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Dissociative Disorder

Disorders Dissociative

Dissociative disorder is a collective term for four different psychiatric conditions - dissociative amnesia including dissociative fugue, dissociative identity disorder, dissociative derealization and atypical dissociative disorder.

Generally, dissociative disorders develop as a defense measure against psychological trauma. Increased prevalence among child abuse victims, rape cases, war veterans, and survivors of concentration camps or natural disasters has been reported.

Diagnosis rests on clinical findings, questionnaires, hypnosis and several laboratory tests to rule out organic or substance-related causes for dissociative symptoms.


Presentation

The key finding of dissociative amnesia is the patient's inability to recall specific autobiographical details that are connected with severe stress episodes. Dissociative amnesia causes significant social distress and reduces the quality of life. Amnesia is usually selective but can span several years up to decades depending on the persistence of the traumatic situation. The stronger the stress, the more pronounced the memory loss [1] [2]. Patients avoid eye contact, show normal activity levels but are aware of their memory loss which may lead to profound frustration. Orientation is normal but anxiety and lack of attentiveness are frequently encountered. Dissociative fugue is a subtype of dissociative amnesia which is characterized by a sudden intentional traveling urge accompanied by dissociative amnesia. Dissociative fugue occurs most often among sexual abuse victims [3] [4] [5]. Dissociative amnesia can be reversible [6].

Cases with dissociative identity disorder are easily irritable and anxious while avoiding eye contact; orientation, long- and short-term memory are often impaired. The characteristic finding of dissociative identity disorder, however, is the existence of at least one additional distinct personalities in one patient. These alter egos can differ significantly from the original character in psychological complexity, body posture, language and even sex. Dissociative identity disorder is almost always accompanied by dissociative amnesia and occurs most frequently in victims of child abuse [3] [7].

Dissociative derealization has also been associated with childhood trauma and stress situations, in particular long-term emotional maltreatment. Patients experience a surreal detachment of their environment and themselves. Their perception of reality is either blurred or unusually sharp, dull and sometimes systematically distorted. Such patients have the tendency to 'remote-control' other people [8].

Patients with the atypical dissociative disorder can present with abnormal dialogue behavior, impaired vigilance or hallucinations. It primarily affects men.

Turkish
  • A total of 92 psychotropic drug-naive patients with PD, recruited from outpatient clinics in the psychiatry department of a Turkish hospital, were involved in the study.[ncbi.nlm.nih.gov]
  • Zoroglu S, Yargic LI, Tutkun H, Ozturk M, Sar V: Dissociative identity disorder in childhood: five Turkish cases. Dissociation 1996;9:253–260. Coons PM: Clinical phenomenology of 25 children and adolescents with dissociative disorders.[doi.org]
  • Frequency of dissociative disorders among psychiatric inpatients in a Turkish university clinic. American Journal of Psychiatry, 155 , 800–805. Van der Hart, O., & Horst, R. (1989). The dissociation theory of Pierre Janet.[nobaproject.com]
Eruptions
  • Abstract The standard of care for the delivery of mental health services has recently undergone a dramatic change spurred on by hundreds of lawsuits against therapists and by erupting controversies in the science of trauma and dissociative disorders.[ncbi.nlm.nih.gov]
  • Instead they are dissociated, or "split off," and may erupt into consciousness from time to time without warning. The affected person cannot control or "edit" these memories.[minddisorders.com]
Dermatitis
  • Ozman M, Erdogan A, Aydemir EH, Oguz O: Dissociative identity disorder presenting as dermatitis artefacta. Int J Dermatol 2006;45:770–771. Peterson G: Children coping with trauma: diagnosis of ‘dissociation identity disorder’.[doi.org]
Motor Symptoms
  • Mixed category of dissociative disorder was highest (n 18, 38%) followed by unspecified and motor symptoms (n 13, 26%) in each group. Depression was present in 42 (84%) patients. Moderate depression was most frequent (n 19, 38%).[ncbi.nlm.nih.gov]
  • PubMed Central View Article PubMed Google Scholar Crimlisk HL, Bhatia K, Cope H, David A, Marsden CD, Ron MA: Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. Brit Med J. 1998, 316: 582-586.[doi.org]
Encephalopathy
  • Along with other possible causes, for example, encephalopathy associated with autoimmune thyroid disease, clinicians should be aware of this possibility.[ncbi.nlm.nih.gov]

Workup

Diagnosis of dissociative disorders rests on an analysis of the patient history, clinical criteria and the exclusion of potential causes like substance abuse.

