In psychiatry, dissociation is defined as an unconscious defense mechanism involving the segregation of any group of mental or behavioral processes from the rest of the person’s psychic activity
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In psychiatry, dissociation is defined as an unconscious defense mechanism involving the segregation of any group of mental or behavioral processes from the rest of the person’s psychic activity. Dissociative disorders involve this mechanism so that there is a disruption in one or more mental functions, such as memory, identity, perception, consciousness, or motor behavior. The disturbance may be sudden or gradual,
transient or chronic, and the signs and symptoms of the disorder are often caused by psychological trauma.
DISSOCIATIVE AMNESIA : The main feature of dissociative amnesia is an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness. The disorder does not result from the direct physiological effects of a substance or a neurological or other general medical condition.
In many cases of acute dissociative amnesia, the psychosocial environment out of which the amnesia develops is massively conflictual, with the patient experiencing intolerable emotions of shame, guilt, despair, rage, and desperation. Traumatic experiences such as physical or sexual abuse can induce the disorder.
Differential Diagnosis of Dissociative Amnesia:
- Ordinary Forgetfulness and Nonpathological Amnesia
- Dementia, Delirium, and Amnestic Disorders due to Medical Conditions.
- Posttraumatic Amnesia.
- Seizure Disorders. .
- Substance-Related Amnesia. .
- Transient Global Amnesia.
Course and Prognosis : Acute dissociative amnesia frequently spontaneously resolves once the person is removed to safety from traumatic or overwhelming circumstances. At the other extreme, some patients do develop chronic forms of generalized, continuous, or severe localized amnesia and are profoundly disabled and require high levels of social support .
Cognitive Therapy. Cognitive therapy may have specific benefits for individuals with trauma disorders. Identifying the specific cognitive distortions that are based in the trauma may provide an access into autobiographical memory for which the patient experiences amnesia.
Hypnosis. Hypnotic interventions can be used to facilitate controlled recall of dissociated memories; to provide support and ego strengthening for the patient; and, finally, to promote working through and integration of dissociated material.
Pharmacologically facilitated interviews using intravenous amobarbital or diazepam (Valium) are used primarily in working with acute amnesias.
DEPERSONALIZATION/DEREALIZATION DISORDER : Depersonalization is defined as the persistent or recurrent feeling of detachment or estrangement from one’s self. The individual may report feeling like an automaton or watching himself or herself in a movie . Derealization is somewhat related and refers to feelings of unreality or of being detached from one’s environment. The patient may describe his or her perception of the outside world as lacking lucidity and emotional coloring, as though dreaming or dead .
Transient experiences of depersonalization and derealization are extremely common in normal and clinical populations. They are the third most commonly reported psychiatric symptoms, after depression and anxiety.
Diagnosis and Clinical Features
A number of distinct components comprise the experience of depersonalization, including a sense of (1) bodily changes, (2) duality of self as observer and actor, (3) being cut off from others, and (4) being cut off from one’s own emotions. Patients experiencing depersonalization often have great difficulty expressing what they are feeling. Trying to express their subjective suffering with banal phrases, such as “I feel
dead,” “Nothing seems real,” or “I’m standing outside of myself,” .
Course and Prognosis
Depersonalization after traumatic experiences or intoxication commonly remits spontaneously after removal from the traumatic circumstances or ending of the episode of intoxication. Depersonalization accompanying mood, psychotic, or other anxiety disorders commonly remits with definitive treatment of these conditions.
Depersonalization disorder itself may have an episodic, relapsing and remitting, or chronic course. Many patients with chronic depersonalization may have a course characterized by severe impairment in occupational, social, and personal functioning. Mean age of onset is thought to be in late adolescence or early adulthood in most cases.
Treatment: SSRI antidepressants, such as fluoxetine (Prozac), may be helpful to patients with depersonalization disorder.
DISSOCIATIVE FUGUE : Dissociative fugue was deleted as a major diagnostic category in DSM-5 and is now diagnosed on a subtype of dissociative amnesia. Dissociative fugue can be seen in patients with both dissociative amnesia and dissociative identity disorder. Dissociative fugue is described as sudden, unexpected travel away from home or one’s customary place of daily activities, with inability to recall some or all of one’s past. This is accompanied by confusion about personal identity or even the assumption of a new identity. The disturbance is not due to the direct physiological effects of a substance or a general medical condition. The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Traumatic circumstances (i.e., combat, rape, recurrent childhood sexual abuse, massive social dislocations, natural disasters), leading to an altered state of consciousness dominated by a wish to flee, are the underlying cause of most fugue episodes. The disorder is thought to be more common during natural disasters, wartime, or times of major social dislocation and violence.
Course and Prognosis
Most fugues are relatively brief, lasting from hours to days. Most individuals appear to recover, although refractory dissociative amnesia may persist in rare cases.
