Dissociative Disorders

1. Dissociative Disorders • Disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. • An example is the fugue state, where someone can walk out of their life, and suddenly aware months or years later, with no memory of the intervening time. (Stone, 2006). • Note there is no mention of repressed memories. • Facing trauma, dissociative detachment may actually protect a person from being overwhelmed by emotion. • The Japanese medieval samurai had a saying for combat: “Assume that you have already been killed in battle, therefore nothing worse can happen to you. Then get on with your duty as a samurai.” (from the movie Shogun, 1981)

2. Dissociative Disorders • DID: two or more distinct identities are said to alternately control the person's behaviour. • The Hillside Strangler was supposedly a classic case of a good and a bad identity. During a hypnosis section, Dr. John Watkins (1984) called forth a hidden personality. This was all a ruse, Bianchi was a practiced liar. • Are clinicians who discover multiple personalities merely triggering role playing in fantasy-prone people? (Spanos, 1996) • Or is it cultural? Once DID was included in the DSM, the number of reported cases exploded to more than 20,000 (McHugh, 1995). • Rather than being provoked by trauma, DID symptoms tend to be exhibited by the fantasy-prone. (Giesbrecht et al., 2010)

3. DID cont'd • But..handedness switches with personality changes. (Henninger, 1992) • Opthamologists have detected shifting visual acuity and eye-muscle balance as patients switched personalities, changes that did not occur among controls trying to simulate DID. (Miller et al., 1991) • DID patients exhibit heightened activity in brain areas associated with the control and inhibition of traumatic memories. (Elzinga et al., 2007) • Is it a form of PTSD? One study of 12 murderers diagnosed with DID, 11 had suffered severe tortuous child abuse. (Lewis et al., 1997) • Can such recollections simply be attributed to vivid imagination and/or therapists' suggestions? (Kihlstrom, 2005)

4. Personality Disorders • Characterized by inflexible and enduring behaviour patterns that impair social functioning. • Avoidant: fearful sensitivity to rejection that predisposes withdrawal. • Schizoid: emotionless disengagement. • Histrionic: attention-getting dramatic or impulsive behaviours that intimidate or manipulate others. • Narcissistic personality: the Joker from Batman (says it all). • These categories are not sharply distinguished, and will be changed in the DSM-5 (Holden, 2010).

5. Antisocial Personality Disorder • Typically a male whose lack of conscience becomes plain before age 15, as he begins to lie, steal, fight, and or display unrestrained sexual behaviour. (Cale & Lillienfeld, 2002). • Despite their remorseless and sometimes criminal behaviour, criminality is not an essential component of antisocial behaviour. (Skeem & Cooke, 2010). • Antisocial personalities behave impulsively, and then feel and fear little. (Fowles & Dindo, 2009). • Twins and adoptions studies reveal that biological relatives of those with the disorder are at increased risk. (Livesley & Jang, 2008). • Fig. 51.1 Stress hormone levels were lower than average before committing any crime. (Magnusson, 1990).(m668 c643 15.11)

6. ASPD cont'd • Boys who later become aggressive or antisocial adolescents tended to be impulsive, uninhibited, unconcerned with social rewards, and low in anxiety. (Caspi et al., 1996) • The genes that put them at risk for antisocial behaviour also put people at risk for dependence on alcohol or other drugs, which helps explain why these disorders often appear in combination. (Dick, 2007). • Fig. 51.2 (m669 c644 15.12)The top-facing PET scans illustrate reduced activation (less red & yellow) in a murderer's frontal cortex--a brain area that helps brake impulsive, aggressive behaviour. • In one study, violent repeat offenders had 11% less frontal lobe tissue than normal. (Raine, 2000). • ASPD exhibit marked deficits in frontal lobe cognitive functions: planning, organization, inhibition. (Morgan & Lillienfeld, 2000).

7. Biopsychosocial roots of crime • Fig. 51.3 (m669 c644 15.13)Danish male babies whose backgrounds were marked both by obstetrical complications and social stresses associated with poverty were twice as likely to be criminal offenders by age 20 to 22 as those in either the biological or social risk groups. (Raine et al., 1996) • Two combined factors: childhood maltreatment and a gene that altered neurotransmitter balance--predicted antisocial problems. (Caspi et al., 2002) • ASPD display a hyper-reactive dopamine reward system that predisposes their impulsive drive to something reward, despite the consequences. (Buckholtz et al., 2010). • Note to remember: everything psychological is also biological.

8. Eating Disorders • Anorexia nervosa: a person (usually an adolescent female) maintains a starvation diet despite being significantly (+15%) underweight. • Bulimia nervosa: a person alternates binge eating (usually high-calorie foods) with purging (by vomiting, laxatives, or fasting). • Binge-eating: significant binge-eating episodes, followed by distress, disgust or guilt, but without the compensatory purging or fasting that marks bulimia nervosa. • Remember to measure underweight or overweight against the Body Mass Index (BMI), not the gross weight on a scale. • Also, these disorders are not a telltale sign of childhood sexual abuse.

9. Eating Disorders Cont'd • Mothers of girls with eating disorders tend to focus on their own weight and on their daughter's weight and appearance. (Pike & Rodin, 1991). • Families of bulimics have higher-than-normal incidence of childhood obesity and negative self-evaluation. (Jacobi et al., 2004) • Familes of anorexics tend to be competitive, high-achieving, and protective. (Pate et al., 1992) • Twins are more likely to share the disorder if they are identical rather than fraternal. (Root et al., 2010). • The rise in eating disorders in N.A has coincided with a dramatic increase in women having a poor body image. (Feingold & Mazzella, 1998).