Psychopathology: Understanding Anxiety and Dissociative Disorders, Exams of Psychopathology

Download Psychopathology: Understanding Anxiety and Dissociative Disorders and more Exams Psychopathology in PDF only on Docsity! Introduction to Psychopathology Alan J. Fridlund, Ph.D. Reactions to Extreme Trauma  Intrusive recollections (daytime flashbacks, nightmares, illusions), and acute distress upon cues suggestive of the trauma  Dissociative symptoms (“psychic numbing”) – emotional detachment – being in a “daze” – dropping out of usual activities – avoidance of topics related to trauma – forgetting key aspects of trauma – feeling that the current setting is not real (derealization) – feeling detached from one‟s body (depersonalization)  Chronic hyperarousal: exaggerated startle, insomnia, hypervigilance, motor restlessness  Aggressiveness (males)  Survival guilt Dissociation Can Be Normal Daydreaming Highway hypnosis “Losing oneself” in a book or movie “Spacing out” in conversation Dissociative Disorders  Dissociative amnesia  Dissociative fugue  Depersonalization disorder  Dissociative identity disorder (Multiple personality disorder)  To be diagnosable, there must be significant distress or impairment Dissociative Amnesia: DSM-IV  Inability to recall important personal information, at a level exceeding normal forgetfulness  Brief episodes may be due to drug or medication side-effects.  True amnesia, non-acknowledgement, or selective operation of memory? Depersonalization Disorder: DSM-IV  Experience of being outside one‟s own body, or having distorted perceptions of oneself.  Intact reality testing during episode (patient is not psychotic)  Significant distress or impairment  Not due to schizophrenia, drugs or medications, Panic Disorder or Acute Stress Disorder, or a general medical condition (seizures) Common Depersonalization Experiences  One‟s own voice sounds remote and unreal  Can‟t touch things properly with hands  Surroundings feel distant and unreal (derealization)  Things look flat, like in a picture  Personal memories feel like someone else had them  Body feels like it doesn‟t belong to the person  One‟s actions feel robotic and mechanical  Emotional behavior unaccompanied by matching experiences  Jamais vu – what was familiar feels unfamiliar  Objects look smaller or further away than they are  Feeling like one‟s self and the world are all illusions  Watching the world from “behind one‟s eyes”  Feeling like one is shrinking or disappearing Depersonalization Disorder: Basic Facts  Commonly found DD Triad: emotional numbing, altered visual perception, altered experience of one‟s body  Depersonalization episodes are common: up to 50% of population reports at least one.  Early emotional abuse and recent intense stressors are risk factors  Diagnosed twice as often in women as men.  Often, peaceful, dreamy affect  May explain many “near-death experiences” – “seeing the light” and watching over one‟s body  Episodes rarely last long enough to be diagnosable Typical Presenting Complaints of DID Patients  Inability to remember events in all or part of a proceeding time period.  Repeated encounters with unfamiliar people who claim to know them  Finding themselves somewhere without knowing how they got there  Finding items among their possessions that they don't remember purchasing Dissociative Identity Disorder: Basic Facts  Not schizophrenia  Diagnosed in up to 5% of inpatient psychiatric admissions, but prevalence figures vary widely across countries (from < 0.01 % to > 10 %).  Mostly diagnosed in females; diagnosis in males often masked by substance abuse or other disorders  Associated with severe child abuse before age 9 (usually 4-6), but the link remains unproven  Can also occur with other trauma (natural disasters, war)  80% of DID patients carry a secondary diagnosis of PTSD  DID patients are extraordinarily good at self-hypnosis The Nature of Sub-Personalities or „Alters‟  Not “multiple personalities” but fragments of one personality separated by “dissociative barriers”  Average DID case has about 10 alters, number can range from 2-100.  Alters can “know” each other or be mutually amnestic  Alters can differ in: – Name – Speech – Mannerisms – Attitudes – Thoughts – Sexual orientation – Physical characteristics like allergies, handedness, eyesight, and EEG Iatrogenic Creation of DID "It may happen that an alter personality will reveal itself to you during this [assessment] process, but more likely it will not. So you may have to elicit an alter... You can begin by indirect [sic] questioning such as, 'Have you ever felt like another part of you does things that you can't control?' If she gives positive or ambiguous responses ask for specific examples. You are trying to develop a picture of what the alter personality is like... At this point you may ask the host personality, "Does this set of feelings have a name?"...Often the host personality will not know. You can then focus upon a particular event or set of behaviors. 'Can I talk to the part of you that is taking those long drives in the country?'“ - from a DID treatment manual Dissociative Identity Disorder: Treatment  Psychotherapy – hypnosis frequently used, sometimes sodium amytal – lasts an average of 4 years, 2-3 times per week – reintegration of personalities: removal of the “dissociative barriers” between them Psychodynamic (“group therapy” for the personalities) Cognitive-behavioral – isolation and strengthening of the dominant personality; minimizing naming of personalities, calling for specific ones; no inter-personality conversations  Sometimes, antianxiety and antidepressant medications Most DID patients are moderately improved by end of therapy – typical outcome is reintegration, but fractionation under stress Treatment of DID by „Recovered Memories‟  Popularization of DID spawned an iatrogenic “Memory Recovery Movement” – based on „recovered memories‟ of abuse – associated with tales of ritual Satanic abuse, bestiality, encounters with animals, demons, angels, etc. – likely confabulation (False Memory Syndrome) – many treatment failures, false accusations and family upheavals  This Memory Recovery Movement is now in professional disfavor.