Chapter 6 part 2
Dissociative disorders
involve changes in memory that occur without apparent organic (or physical) cause. In such disorders, one part of the person's memory seems to be dissociated, or separated, from the rest.
Amnesia
is the partial or total forgetting of past experiences.
Memory
necessary to the sense of wholeness and identity, link between past, present, future. While memory may not always be accurate in detail, it serves as a recognition and link to the continuity of our experiences.
One-way amnesic relationships:
some subpersonalities are aware of others, but the awareness is not mutual (most common type). The aware personalities are called co-conscious subpersonalities that typically do not interact with other subpersonalities, but rather are quietly aware of them ("quiet observers"
Mutually amnesic relationships:
subpersonalities have no awareness of each other
Anterograde amnesia:
the blotting out of a period of time after the precipitating stress (psychological or physical stress)
Retrograde amnesia
the blotting out of a period of time prior to the precipitating stress (psychological or physical stress)
Behavioral View
Behaviorists believe that dissociation grows from normal memory processes and is a response learned through operant conditioning: Momentary forgetting of trauma leads to a drop in anxiety, which increases the likelihood of future forgetting (dissociation is negatively reinforced by reducing the person's anxiety) Like psychodynamic theorists, they view dissociation as an escape from anxiety, but behaviorists believe that the dissociation occurs as a result of reinforcement, rather than from the unconscious. Theory based largely on case studies, and fails to explain how disorder develops in non-abused individuals or why it selectively occurs in some but not all abused individuals
DID2
Despite strong physiologic evidence, some clinicians and researchers still suspect that all or most cases are iatrogenic (unintentionally produced by clinicians through the unwitting power of suggestion or use of hypnosis). Number of people diagnosed with DID has increased substantially over the last few decades. Question becomes whether the disorder is occurring more frequently, being identified/diagnosed now more accurately, or being unwittingly induced by clinicians. Disorder becoming recognized in popular culture through books, movies and television shows featuring actual and fictionalized cases of DID.
Generalized Amneisa
The person forgets his/her entire past life experiences and identity. Extremely rare form of amnesia.
Identity
psychological, subjective sense of who we are; our recognition and awareness of ourselves.
Selective amnesia
A person forgets only certain events that occurred during a circumscribed period of time.
Continuous Amnesia
-A person forgets all events that occur after a specific period up to the present, including events that occur after the onset of amnesia. Also a rare form of amnesia-
Dissociate fugue
A person not only forgets his/her own personal identity and information, but also travels/flees to a new location. Fugue is usually brief, and a new identity is not typically formed. For others, the fugue is more severe: people may travel far from home, take a new name and establish new relationships, and even a new line of work; some display new personality characteristics Generally rare but when it does occur, it typically follows a stressful event (eg, wartime experience or natural disaster). Affects episodic memories rather than semantic knowledge. Fugue will generally end abruptly as they "awaken" in unfamiliar surroundings. Often people will experience amnesia about the fugue period after "awakening" from the state
dissociative amnesia
A person with is unable to recall important information (often upsetting info) about their lives after a stressful event. Usually an anterograde amnesia that often follows a psychologically traumatic event.
Localized Amenisia
All events occurring during a circumscribed period of time are blocked out, almost always begins with a disturbing event. Also called circumscribed amnesia. Is the most common type of dissociative amnesia. Forgotten period is called an amnestic episode.
DID
Also popularly known as Multiple Personality Disorder. A person with dissociative identity disorder develops two or more distinct personalities called subpersonalities or alternate personalities. Each has own unique set of memories, behaviors, thoughts, emotions. Usually a dominant personality called the primary personality or host personality appears more often than the other personalities. The transition from one personality to another, switching, can be sudden and/or dramatic.
State dependent learning
Based on premise that if an individual learns something while in a particular situation or state of mind, they are likely to remember it best when they are in a similar condition (situation or state of mind). Research finds evidence of state-dependent learning in studies with drugs, as well as mood-specific states (happy, sad, etc). Arousal levels related to state are key in learning and encoding memory, more likely to be recalled when in the same arousal state. Theory relates to dissociative disorders by suggesting that people who have very narrow or rigid state-to-memory links may only remember events in particular states of arousal, thus creating periods of amnesia or different sets of memories (i.e., personalities) in different states
self hypnosis
Based on premise that if an individual learns something while in a particular situation or state of mind, they are likely to remember it best when they are in a similar condition (situation or state of mind). Research finds evidence of state-dependent learning in studies with drugs, as well as mood-specific states (happy, sad, etc). Arousal levels related to state are key in learning and encoding memory, more likely to be recalled when in the same arousal state. Theory relates to dissociative disorders by suggesting that people who have very narrow or rigid state-to-memory links may only remember events in particular states of arousal, thus creating periods of amnesia or different sets of memories (i.e., personalities) in different states
Dissaciative Memory continued
Dissociative amnesia interferes primarily with episodic memory (one's autobiographical memory of personal material), while semantic memory (memory for abstract or encyclopedic information) remains intact. Prevalence is largely unknown, but increases among victims of wartime and natural disasters. Also occurs in victims of sexual abuse or trauma. Within episodic memory, there is often some evidence that implicit memories remain intact, but explicit memories are gone. For example, a person may be able to recite an address or phone number, but is unaware of the personal connection.
