood abuse through age
• Controversial and harmful