DISSOCIATIVE AND SOMATOFORM DISORDERS:DISSOCIATIVE DISORDERS

<< ACUTE AND POSTTRAUMATIC STRESS DISORDERS

DISSOCIATIVE and SOMATOFORM DISORDERS:SOMATOFORM DISORDERS >>

Abnormal Psychology PSY404

Lesson 32

DISSOCIATIVE AND SOMATOFORM DISORDERS

What is stress?

· Stress is a process of adjusting to circumstances that disrupt or threaten to disrupt person's

equilibrium.

· Scientists define stress as any challenging event that requires physiological, cognitive, or behavioral

adaptation.

· Stress is an unavoidable, and in some cases a desirable, fact of everyday life.

· Some stressors, however, are so catastrophic and horrifying that they can cause serious

psychological harm.

· Such traumatic stress is defined in DSM-IV-TR as an event that involves actual or threatened

death or serious injury to self or others and creates intense feelings of fear, helplessness, or horror.

1-Acute stress disorder (ASD) occurs within 4 weeks after exposure to traumatic stress

and is characterized by dissociative symptoms, re-experiencing of the event, avoidance of reminders

of the trauma, and marked anxiety or arousal.

2-Posttraumatic stress disorder (PTSD) is also defined by symptoms of re-experiencing,

avoidance, and arousal, but in PTSD the symptoms either are longer lasting or have a delayed

onset.

Symptoms of ASD and PTSD

1-People who have been confronted with a traumatic stressor re-experience the event in a number of

different ways.

2-Many people with ASD or PTSD have repeated and intrusive flashbacks, sudden memories during

which the trauma is replayed in images or thoughts--often at full emotional intensity.

3-In rare cases, re-experiencing occurs as a dissociative state, and the person feels and acts as if the trauma

actually were recurring in the moment.

4-Marked or persistent avoidance of stimuli associated with the trauma is another symptom of ASD

and PTSD.

Example

1- December 2004 tsunami trauma

2- September 11th 2001 trauma

3- October 8th trauma

· Trauma victims may attempt to avoid thoughts or feelings related to the event, or they may avoid

people, places, or activities that remind them of the trauma.

5-In PTSD, the avoidance also may manifest itself as a general numbing of responsiveness.

· People suffering from PTSD often complain that they suffer from "emotional anesthesia"--their

feelings seem dampened or even nonexistent.

6- People with ASD and PTSD also experience increased arousal and anxiety following the trauma, a

symptom which predicts a worse prognosis when it is more severe.

7-A number of people with PTSD or ASD also have an exaggerated startle response, excessive fear reactions

to unexpected stimuli, such as loud noises.

8-Other people experience depersonalization, feeling cut off from themselves or their environment.

People with this symptom may report feeling like a robot or as if they were sleepwalking.

9-Derealization is characterized by a marked sense of unreality about yourself or the world around you.

· ASD also may be characterized by features of dissociative amnesia, specifically the inability to recall

important aspects of the traumatic experience.

· DSM-IV-TR lists a sense of numbing or detachment from others as dissociative symptoms that

characterize acute stress disorder.

Diagnosis of ASD and PTSD

Maladaptive reactions to traumatic stress have long been of interest to the military.

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Historically, most of the military's concern has focused on men who leave the field of action as a

result of what has been called "shell shock" or "combat neurosis."

The basic diagnostic criteria for PTSD--re-experiencing, avoidance, and arousal--have remained

more or less the same in revisions of the DSM.

However, two significant changes in the classification of traumatic stress disorders were made with

the publication of DSM-IV in 1994: Acute stress disorder was included as a separate diagnostic

category, and the definition of trauma was altered.

Prevention and Treatment of ASD and PTSD

· Mounting evidence supports the effectiveness of various cognitive behavioral treatments.

· A recent consensus statement on the treatment of PTSD concluded that antidepressant medication

and psychotherapy involving therapeutic re-exposure are the two "first-line" therapies for PTSD.

· Let us talk about dissociative disorders.

· Is it possible to forget who are you?

· It is really possible to forget your past?

· Can you have no recollection of your family at all?

· Is it actually possible to have no memory of your personal identity or family or work role?

· And is it true that there are more cases today than even before?

DISSOCIATIVE DISORDERS

Individuals with a dissociative disorder experience a severe disruption or alteration of their identity,

memory, or consciousness. It is based on the unbelievable.

