Dissociation and conversion disorders
A brief history of Dissociative disorder :There are description of dissociative (conversion) disorder in ancient Greek, at that time the disorder was thought to result from abnormalities of position or function of uterus this persist is until 17th century the idea become accepted that the hysteria is a disorder of brain and by 19 century the important of predisposing constitution and organic causes of this brain disorder were recognized , it was accepted also that the usual provoking cause was strong emotion.
A brief history of Dissociative disorder (cont.)
Later years of 19 century Charcot study hysteria charcot French Neurologist working in Paris hospital , he believed at first that the symptoms of hysteria were caused by functional disorder of the brain which render patients susceptibility to hypnosis as result of this hypnosis new symptoms can be induced in patients by suggestion. Later Chorcot pupil Janet believed that the patient had lost the normal integration of the various part of mental functioning.A brief history of Dissociative disorder (cont.)
Freud and Breuer studied Hysteria (Dissociative Disorder) and report their findings and that hysteria was caused by emotionally charged idea usually sexual which had become lodged in the patient uncoacious mind and were excluded from conciousnees by repression.Current live situation
Mobilization of an old couflectAnxiety
Defence Dissociation Mechanisms Repression
Dissociative Disorder
A brief history of Dissociative disorder (cont.)
Later on appears slater who reported 7 years following study of 85 patients diagnosed as having hysteria 30 had definite organic disease and 34 had definite psychiatric disorder other than dissociative disorder. Dissociative and conversion (Hysteria) are neurotic disorders in which psychological conflicts and Anxiety are transformed into physical or mental symptoms these symptoms are sensory, motor, autonomic N.S or mental symptoms.
A brief history of Dissociative disorder (cont.)
Or can be define :- as a state of disrupted consciousness, memory, identify or perception of the environment. People with D.D have lost the sense of their identify, or they are confused about who they are, their integrated thought, feeling and action is abnormal. Dissociation arises as self-defense against trauma it help people remove themselves from trauma at time that it occur.A brief history of Dissociative disorder (cont.)
Normal people very in their hypnotizablity, patient with D.D are not necessarily more hypnotizable than are people without disorder, but hypnosis is an example dissociative state in normal people .The word Hysteria is still in use but not very frequent. It is much more common in young age group, it can occur in middle and old age . It much more is common in female than male.A brief history of Dissociative disorder (cont.)
More common in low social class No.5. in conversional disorden there is always gain. Primary gain in which there is attention from others to get advantage from external world through the illness. In dissociative and conversion there is absence of relavent physical pathology.Aetiology
Hysterical personality:These people have great need for love and affection from others, the constitution of their personality from birth is abnormal (Hysterical treat). Parent influence, these patients may have Hysterical or anxious parent. Intelligence, Education and general back-ground, dull uneducated persons are likely to develop hysterical symptom when they met with difficulty. physical illness- this may suggest to the parent the idea that the illness is a solution to his problem in which the patient develop hysterical exaggeration of his physical illness.Types of dissociative (or conversion disorders)
motor and sensory dissociative (or conversion disorders). Dissociative disorder with mental symptoms.Motor disorders :-
Paralysis of voluntary muscle. Disordered gait Tremor and tics Aphonia and Mutism Convulsions
Pt. not unconscious Movement not regular No incontinence of urine Cyanosis, injury, bitting tongue not occur
Sensory disorders :-
Hypeaethesia and parasthesia Aneathesia Pain (psychogenic pain) Blindness DeafnessBriquet’s syndrome :- This term applied to server form of dissociative disorder with multiple physical symptoms starts before he age of 30 years last many years, it is not due to physical disease, injury or effect of medications or alcohol.
Dissociative disorders with mental symptoms
Dissociative amnesia Dissociative fugue Trance and possession disorder Ganser syndrome Multiple personalityDissociative Amnesia:-
It’s symptoms is the inability to recall information usually about stressful or traumatic events in people’s lives and there is no evidence of underlying brain disorder patient retain the capacity to learn new information.A common form of D.A involves amnesia for personal identity but intact memory of general information.Dissociate damnesia:-(Cont.)
The clinical picture is exactly the reverse of the one seen in dementia in which patient may remember their name but forget general information. The diagnosis can be made from history, the forgotten information is usually of traumatic and stressful nature and are not the result of general medical condition example head trauma or ingestion of toxic substance.Clinical Features:
In D.A the history usually reveals a precipitation emotional trauma changed with painful emotional and psychological conflict. For example natural disaster in which people witnessed sever injuries or feared for their lives.D.A may take one of the following forms:
Localized the most common type-loss of memory for short time (a few hours or days). Generalized-loss of memory for a whole life. Selective-failure to recall some but not all events.Treatment
One of the Benzodiazepines may help patient to remove their forgotten memories. Psychotherapy is recommended to help the patient to regain their memory.Dissociative Fugue
Is extremely rare is a loss of memory with wandering away from a person usual surrounding environment and fair to remember important aspect of their persons identities (name, family, work) patient take an entirely new identity and occupation. The etiology-basically psychological such as sad mood, abnormal personality, or a variety of stressors.Dissociative Fugue (Cont.)
We have to differentiate it form Epilepsy Intoxication MalingeringDissociative Fugue (Cont.)
Treatment Psychotherapy is usually indicated. Most midly accepted techniques Abreaction.Dissociated identity disorder
People with this disorder have two or more distict personalities each of which determines behavior and attitudes during any period that it is the dominant personality.