Dissociative fugue is usually treated with psychodynamically oriented psychotherapy that focuses on helping the patient recover memory for identity and recent experience. Hypnotherapy and pharmacologically facilitated interviews are frequently necessary adjunctive techniques to assist with memory recovery.
DISSOCIATIVE IDENTITY DISORDER : Dissociative identity disorder (previously called multiple personality disorder ) is characterized by the presence of two or more distinct identities or personality states. The identities or personality states differ from one another in that each presents as having its own pattern of perceiving, relating to, and thinking about the environment and self, in short, its own personality.
Etiology : Dissociative identity disorder is strongly linked to severe experiences of early childhood trauma, usually maltreatment. Physical and sexual abuse are the most frequently reported sources of childhood trauma.
OTHER SPECIFIED OR UNSPECIFIED DISSOCIATIVE DISORDER
The category of dissociative disorder covers all of the conditions characterized by a primary dissociative response that do not meet diagnostic criteria for one of the other DSM-5 dissociative disorders.
Dissociative Trance Disorder
Dissociative trance disorder is manifest by a temporary, marked alteration in the state of consciousness or by loss of the customary sense of personal identity without the replacement by an alternate sense of identity. In this possessed state, the individual exhibits stereotypical and culturally determined behaviors or experiences being controlled by the possessing entity. There must be partial or full amnesia for the event. The trance or possession state must not be a normally accepted part of a cultural or religious practice and must cause significant distress or functional impairment in one or more of the usual domains. Finally, the dissociative trance state must not occur exclusively during the course of a psychotic disorder and is not the result of any substance use or general medical condition.
Brainwashing : DSM-5 describes this dissociative disorder as “identity disturbance due to prolonged and intense coercive persuasion. It implies that under conditions of adequate stress and duress, individuals can be made to comply with the demands of those in power, thereby undergoing major changes in their personality, beliefs, and behaviors. Persons subjected to such conditions can undergo considerable harm, including loss of health and life, and they typically manifest a variety of posttraumatic and dissociative symptoms.
Ganser Syndrome : Found in prisoners and characterized by the giving of approximate answers (paralogia) together with a clouding of consciousness and is frequently accompanied by hallucinations and other dissociative, somatoform, or conversion symptom.
Behavioral response to an unconscious drive or impulse that brings about temporary partial relief of inner tension; relief is attained by reacting to a present situation as if it were the situation that originally gave rise to the drive or impulse.
Common in borderline states.
The subjective and immediate experience of emotion attached to ideas or mental representations of objects.
Affect has outward manifestations that can be classified as: restricted, blunted, flattened, broad, labile, appropriate, or inappropriate.
Morbid fear of open places or leaving the familiar setting of the home.
May be present with or without panic attacks.
Subjective feeling of motor restlessness, manifested by a compelling need to be in constant movement; may be seen as an extrapyramidal adverse effect of antipsychotic medication.
May be mistaken for psychotic agitation.
Loss of interest in, and withdrawal from, all regular and pleasurable activities.
Often associated with depression.
Loss or decrease in appetite. In anorexia nervosa, appetite may be preserved, but the patient refuses to eat.
Dulled emotional tone associated with detachment or indifference.
Observed in certain types of schizophrenia and depression.
Inability to perform a voluntary, purposeful motor activity; cannot be explained by paralysis or other motor or sensory impairment.
In constructional apraxia, a patient cannot draw two-or-three-dimensional forms.
Lack of coordination, physical or mental.
1) In neurology, refers to loss of muscular coordination.
2) In psychiatry, term “intrapsychic ataxia” refers to lack of coordination b/t feelings & thoughts.
Seen in schizophrenia, severe OCD.
False perception of sound, usually voices, but also other noises, such as music.
This is the most common hallucination in psychiatric disorders.
1) Warning sensations, such as automatisms, fullness in the stomach, blushing, and changes in respiration; cognitive sensations & mood states usually experienced before a seizure.
2) A sensory prodrome that precedes a classic migraine headache.
False belief that is patently absurd or fantastic (e.g., invaders from space have implanted electrodes in a person’s brain).
Common in schizophrenia.
In “nonbizarre delusions,” content is usually within the realm of possibility.
Abrupt interruption in train of thinking before a thought ot idea is finished; after a brief pause, the person indicates no recall of what was being said or was going to be said.
Also known as “thought deprivation” or “increased thought latency.”
Common in schizophrenia and severe anxiety.
Disturbance of affect manifested by a severe reduction in the intensity of externalized feeling tone.
One of the fundamental symptoms of schizophrenia, as outlined by Eugen Bleuler.
Grinding or gnashing of the teeth, typically occurring during sleep.
Seen in anxiety disorder.
Temporary sudden loss of muscle tone, causing weakness and immobilization; can be precipitated by a variety of emotional states and is often followed by sleep.
Commonly seen in narcolepsy.
Disturbance in the associative thought and speech processes in which a patient digresses into unnecessary details & inappropriate thoughts before communicating the central idea.
