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Dissociative Disorders David RM Trotter, PhD Dissociative Disorders David RM Trotter, PhD

Dissociative Disorders David RM Trotter, PhD - PowerPoint Presentation

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Dissociative Disorders David RM Trotter, PhD - PPT Presentation

Associate Professor Departments of Family Medicine and Medical Education Objectives By the end of this presentation you should be able to Discuss dissociation from a clinical and nonclinical perspective ID: 916448

disorder dissociative amnesia disorders dissociative disorder disorders amnesia dissociation depersonalization identity common derealization symptoms events substance experience personality trauma

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Slide1

Dissociative Disorders

David RM Trotter, PhD

Associate Professor

Departments of Family Medicine and Medical Education

Slide2

Objectives

By the end of this presentation, you should be able to:

Discuss dissociation from a clinical and non-clinical perspective

Review the epidemiology of Dissociative Disorders

Describe the criteria for the various Dissociative Disorders

Outline common treatments for Dissociative Disorders

Slide3

What is Dissociation???

Dissociation is an experience in which there is a discontinuity in conscious awareness. This occurs when there is a disconnection in the usually integrated functions of consciousness, memory, perception, emotions, actions, identity, body representation, and/or motor control.

Slide4

Common Dissociative Experiences

Depersonalization

: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g. perceptual alteration, distorted sense of time, unreal or absent self, emotional and/or physical numbing)

Derealization

: Experiences of unreality or detachment with respect to surroundings (e.g. individual or objects are experience as unreal, dreamlike, foggy, lifeless, or visually distorted)

Dissociative Amnesia

: Inability to recall important personal information in a way that cannot be explained by ordinary forgetting

Identify Confusion or Alteration

:

Confusion: Confusion about who one is. For example, they may at times enjoy activities (e.g. drugs, alcohol, recklessness) that at other times they find repugnant.

Alteration: The shifting of personality states

Slide5

Positive and Negative Dissociative Symptoms

Positive: Addition of an experience not typically there

E.g. fragmentation of identity, depersonalization,

d

erealization

Negative: Lack of a typical experience

E.g.

a

mnesia

NOTE: Think of this in the same way you think of positive and negative psychotic symptoms

Slide6

Dissociation Occurs on a Continuum: Common Dissociation

Daydreaming

Being so absorbed in something (e.g. book/movie) that you are not aware of what is happing around you

Feeling “detached” for your body in some way

Loosing track of time

Feeling emotionally numb

Slide7

Dissociation Occurs on a Continuum: Less Common Dissociation

Chronic

Derealization

and/or Depersonalization

Amnesia for specific events, types of events, or important personal information

The presents of more than one personality state

Slide8

Causes for Severe Forms of Dissociation

Causes assumed to be largely environmental and genetic

A history of trauma is very common among individuals with dissociative disorder

s. This may include ACEs (e.g. abuse, neglect) or other intolerable/overwhelming experiences.

Dissociation during a traumatic event predicts likelihood of dissociation occurring later.

Remember, dissociation during a traumatic event is acutely adaptive. However, it may become disrupted later.

Slide9

What is the primary function of Dissociation?

Defense/Coping Mechanism

Slide10

Dissociative Disorders

Dissociative Identity Disorder (Previously Multiple Personality Disorder)

Dissociative Amnesia

Depersonalization/

Derealization

Disorder

Other/Unspecified Dissociative Disorder

Slide11

Dissociative Identity Disorder

Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves remarked discontinuity in senses of self and sense of agency, accompanied by related alterations in affect, behaviors, consciousness, memory, perception, cognition and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

Recurrent gaps in the recall of everyday events, important personal information, and /or traumatic evens that are inconsistent with ordinary forgetting.

