Post Traumatic Stress Disorder and Dissociative Disorder

What is the cormorbidity of major depressive disorder, anxiety disorder, drug abuse, and eating disorders with DID?

MDD: 97 % Anxiety Disorder: 90 % (most often PTSD) Drug abuse: 65 % Eating disorder: 38 % Most people with DID also have a personality disorder.

What is the lifetime prevalence of depersonalization/derealization disorder?

0.8 - 2.8 %. Average onset age is 23.

How many % how firefighters, ambulance personnel and police experience PTSD?

10 % (with ambulance workers the most affected).

How many people experience PTSD after the tsunami i Asia? And how many after hurricane Katrina?

15 % and 30 % (12 % in the surrounding areas of New Orleans).

How many % of soldiers in the Vietnam war had PTSD?

19 % - 9 % still had it after 10-12 years. Today approximately 15-19 % of soldiers deployed to Iraq and 11 % of those deployed to Afghanistan can be diagnosed with PTSD. 42 % of the ones returned from Iraq show some kind of mental health problem.

When was DID first included in DSM?

1980 in DSM-III.

How many % arrested for homicide claim to have amnesia for the killings?

25-45 %.

How many disorders have people with DID often been diagnosed with previously?

3 other disorders.

How many people with DID have a history of suicide attempts and how many have recurrent suicidal thoughts?

3-quarters have attempted suicide and 90 % have suicidal thoughts.

How many % of Afghan citizens have PTSD and how many have other anxiety symptoms?

42 % have PTSD. 72 % have some kind of anxiety (90 % in women).

How many sexual assault survivors experience PTSD?

46 % at some time in their life. Most women report PTSD right after the abuse, 50 % after 3 months and 25 % still after 4-5 years.

Neurobiological studies using PET and MRI have shown differences in brain activity between those with and those without PTSD in response to threatening or emotional stimuli. What are the differences?

Amygdala responds more actively. The medial prefrontal cortex, which modulates the activity of the amygdala is less active in severe PTSD. Thus they may be more reactive and less able to dampen reactions. The hippocampus may show shrinkage.

How many people in Western settings with DID feel as if they're possessed?

60 %. In DSM-5 the words "or an experience of possession" have been added to criterion A. Also helps include other, nonwestern cultures.

How many adults will be exposed to a traumatic event and develop PTSD at some time in their lives?

7 %. Women at greater risk.

What is Ross's theory of DID?

A result of coping strategies used by persons faced with intolerable trauma - most often childhood sexual/physical abuse that they are powerless to escape. DID is an internal divide-and-conquer strategy in which intolerable knowledge and feelings is split up into manageable parts. The compartments are personified and take on their own life.

What is dissociative fugue?

A subtype of dissociative amnesia, in which the person travels to a new place and may assume a new identity with no memory of his or her previous identity. A fugue may last for days or years, happen many times or just once.

What are the seven symptom categories of PTSD?

A) Trauma as defined by DSM-5 B) Intrusion/re-experiencing symptoms C) Avoidance symptoms D) Negative cognitions or mood E) Changes in arousal or reactivity F) Lasting more than 1 month G) With clinically significant distress or impairment

What is adjustment disorder?

Another trauma- and stress related disorder, which consists of emotional and behavioral symptoms (depressive, anxiety symptoms, and/or antisocial behaviors) that arise within 3 months of the experience of a stressor. The stressors do not have to be extreme like in PTSD and acute stress disorder. A diagnosis for those who do not meet the criteria for PTSD, acute stress disorder, or anxiety or mood disorder after a stressful event.

How did french neurologist Pierre Janet view dissociation?

As a process in which components of mental experience are split off from consciousness but remain accessible through dreams and hypnosis.

What is dissociative amnesia?

As described in criterion A for the disorder: An inability to recall important information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.

PTSD have been called three different things in the two world wars and the Korean war...?

Combat fatigue syndrome, war zone stress, and shell shock.

What is the DSM-5s constrains on the term trauma?

Criterion A. Exposure to actual or threatened death, serious injury or sexual violence in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s). 2. Witnessing, in person, the event(s) as it occurred to others. 3. Learning that the traumatic event(s) occurred to a close family member or friend. 4. Experiencing repeated or extreme exposure to averse details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: A4 does not apply through electronic media (unless work related).

What is the cardinal symptom of dissociative identity disorder (DID)?

