Dissociative disorders
What is the course of dissociative fugue?
Usually lasts few hours to several days, may last longer. After episode, patient with assume old identity without remembering time of fugue
Who gets Dissociative Identity Disorder?
Women account for more than 90% of patients
Are patients with dissociative amnesia aware that they are unable to remember things? Are they troubled by it?
Yes, typically aware. Not very troubled by it.
Who gets dissociative amnesia more often, younger adults or older adults?
Younger adults
DSM IV criteria for diagnosis of Dissociative amnesia
1. At least one episode of inability to remember important personal details, usually involving a stressful or traumatic event 2. Amnesia cannot be explained by ordinary forgetfulness 3. Symptoms cause significant distress or impairment in daily functioning and cannot be explained by another disorder, medical condition or substance use
DM IV criteria for depersonalization disorder
1. Persistent or recurrent experience of being detached from one's body or mental processes 2. Reality testing remains intact during episode 3. Causes social/occupational impairment and cannot be accounted for by another mental or physical disorder
DSM IV criteria for Dissociative Identity Disorder
1. Presence of two ore more distinct identities 2. At least two of the identities take control of the person's behavior 3. Inability to recall personal information of other personality when the other is dominant 4. Not due to effects of substance or medical condition
What proportion of patients with dissociative identity disorder attempt suicide?
1/3
Who gets depersonalization disorder?
2x women than men
What is the average age of diagnosis for Dissociative identity disorder?
30
What is the course of dissociative amnesia?
Most patients abruptly return to normal after minutes or days. Recurrences are uncommon.
Are patients with dissociative fugue aware of their amnesia?
No. They are unaware of tehir amnesia and new identity, and they never recall the period of fugue
What is the treatment for depersonalization disorder?
Antianxiety agents or SSRIs to treat associated anxiety/depression
When is the average onset of depersonalization disorder?
Average onset between ages 15 and 30
What is the course of depersonalization disorder?
Often chronic (with either steady or intermittent course) but may remit without tx
What is dissociative fugue?
Characterized by sudden unexpected travel away from home, accompanied by the inability to recall parts of one's past or identity. Patients often assume an entirely new identity and occupation after arriving in new location.
What comorbid conditions are common with dissociative identity disorder?
Comorbid major depression Anxiety disorders Borderline personality disorder Substance abuse
Which dissociative disorder has the worst prognosis out of all the dissociative disorders?
Dissociative Identity Disorder
What is the most common dissociative disorder?
Dissociative amnesia
T/F. Symptoms of dissociative disorders are often due to an underlying medical condition or substance use.
F. Onset is related to a stressful life event or personal problem Many patients with a history of trauma or abuse during childhood
What are predisposing factors for developing dissociative fugue?
Heavy use of alcohol Major depression Head trauma Epilepsi
What is important to do in order to prevent recurrences of dissociative amnesia?
Help patients retrieve lost memories
What is the treatment for dissociative personality disorder?
Hypnosis Drug assisted interviewing Insight oriented psychotherapy Pharmacotherapy if comorbid disorder develops
What medications are commonly given to patients with dissociative amnesia to help them talk more freely?
Hypnosis Sodium amobarbital Lorazepam
What is the difference between individuals with dissociative amnesia and dissociative fugue?
Individuals with dissociative amnesia are aware that they have forgotten things Patients with dissociative fugue are not aware
Which other conditions have an increased incidence of occurring with dissociative amnesia?
Major depression Anxiety disorders
Which gender more commonly gets dissociative amnesia?
More common in women than men
What precipitates onset of dissociative fugue?
Onset associated with stressful life event-- response to life stressor or personal conflict
How do you differentiate dissociative amnesia vs dementia?
Patients are often unable to recall their name or other important information but will remember OBSCURE DETAILS in dissociative amnesia. The opposite is true in dementia.
What is the prognosis for dissociative identity disorder?
Poor. Patients with earlier onset have poorer diagnosis
Most patients with dissociative identity disorder have experienced what?
Prior trauma, especially childhood physical or sexual abuse
What is necessary for the diagnosis of dissociative amnesia?
Requires that amnesia be the only dissociative symptom present
What is a predisposing factor for depersonalization disorder?
Severe stress
What is the treatment for dissociative fugue?
Similar to dissociative amnesia Important to help patient retrieve lost memories
T/F. Amnesia is a prominent symptom in all of the dissociative disorders except depersonalization disorder.
T
T/F. Symptoms of multiple personality disorder may be similar to those with borderline personality disorder.
T
T/F. Transient symptoms of depersonalization are common in normal people during times of stress.
T
Increased incidence of comorbid anxiety disorders and major adepression with depersonalization T/F
T.
What is abreaction?
The strong reaction patients often get when retrieving traumatic memories
What is the course of dissociative identity disorder?
Usually chronic with incomplete recovery