Observed in schizophrenia, obsessional disturbances, & certain cases of dementia.
State of profound unconsciousness from which a person cannot be roused, with minimal or no detectable responsiveness to stimuli.
Seen in injury or disease of the brain, in systemic conditions (diabetes ketoacidosis & uremia) and intoxiations with alcohol and other drugs.
Coma can also occur in severe catatonic states and in conversion disorder.
Unconscious filling of gaps in memory by imagining experiences or events that have no basis in fact; should be differentiated from lying.
Commonly seen in amnestic syndromes.
Inability to copy a drawing, such as a sube, clock, or pentagon, as a result of brain lesion (also seen in some dementias).
Deterioration of psychic functioning caused by a breakdown of defense mechanisms.
Seen in psychotic states.
Acute & sometimes fatal reaction to withdrawal from alcohol, usually occuring in the first 72-96 hours after the cessation of heavy drinking; distinctive characteristics are marked autonomic hyperactivity (tachycardia, fever, hyperhidrosis, dilated pupils), usually accompanied by tremulousness, hallucinations, illusions & delusions.
Called “alcohol withdrawal delirium” in DSM-IV-TR.
False belief of being harassed or persecuted; often found in litigious patients who have a pathological tendency to take legal action because of imagined mistreatment.
Most common delusion.
Sensation of unreality concerning oneself, parts of oneself, or one’s environment that occurs under extreme stress or fatigue.
Seen in schizophrenia, depersonalization disorder, & schizotypal personality disorder.
Mental state characterized by feelings of sadness, loneliness, despair, low self-esteem, & self-reproach; accopmanying signs include psychomotor retardation or, at times, agitation, withdrawal from interpersonal contact, and vegetative symptoms, such as insomnia and anorexia.
The term refers to a mood that is so characterized or to a mood disorder.
1) removal of an inhibitory effect, as in the reduction of the inhibitory function of the cerebral cortex by alcohol;
2) In psychiatry, a greater freedom to act in accordance with inner drives or feelings and with less regard for restraints dictated by cultural norms or one’s superego.
Unconscious defense mechanism involving the segregation of any group of mental or behavioral processes from the rest of the person’s psychic activity; may entail the separation of an idea from its accompanying emotional tone, as seen in dissociative and conversion disorders.
Seen in dissociative disorders.
Difficulty in performing movements.
Seen in extrapyramidal disorders.
Feeling of unpleasantness or discomfort; a mood of general dissatisfaction and restlessness.
Occurs in depression and anxiety.
Extrapyramidal motor disturbance consisting of slow, sustained contractions of the axial or appendicular musculature; one movement often predominates, leading to relatively sustained postural deviations.
Acute dystonic reactions (facial grimacing and torticollis) are occasionally seen with the initiation of antipsychotic drug therapy.
Psychopathological repeating of words or phrases of one person by another; tends to be repetitive and persistent.
Seen in certain kinds of schizophrenia, particularly the catatonic types.
Exaggerated feeling of well-being that is inappropriate to real events.
Can occur with drugs such as opiates, amphetamines, and alcohol.
Act of not facing up to, or strategically eluding, something; consists of suppressing an idea that is next in a thought series and replacing it with another idea closely related to it.
Also called paralogia and perverted logic.
Rapid succession of fragmentary thoughts or speech in which content changes abruptly and speech may be incoherent.
Seen in mania.
Tactile hallucination involving the sensation that tiny insects are crawling over the skin.
Seen in cocaine addiction and delirium tremens.
Exaggerated feelings of one’s importance, power, knowledge, or identity.
Occurs in delusional disorder and manic states.
Increased muscular activity. The term is commonly used to describe a disturbance found in children that is manifested by constant restlestness, overactivity, distractibility, and difficulties in learning.
Seen in ADHD.
Excessive attention to, and focus on, all internal and external stimuli.
Usually seen in delusional or paranoid states.
Mood abnormality with the qualitative characteristics of mania, but somewhat less intense.
Seen in cyclothymic disorder.
Perceptual misinterpretation of a real external stimulus.
(Compare with hallucination)
Characteristic schizophrenia thinking or speech disturbance involving a disorder in the logical progfression of thoughts, manifested as a failure to communicate verbally adequately; unrelated and unconnected ideas shift from one subject to another.
See also tangentiality.
Mood state characterized by elation, agitation, hyperactivity, hypersexuality, and accelerated thinking and speaking (flight of ideas).
Seen in Bipolar I disorder.
Aphasia in which understanding is intact, but the ability to speak is lost.
Also called Broca’s, expressive, or nonfluent aphasia.
1) Pathological repetition of the same response to different stimuli, as in a repetition of the same verbal response to different questions; 2) Persistent repetition of specific words or concepts in the process of speaking.
Seen in cognitive disorders, schizophrenia, and other mental illness.
Reducation in intensity of feeling tone, which is less severe than in blunted affect, but clearly reduced.
See also constricted affect.
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