Criterion A. The apparent presence of two or more (multiple) personalities with distinct qualities, referred to as alters or alternate identities. Child alters seem to be the most common. Persecutor personality alters inflict punishment on the other personalities by engaging in self-mutilative behaviors or suicide attempts. Often the host personality is left to deal with the pain when the persecutor alter "goes back inside". Another type of alter is the protector personality. May take over and deal with situations the host cannot handle. Protectors sometimes control the switching from one personality to another and may report on thoughts and intentions of other alters.

What are the three dissociative disorders?

Dissociative Identity Disorder Dissociative Amnesia Dissociative Depersonalization/Derealization Disorder

Psychotherapies for PTSD generally have three goals which are...?

Exposing clients to what they fear in order to extinguish that fear, challenging distorted cognitions that contribute to symptoms, and helping clients reduce stress in their lives. These goals are addressed in CBT (proven helpful) and in stress-management therapies. Systematic desensitization is used in CBT. Some clients who cant tolerate exposure may receive stress-inoculation therapy that teaches skills to overcome problems in their life that add to the stress. SSRIs and benzodiazepines are used to treat symptoms.

What is another common symptom of DID?

Hearing voices.

Which ethnic group may be more likely to experience dissociation?

Latinos. Dissociative symptoms may be part of the syndrome ataque de nervios, a culturally accepted reaction to stress.

How many psychiatrists in the U.S. believe that there is strong empirical evidence that the dissociative disorders are valid diagnoses?

Less than one quarter.

Is the cortisol level in people with PTSD higher or lower than in people without it?

Lower when not exposed to trauma reminders. May increase the risk of PTSD because there's not enough cortisol to reduce the activity of the sympathetic nervous system. Abnormally low cortisol may be heritable risk factor.

What are the two kinds of amnesia?

Organic amnesia - caused by brain injury resulting from disease, drugs, accidents, or surgery. Anterograde amnesia - the inability to remember new information. Psychogenic amnesia - arises in the absence of any brain injury or disease and is thought to have psychological causes. Rarely involves anterograde amnesia. Retrograde amnesia, the inability to remember things from the past, can have both organic and psychogenic causes. In psychogenic cases what is forgotten is often personal information, not general information - both is often forgotten i organic cases.

Which disorder is frequently comorbid with DID?

PTSD.

The treatment of DID involves trying to integrate the personalities. What is the result of a study of successful integration?

Patient are symptom free for 2 years.

What does Hilgard think the problem in dissociative disorder is?

People with dissociative disorder may have problems integrating their active and receptive consciousness. Different aspects of consciousness don't integrate with each other and remain split, operating independently.

What is depersonalization?

Persistent of recurrent experiences of feeling detached from, and as if one were an outside observer of, one's mental processes or body (e.g. feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).

What is derealization?

Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).

What are the two disorders that by definition are the consequences of experiencing extreme stressors, referred to as traumas?

Post Traumatic Stress Disorder and Acute Stress Disorder.

What are the three strong predictors of people's reactions to trauma?

Severity of the trauma, it's duration and the individuals proximity to the trauma. Availability of emotional support also predicts recovery. People with self-destructive or avoidant coping styles are more likely to develop PTSD as are those who were anxious before the traumatic event happened and those who tend to use dissociation as a coping mechanism.

How many of the 135 persons with DID reported having been sexually or physically abused?

Sexually: 92 % Physically: 90 % Other traumas associated with the development of DID include kidnapping, natural disasters, war, famine, and religious persecution.

What's the prevalence of DID?

Studies of psychiatric care find that between 1 in 6 percent of patients can be diagnosed with DID. The vast majority are adult women.

What is the idea of DID in the sociocognitive model?

The alters are created by patients who adopt the idea or narrative of dissociative identity disorder as an explanation that fits their lives. The identities are not true personalities with clear-cut demarcations but rather a metaphor used by the patients to understand their subjective experiences. It's not faking but playing a role that helps patients deal with the stresses, reinforced by concern and attention for others.

A PTSD sufferer can experience symptoms of dissociation, a process in which different facets of their sense of self, memories or consciousness become disconnected from one another. In DSM-5 the needs to be specified as?

The subtype PTSD with prominent dissociative (depersonalization/derealization) symptoms.

Who are more likely to experience PTSD?

Women and african americans.