The main criterion for the diagnosis of dissociative amnesia is the trauma-related inability of a victim to recall important personal information causing substantial social distress. Dissociative identity disorder is characterized by the existence of alter egos in addition to dissociative amnesia. A key symptom of dissociative depersonalization is a distorted perception of reality and self [7].

Psychiatric examinations will reveal these features. Family history analysis should focus on traumatic events like abuse during childhood. Further exams should corroborate the diagnosis by excluding organic causative factors. Electroencephalography (EEG) and magnetic resonance imaging (MRI) procedures can help to rule out physical causes. Substance abuse (e.g. cannabis) can be proven with urinalysis [8].

Helicobacter Pylori
  • The present case reports on a 51-year-old woman with gastritis who received clarithromycin combined with rabeprazole for Helicobacter pylori infection.[ncbi.nlm.nih.gov]

Treatment

  • Abstract Although treatment outcome research on dissociative disorders (DD) is increasing, an examination of treatment progress in young adults with these disorders remains noticeably absent from the literature.[ncbi.nlm.nih.gov]
  • The latest research indicates that DD patients show a suboptimal response to standard exposure-based treatments for posttraumatic stress disorder as well as high levels of attrition from treatment.[ncbi.nlm.nih.gov]
  • Case examples are used to illustrate successful treatment. Although treatment of incest survivors with dissociative disorders is difficult, success can be anticipated, and the rewards to the patient and the satisfaction for the therapist are great.[ncbi.nlm.nih.gov]
  • Phase-orientated treatment has been shown to improve dissociative identity disorder.[theconversation.com]

Prognosis

  • Prognosis of Dissociative Disorders The prognosis of dissociative disorders varies by type. Dissociative amnesia and dissociative fugue have a good prognosis, resolving spontaenously and recurring rarely.[myvmc.com]
  • A better prognosis was found in dissociative disorder children and adolescents with younger age at first presentation [ 24 ].[doi.org]
  • ., disaster and war) and acute life stress leads to significant distress or impairment not the result of substance abuse or general medical condition Treatment psychotherapy Prognosis, Prevention and Complications amnesia of previous life is typically[step2.medbullets.com]
  • Treatment and Prognosis of Dissociative Disorders Dissociative disorders rarely resolve on their own, and professional treatment is required.[bridgestorecovery.com]
  • Prognosis Prognoses for dissociative disorders vary. Recovery from dissociative fugue is usually rapid. Dissociative amnesia may resolve quickly, but can become a chronic disorder in some patients.[medical-dictionary.thefreedictionary.com]

Etiology

  • This article presents a summary of the BASK model of dissociation and two other models and gives ideas on how these models may be applied to the understanding of the etiology of dissociative disorders and their treatment.[ncbi.nlm.nih.gov]
  • These findings support the early childhood etiology of DDs and subsequent maladaptive cycles of adult abuse. Enquiries about childhood maltreatment should include a history of emotional neglect by biological parents/siblings.[ncbi.nlm.nih.gov]
  • Etiology of Dissociative Disorders Many researchers believe that severe stress plays a role in the onset of dissociative disorders. However, they cannot explain why only a small minority of people who experience severe stress develop such disorders.[sparknotes.com]
  • The purpose of this article is to review the published cases of childhood DID in order to evaluate its scientific status, and to answer research questions related to the etiological models.[doi.org]
  • Even the claimed etiological link between trauma/abuse and dissociation has been questioned.[en.wikipedia.org]

