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Day # 111: Intro to Dissociative Disorders

If you are following along in the suggested curriculum you have now finished the first seven themes (psychotic disorders, depressive disorders, bipolar disorder, anxiety disorders, emergency psychiatry, OCD and related disorders, and trauma/stressor related disorders). Excellent work!


We will now begin the eighth theme in the Bullet Psych curriculum which is dissociative disorders. This includes Dissociative Identity Disorder (DID), Dissociative Amnesia, Depersonalization/Derealization Disorder, and Other Specified/Unspecified Dissociative Disorder. Today we will discuss a brief overview of these disorders.


Today's Content Level: Beginner; Intermediate (Review)



INTRODUCTION


•Dissociation is a disrupted or distorted integration of identity, perception, consciousness, memories, identity, or behaviors. This may involve feelings of detachment from one's self or surroundings or individuals may experience lapses in their autobiographical memory.



Definitions

  • Depersonalization: Sense of detachment from one's self. May include experiences of being an outside observer of your body, thoughts, feelings, and actions.

  • Derealization: Sense of detachment from one's surroundings. Surroundings may be foggy, distorted, or dream-like.

  • Dissociative amnesia: Unable to recall important autobiographical information.


•Transient dissociative responses can occur in the context or aftermath of stressful and traumatic events, particularly during childhood. It is proposed that dissociation may initially help neutralize the impact of the trauma, but can quickly become maladaptive.


•Keep in mind that some experts, while controversial, argue that dissociative experiences are universal and comprise a spectrum from normal to pathological. Deciding which dissociative responses are pathological is based on severity, timing, frequency, impact on function, and inability to avoid dissociation. 1


DIAGNOSTIC CRITERIA 2


Just like other disorders in the DSM-5, to meet criteria for a dissociative disorder the symptoms must:

  • Cause clinically significant distress or impairment in function (social, occupational, or other important areas).

  • Symptoms must not be attributable to the effects of a substance (drug abuse or medication) or another medical condition (ex: seizures, traumatic brain injury, transient global amnesia, mild/major neurocognitive disorder, other neurological conditions).

  • Symptoms must not be better explained by another mental disorder such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, post-traumatic stress disorder, or one of the other dissociative disorders.


Dissociative Identity Disorder (DID)

  • Disruption of identity manifested as the existence of two or more personality states. Involves marked differences in affect, memory, and behaviors. These symptoms may be observed by others or self-reported.

  • Recurrent memory lapses regarding daily occurrences, autobiographical information, and/or traumatic events. Not consistent with ordinary forgetfulness.

  • Symptoms are not better explained by broadly accepted cultural/religious practice as well as imaginary friends / fantasy play in children.


Dissociative Amnesia

  • Inability to recall important autobiographical information that is inconsistent with ordinary forgetfulness.

  • Forgotten memories are often traumatic or stressful in nature. Most often selective amnesia for a specific event(s) or generalized for identity and life history.

  • Amnesia not better explained by dissociative identity disorder, postraumatic or acute stress disorder, somatic symptom disorder, or major/mild neurocognitive disorder.

  • Specifier: With dissociative fugue. Some individuals may experience dissociative fugue symptoms which is sudden and unexpected travel or "bewildered wondering" away from home that is accompanied by amnesia for identity or other autobiographical information.


Depersonalization / Derealization Disorder

  • Persistent or recurrent experiences of depersonalization, derealization, or both.

  • Depersonalization: Detachment from self. Sense of unreality or detachment from one’s body, thoughts, feelings, or actions

  • Derealization: Detachment or sense of unreality from surroundings.

  • Reality testing remains intact during the episode (ie. not psychotic).


Other Specified Dissociative Disorder

  • Characterized by symptoms of dissociation that cause significant distress or impairment of functioning, but do not meet the full criteria for a specific dissociative disorder. Examples include:

  • Chronic and recurrent syndromes of mixed dissociative symptoms: Without dissociative amnesia.

  • Identity disturbance due to prolonged and intense coercive persuasion: Examples include brainwashing, political imprisonment, indoctrination by religious sects/cults/terror organization, torture, etc...

  • Acute dissociative reactions to stressful events: lasting hours, days, or less than one month.

  • Dissociative trance: acute narrowing or loss of awareness of surroundings that leads to unresponsiveness +/- minor stereotyped behaviors.



CONCLUSION


Congrats on finishing day 1 of the dissociative disorders theme. Next post we will discuss the epidemiology and pathogenesis of dissociative disorders.


Resources for today's post include DSM-5, Pocket Psychiatry, and First Aid for Psychiatry.












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