Example

A housewife forgets her name her entire past life has dissociative disorder.

A policeman, who abandoned his family, has dissociative disorder.

They are characterized by persistent, maladaptive disruptions in the integration of memory,

consciousness, or identity the person with a dissociative disorder may be unable to remember many

details about the past; he or she may wander far from home and perhaps assume a new identity; or

two or more personalities may coexist within the same person.

Dissociative disorders once were viewed as expressions of hysteria.

In Greek, hysteria means "uterus," and the term hysteria reflects ancient speculation that these

disorders were caused by frustrated sexual desires, particularly the desire to have a baby.

Janet was a French philosophy professor who conducted psychological experiments on dissociation

and both Janet and Freud were eager to explain and treat hysteria, and the problem led both of

them to develop theories about unconscious mental processes.

Janet saw dissociation as an abnormal process.

In contrast, Freud considered dissociation as a normal process, a routine means through which the

ego defended itself against unacceptable unconscious thoughts.

Freud saw dissociation and repression as similar processes, and in fact, he often used the two terms

interchangeably.

Hypnosis is in which subjects experience loss of control over their actions in response to

suggestions from the hypnotist, is a topic of historical importance and contemporary debate about

the unconscious mind.

All agree that demonstrations of the power of hypnotic suggestion are impressive.

However, some experts assert that hypnosis is the dissociative experience of an altered state of

consciousness.

Symptoms of Dissociative Disorders

1-The symptoms of dissociative

disorders

apparently

involve

mental

processes

that

occur outside of conscious awareness.

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2-Extreme cases of dissociation include a split in the functioning of the individual's some researchers

and clinicians argue that DID is linked with a past trauma, particularly with child's physical or sexual

abuse.

A related issue is very controversial topic of recovered memories, dramatic recollections of long-ago

traumatic experiences supposedly blocked from the conscious mind by dissociation.

3-Depersonalization is a form of dissociation wherein people feel detached from themselves or their social

or physical environment.

4-Amnesia--the partial or complete loss of recall for particular events or for a particular period of

time.

5-Brain injury or disease can cause amnesia.

6-But Psychogenic Amnesia (psychologically caused amnesia) results from traumatic stress or other

emotional distress.

· Psychogenic amnesia may occur alone or in conjunction with other dissociative experiences.

7-It is widely accepted that fugue and psychogenic amnesia are usually precipitated by trauma, thus

providing another link between dissociation and traumatic stress disorders.

· Much more controversial is the role that trauma might play in dissociative identity disorder (DID).

Diagnosis of Dissociative Disorders

For centuries, theorists considered dissociative and somatoform disorders as alternative forms of

hysteria.

· However, the descriptive approach to classification introduced in DSM-III (1980) led to the

separation of dissociative and somatoform disorders into discrete diagnostic categories.

· The distinction is preserved in DSM-IV-TR (2000), because the symptoms of the two disorders

differ greatly.

· The types of dissociative disorders discussed in this lecture are dissociative amnesia, dissociative

fugue, dissociative identity disorder and depersonalized disorder. Although dissociative disorders

typically involve disruption of identity, dissociative amnesia can involve loss of memory without

loss of identity.

· The term psychogenic was used in the names of these disorders- as in psychogenic amnesia and

psychogenic fugue - to indicate that the fugue or memory loss is not physically caused.

1- Dissociative Amnesia

· Each of us, throughout our lives, has forgotten certain things- a person's name, a friend's birthday,

the need to stop at a store on the way home. Forgetfulness, however, is not yet the same as

memory loss. The person with memory loss is unable to recall important personal information too

extensive to be viewed in terms of forgetfulness. When there is actual damage to the brain, from

injury or disease, the information that isn't recalled is lost forever.

· But in dissociative (psychogenic) amnesia, the memory system is not physically damaged, yet there

is selective psychologically motivated forgetting. Often, what has been forgotten is traumatic for

the individual. It can sometimes be retrieved from memory.

· There are two main types of amnesia: selective and generalized. In cases of selective dissociative

amnesia, a person forgets some but not of what happened during a certain period of time.

· In contrast to the selective dissociative amnesia, the person who is suffering from generalized

dissociative amnesia forgets one's entire life history.

· What did you eat for breakfast today? When is your birthday? These questions do not tax our

memory system and appear easy to answer. When you read a textbook but struggle to answer exam

questions, you might complain that just "can't remember." Why?