The symptoms cause distress or impairment

The disturbance is not a normal part of a broadly accepted cultural or religious practice. NOTE: In children, the symptoms are not better explained by imaginary playmates or other fantasy play

Symptoms are not attributable to the psychological effects of a substance or another medical condition

Slide12

Dissociative Identity Disorder

Prevalence (12-month): 1.5% in the general population

Male 1.6%

Female 1.4%

Often comorbid with other issues including depressive, anxiety, substance, self-injury, non-epileptic seizure disorders

Developmental Couse

Often associated with childhood trauma (about 90%)

Decompensation often associated with a trigger: removal from traumatic situation, children reaching same age as they were when abuse began/occurred, later traumatic events (e.g. care accident), death or illness of abuser

70% of outpatients with DID have attempted suicide in the past

Slide13

Dissociative Identity Disorder

Differential Diagnosis

Major Depressive Disorder

Bipolar Disorders

PTSD

Psychotic Disorders

Substance/Medication-induced disorders

Personality Disorders

Conversion Disorder

Seizure Disorders

Factitious Disorder and Malingering

Slide14

Dissociative Identity Disorder

Slide15

Dissociative Amnesia

An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. NOTE: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identify and life history

The symptoms cause distress or impairment

The disturbance is not attributable to use of a substance or another medical condition

The disturbance is not attributable to another dissociative disorder

With Dissociative Fugue: Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for another important autobiographical information

Slide16

Dissociative Amnesia

Diagnostic Features

Lack of memories is not a function of organic (i.e. neurological damage or toxicity) problems.

Localized Amnesia: Failure to remember events that happened during a specific time frame

Selective Amnesia: Failure to remember some, but not all, or events that happened during a time frame

Generalized Amnesia: A failure to remember ALL one’s life history (very rare). Often associated with dissociative fugue.

Slide17

Dissociative Amnesia

Prevalence (12-month): 1.8%

Male: 1.0%

Female: 2.6%

Developmental Course:

Trauma history is very common

Individual is often unaware of the amnesia

Onset of amnesia post trauma can be hours, days, or longer

Amnesia can last decades

After amnesia remits there is often significant depression and anxiety

Slide18

Dissociative Amnesia

Suicide Risk: This risk is high among those with dissociative amnesia, especially if amnesia remits suddenly.

Differential Diagnosis:

DID

PTSD

Neurocognitive Disorders

Substance-related Disorders

TBI

Seizure Disorders

Fictitious Disorder or Malingering

Age related memory changes

Slide19

Depersonalization/Derealization Disorder

The presence of persistent or recurrent experiences of depersonalization,

derealization

, or both

During the depersonalization or

dereaslization

experiences, reality testing remains intact

The symptoms cause distress or impairment

The disturbance is not a function a substance or medication

Not better explained by another disorder (e.g. PTSD, OCD, MDD, another Dissociative Disorder)

Slide20

Depersonalization/Derealization Disorder

Prevalence:

About 50% of US adults will report at least one episode of

Depersonalization or

Derealization

every year. However, to meet full criteria for this disorder is less common

Life-Time Prevalence: 2.0% (gender ration 1:1)

Developmental Course:

Mean age of onset is 16-years (only 5% report onset after age 25, onset after age 40 is extremely rare)

1/3 experience a discrete episode, 1/3 report continuous SXS, and 1/3 report intermittent episodes that eventually become continuous

Slide21

Depersonalization/Derealization Disorder

Differential Diagnosis:

MDD

OCD

Illness anxiety disorder

Other Dissociative Disorders

Anxiety disorders

Psychotic disorders

Substance/medication-related disorders

Comorbidity: High with MDD and any anxiety disorder (except PTSD). Also often comorbid with Avoidant, Borderline, and Obsessive-Compulsive Personality Disorders

Slide22

Treatments

Psychotherapy is the First Line treatment (e.g. CBT, EMDR, DBT). Counseling is often trauma focused

Focus: Improvement of coping skills

Common Elements: Crisis response planning, removal from environment (if needed), labeling emotions, identifying triggers,

building distress tolerance

, coping skills training

Some “traditional” DID Psychotherapies that involve “discovery of alters” have been shown to be harmful.

Medications: Common medications include antidepressants, anxiolytics, and some atypical antipsychotics.

Meds are considered secondary or adjunctive

Slide23

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition/ Arlington, VA, American Psychiatric Association, 2013.

International

Society for the Study of Trauma and Dissociation, Dissociation FAQs (

www.isst-d.org

, 11/23/2016

)

Lilienfeld

, S. (2007). Psychological Treatments that Cause Harm.

Perspectives

on Psychological Science 2 (1),

53-70.