Epidemiology

  • ., neuroanatomy, genetics, and epidemiology) and then leads them through diagnostic topics (e.g., neuroimaging, laboratory testing, and the neuropsychological examination), before arriving at the psychiatric disorders (e.g., dissociative disorders, mood[books.google.com]
  • This article reviews the epidemiology and clinical symptomatology of these disorders. In addition, various screening and diagnostic instruments, such as the DES, Structured Clinical Interview for Dissociative Disorders, and MMPI, are discussed.[ncbi.nlm.nih.gov]
  • Ross CA: Epidemiology of multiple personality disorder and dissociation. Psychiatr Clin North Am 1991;14:503–517. Ross CA: Epidemiology of dissociation in children and adolescents. Child Adolesc Psychiatr Clin N Am 1996;5:273–284.[doi.org]
  • Social Psychiatry and Psychiatric Epidemiology, 36, 63 – 69. Google Scholar Crossref Medline ISI Aldridge-Morris, R. ( 1989 ). Multiple personality: An exercise in deception. Hillsdale, NJ : Erlbaum. Google Scholar Allen, J. J. B., Movius, H.[doi.org]
  • Social Psychiatry and Psychiatric Epidemiology , (in press). Levin, R., & Fireman, G. (2002). Nightmare prevalence, nightmare distress, and self-reported psychological disturbance. Sleep, 25 , 205–212. Levitan, H. L. (1967).[nobaproject.com]
Sex distribution
Age distribution

Pathophysiology

  • Persistent elevations of cerebrospinal fluid concentrations of corticotropin-releasing factor in adult nonhuman primates exposed to early-life stressors: Implications for the pathophysiology of mood and anxiety disorders .[doi.org]

Prevention

  • Future research should not only address treatment outcomes, but also focus on public policy around prevention and detection of extreme trauma.[theconversation.com]
  • These findings point to dissociation and depression severity as important correlates of NSSI and suicidality in patients with dissociative disorders and have implications for self-harm prevention and treatment.[ncbi.nlm.nih.gov]
  • ., disaster and war) and acute life stress leads to significant distress or impairment not the result of substance abuse or general medical condition Treatment psychotherapy Prognosis, Prevention and Complications amnesia of previous life is typically[step2.medbullets.com]
  • Prevention Since the primary cause of dissociative disorders is thought to involve extended periods of humanly inflicted trauma, prevention depends on the elimination of child abuse and psychological abuse of adult prisoners or hostages.[medical-dictionary.thefreedictionary.com]

References

Article

  1. Conway MA, Pleydell-Pearce CW. The construction of autobiographical memories in the self-memory system. Psychol Rev. 2000;107(2):261-288.
  2. Bremner JD, Krystal JH, Charney DS, Southwick SM. Neural Mechanisms in dissociative amnesia for childhood abuse: relevance to the current controversy surrounding the "false memory syndrome". Am J Psychiatry. 1996; 153(7):71-82.
  3. American Psychiatric Association. Dissociative disorders. Desk reference to the diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Washington, DC: APA Press; 2013.
  4. Conway MA, Pleydell-Pearce CW. The construction of autobiographical memories in the self-memory system. Psychol Rev. 2000;107(2):261-288.
  5. Sadock BJ, Sadok VA. Kaplan and Sadock’s Synopsis of Psychiatry. 10th edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
  6. Spiegel D, Loewenstein RJ, Lewis-Fernández R, et al. Dissociative disorders in DSM-5. Depress Anxiety. 2011;28(9):824-852.
  7. Zlotnick C, Begin A, Shea MT, et al. The relationship between characteristics of sexual abuse and dissociative experiences. Compr Psychiatry. 1994;35(6):465–470.
  8. Simeon D. Depersonalisation disorder: a contemporary overview. CNS Drugs. 2004;18(6):343-354.

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Last updated: 2019-07-11 20:56