1- Forgetting happens as a routine part of life, and there are several explanations for why you forget.

Decay theory maintains that loss of memory is a result of disuse and the passage of time; if information is

not used or rehearsed it fades over time.

2- Interference theory suggests that memory has a limited capacity; when its capacity is reached; you are

susceptible to confusion and forgetting.

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3- Another theory suggests that forgetting occurs when there is failure in the process of retrieving

information. The information is there, stored away, but it appears to have been forgotten because you

cannot retrieve it.

· Repression, then, is motivated forgetting, or the burying of unwanted memories in the unconscious

where they stay largely unreachable.

2- Dissociative fugue

The fugue state involves physical retreat; during a fugue, the individual suddenly and unexpectedly

departs. Two important features for diagnosing dissociative (psychogenic) fugue are listed in DSM-

IV: a sudden unexpected travel away from home or work with an inability to recall one's past, and

confusion about personal identity. Marked confusion about personal identity interferes with routine

daily activities, so, in an effort to adjust and relate to others, the person assumes a new identity. Despite

the new assumed identity, characteristics of the "old self" are recognizable. Often, complicated

behaviors are carried out during the fugue. A victim may drive a long distance, find a place to live,

obtain employment, and begin a new life.

Who is Affected with Dissociative Amnesia and Fugue?

Both dissociative amnesia and fugue are rare. Reports of case suggest that these disorders can appear at

any point in the life span, though less among the elderly. Amnesia is most frequent among adolescent

and young women, but its incidence increases slightly among men.

Treating Dissociative Amnesia and Fugue

Not surprisingly, a person in an amnesic or in a fugue state who is unaware of important facts about his

or her own identity is often equally uninformed about the need for therapy. Typically, dissociative

amnesic and fugue patients do not seek treatment themselves but, rather, are referred to a therapist

after an episode has occurred. The therapy itself often addresses clients' need for more adaptive ways to

manage personal distress and conflict.

· Stress management programs, may be used to treat dissociative amnesia and fugue.

3- Dissociative Identity Disorder (DID)

· Also known as multiple personality disorder, is characterized by the existence of two or more

distinct personalities in a single individual.

· At least two of these personalities repeatedly take control of the person's behavior, and the

individual's inability to recall information is too extensive to be explained by ordinary forgetfulness.

· The original personality especially is likely to have amnesia for subsequent personalities, which may

or may not be aware of the "alternates."

· DID has received considerable public attention, but where does it fit among the many different

types of psychological disorders? Readers may wonder whether it is related to the personality disorders.

It is not: Unlike DID, personality disorders involve clusters of behavioral traits that are excessive,

maladaptive, lifelong, and pervasive. Also, although DID may resemble a "split mind," which is the

literal translation of the word schizophrenia.

Examples

1-"Sybil," a girl with sixteen personalities, DID is characterized by the presence of two or more distinct

personalities of personality states within one individual patterns.

2-The Three Faces of Eve, who describes a client, whose three different personalities virtual opposites in

terms of their emotional and behavioral patterns. Eve White was the quiet, polite, hard-working, and

conservative mother of a young daughter; Eve Black was seductive, impulsive, risk-taking, and

adventure-seeking. Jane, the third personality, was a confident and capable woman.

Who Is Affected with DID?

DID has been found to occur many time more often in women than in men (estimated rates are three

to nine times higher in women). The most common explanations offered for this variance are that

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women are typically more exposed to sexual abuse, women may handle their psychological traumas in

"internal" ways and finally women tend to seek help more than men do.

Treating DID

Antidepressants and anti-anxiety drugs would be the medications commonly used in these

circumstances. Once DID is detected, however, the typical treatment involves psychotherapy aimed at

helping replace the patients' internal division with a unity of personalities (Putnam, 1989).

4- Depersonalization disorder

· Depersonalization disorder is a less dramatic problem that is characterized by severe and persistent

feelings of being detached from oneself.

· Depersonalization experiences include such sensations as feeling as though you were in a dream or

were floating above your body and observing yourself acted.

Diagnosis of Dissociative Disorders (continued)

Occasional depersonalization experiences are normal and are reported by about half of the population.

Causes of Dissociative Disorders

The onset of dissociative amnesia and fugue usually can be traced to a specific traumatic experience.

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