Dissociative Disorders

1. Dissociative Disorders Done By: Mahmoud Nalawi Anas AL Quzaa 1

2. Definition Dissociative disorders are defined by a loss of memory, identity, or sense of self (one�s sense of self is the normal integration of one�s thoughts, behaviors, perceptions, feelings, and memory into a unique identity). Amnesia and feelings of detachment often arise suddenly and may be temporary in duration. 2

3. Definition Examples of dissociative disorders: Dissociative amnesia. Dissociative fugue. Dissociative identify disorder. Depersonalization disorder. 3

4. Definition Unlike the amnesia present in amnestic disorders, symptoms of dissociative disorders are never due to an underlying medical condition or substance use. The onset is related to a stressful life event or personal problem. (history of trauma, abuse during childhood). 4

5. Dissociatve Amnesia Amnesia is a prominent symptoms in all of the dissociatve disorders except depersonalization disorder. The diagnosis requires that amnesia must be the only dissociative symptom present. Patients with this disorder are often aware about having difficulty remembering but they are not bothered by it. Patients are often unable to recall their name or other important information but will remember obscure details. 5

6. Diagnosis and DSM-IV Criteria At least one episode of inability to recall important personal information, usually involving a traumatic or stressful event. The amnesia cannot be explained by ordinary forgetfulness. Symptoms cause significant distress or impairment in daily functioning and cannot be explained by another disorder, medical condition, or substance use. 6

7. Epidemiology Most common dissociative disorder. Women > Men Younger adults > older Increased incidence of comorbid major depression and anxiety disorders. Course and Prognosis Many patients abruptly return to normal after minutes or days. Recurrences are uncommon 7

8. Treatment It is important to help patients retrieve their lost memories in order to prevent future recurrences. Hypnosis or administration of sodium amobarbital or lorazepam during the interview may be useful to help patients talk freely. Subsequent psychotherapy is recommended. Ativan is used more than sodium amobarbital. (safer, and better tolerated). 8

9. Dissociative Fugue Dissociative fugue is characterized by sudden, unexpected travel away from home, accompanied by the inability to recall parts of one�s past or identity. Patients usually assume an entirely new identity and occupation after arriving in the new location. They are unaware of their amnesia and new identity, still they never recall the period of the fugue. 9

10. Diagnosis and DSM-IV Criteria Sudden, unexpected travel away from home or work plus inability to recall one�s past. Confusion about personal identity or assumption of new identity. Not due to dissociative identity disorder or the physiological effects of a substance or medical disorder. Symptoms cause impairment in social or occupational functioning. 10

11. Epidemiology Rare. Predisposing factors include heavy use of alcohol, major depression, history of head trauma, and epilepsy. Onset associated with stressful life event (dissociative fugue is often viewed as a response to a life stressor or personal conflict. 11

12. Course and Prognosis It usually lasts a few hours to several days, but may last longer. After the episode, the patient will assume his/her old identity Treatment Similar as dissociative amnesia. 12

13. Dissociative Identity Disorder (Multiple Personality Disorder) Patients with dissociative identity disorder have two or more distinct personalities that alternately control their behaviors and thoughts. Patients are often unable to recall personal information. While one personality is dominant, that personality is usually unaware of events that occurred during prior personality states. 13

14. Diagnosis and DSM-IV Criteria Presence of two or more distinct identities. At least two of the identities recurrently take control of the person�s behavior. Inability to recall personal information of one personality when other is dominant. Not due to effects of substance or medical condition. 14

15. Epidemiology Women account for more than 90% of patients. Most patients have experienced prior trauma, specially childhood physical or sexual abuse. Average age of diagnosis is 30 years. High incidence of comorbid major depression, anxiety disorders, borderline personality disorder, and substance abuse. Up to one third of patients attempt suicide. 15

16. Course and Prognosis Course is usually chronic with incomplete recovery. Worst prognosis of all dissociative disorders. Patients with an earlier onset have a poorer prognosis. 16

17. Treatment Hypnosis. Drug-assisted interviewing. Insight-oriented psychotherapy. Pharmacotherapy is needed if comorbid disorders develops ( major depression). 17

18. Depersonalization Disorder Depersonalization disorder is characterized by persistent or recurrent feelings of detachment from one�s self, environment (derealization), or social situation. Patients feel separated from their bodies and mental processes, as if they are outside observers. They are aware of their symptoms and often fear they are going crazy. Often accompanied by anxiety or panic. 18

19. Diagnosis and DSM-IV Criteria Persistent or recurrent experiences of being detached from one�s body or mental processes. Reality testing remains intact during episode. Cause social/occupational impairment and cannot be accounted for by another mental or physical disorder. 19

20. Epidemiology Approximately twice as common in women than men. Average onset between ages 15 and 30. Increased incidence of commorbid anxiety disorders and major depression. Severe stress is a predisposing factor. 20

21. Course and Prognosis Often chronic, but may remit without treatment. Treatment Antianxiety agents or SSRIs to treat associated symptoms of anxiety or major depression. 21

22. Thank You ! 22