treatment DIA
Most common treatments for dissociative amnesia and fugue are psychodynamic therapy, hypnotic therapy, and medication management/drug therapy. Psychodynamic therapy is thought to be effective for these disorders because of its emphasis on the unconscious and repression (help individuals to search their unconscious and bring forgotten experiences into consciousness). People with dissociative disorders tend to be more highly suggestible and benefit from hypnotherapy that elicits forgotten memories. So called "truth serums" (barbiturates) or injections of sodium amobarbital (Amytal) or sodium pentobarbital (Pentothal) work by calming people and reducing inhibitions, which helps people to recall anxiety-producing events. This approach has mixed results (efficacy).
treatment DIA &DIF
People with dissociative amnesia and fugue often recover on their own Only sometimes do their memory problems linger and require treatment In contrast, people with DID usually require treatment to regain their lost memories and develop an integrated personality Treatment for dissociative amnesia and fugue tends to be more successful than treatment for DID
DID Depersonalization
People with this disorder feel as though they have become separated from their body and are observing themselves from outside This sense of unreality can extend to other sensory experiences and behavior Depersonalization experiences by themselves do not indicate a depersonalization disorder Transient depersonalization reactions are fairly common The symptoms of a depersonalization disorder are persistent or recurrent, cause considerable distress, and interfere with social relationships and job performance
GOALS OF TREATMENT DID
Regardless of the clinician's theoretical orientation, the treatment approach for DID is somewhat uniform. 1. Goal is to integrate several or all of the personalities. 2. Each alter has to be helped to understand that he/she is part of 1 person and that the alters are self-generated. 3. Therapist uses alter's names only for convenience, but does not confirm the existence of separate, autonomous personalities who do not share in overall responsibility of the whole person. 4. All alters should be treated with fairness and empathy. 5. Therapist encourages empathy and cooperation among the alters. 6. Gentleness and supportiveness are needed in consideration of childhood trauma that probably gave rise to the alters.
Self hypnosis2
Some theorists view hypnosis as an out of the ordinary function of the mind, or special process. Thus, internal trances that are the result of hypnotic suggestibility function as a coping mechanism, and produce significantly altered states of conscious functioning. Other theorists maintain that self-hypnosis is produced by common social and cognitive processes. Individuals with a dissociative disorder are highly motivated to forget unpleasant experiences, and provide themselves with suggestions not to remember those events. Thus, their "forgetting" is the result of self-fulfilling expectations and focusing their attention on other things (common social and cognitive processes that we all engage in).
DID description
Subpersonalities may differ in having not only their own names, but also different vital statistics (incl. age, gender, race and personal history), and abilities and preferences (incl. different handwriting styles, talents/skills such as playing an instrument, speaking a foreign lang., driving). Physiological responses in studies of people with DID show evidence of changes in EEG patterns, blood pressure levels, allergies, and differences in autonomic nervous system activity between the different personalities or "alters". Physiologic changes were studied against control groups of people pretending to have multiple personalities, and results consistently showed that those diagnosed with dissociative identity disorder demonstrated brain reaction changes that could not be duplicated by faking
Psychodynamic view
Thought to be caused by ego defense mechanism of repression in which people defend against anxiety by unconsciously preventing painful memories, thoughts or impulses from coming into conscious awareness. Dissociate fugue and amnesia result from a single episode of massive repression, while dissociative identity disorder is the culmination of a lifetime of excessive repression. Most of the evidence for the psychodynamic perspective comes from case histories (individuals seriously abused as children). Theory does not offer explanations for dissociative disorders that result from cases that do not involve abuse, or why
treatment of DID
Treatment for dissociative identity disorder emphasizes recognizing nature of the disorder, recovering memory gaps & integrating the subpersoanlities into a single identity. Recognizing the disorder: -Focuses on therapist building rapport/bond with the primary and each alternate personality. Therapists try to educate the patients and help them recognize the nature of the disorder -Introducing personalities to each other (hypnosis or video) is done. -Family or group therapy is used to educate about the disorder also. Recovering memories: -May include previously described methods such as psychodynamic therapy, hypnotherapy, drug therapy, etc. Tends to be slow process. Integrating the subpersonalities: -Fusion can be the most difficult portion of therapy, and it is sometimes difficult for the patient to let go of different subpersonalities (subpersonalities may see this as a form of death). After fusion, further therapy is needed to maintain results.
Mutually cognizant patterns
each subpersonality is aware of the rest.