Dissociative Disorder

Dissociative disorder

تصدع الوعي
- dissociative symptoms seemed to have remove clusters of mental elements from their conscious , awareness and willful controlتحكم عنيد .

- Freud's early theories of unconscious were basedlargely on work with patient who appear to have ( splitting of unconsciousness ) that could be integrated via hypnosis or psychoanalysis of the rest of the mind
in dissociative disorder the following are dissociated from rest of the mind
memory ,
personal identify ,
consciousness
So that patient experience amnesia , fugue state هيام, altered personality state , episodes of depersonalization , these lost cluster of mental events can be recovered quiet suddenly .

dissociative disorder are dramaticsمستمدة من الاعمال الدرامية and have received much publicity in literature , in film and on television , but mild dissociative phenomena are normal feature of everyday life .
for Ex, people commonly become so absorbed in reading a book that they loss awareness of what is happening in the environment or become lost in thought and fail to get off bus at proper stop .
other ex. Hypnotic trance غيبوبة ----- certain type and religious experience ( e.g speaking )

Major categories of dissociative disorder

1- dissociative amnesia( sudden inability to recall important personal information ) . فقدان الذاكرة التصدعي
2- dissociative fugue ( amnesia combined with sudden travel away from home )السير الغير مالوف التصدعي
3- dissociative identity disorder : the presence of two or more distinct personality withinindividual , each of which is dominant atspp time . أضطراب الهوية التصدعية
4- depolarization disease : feeling of self-estrangementجفاء للذات or unreality that impair social or occupational functionأضطراب الذات التصدعيي each of which is dominant of spp time .escene of two or more distinict personality withinreoverd quiet suddenly


dissociative amnesia


sudden inability to recall important personal information ( eg. Name , occupation , fairly ).
This might be amnesia for one entire life up until moment of onset or it is amnesia for circumscribed period of time e.g for event surrounding car crash.
amnesia may be selective , some events during specific time are forgotten , whereas others are subjected to recall .
onset of dissociative amnesia is often abrupt and follow stressful or traumatic events.
people with diss. Amnesia usually first enter into an altered state of consciousness in which they perform complex activities , may wanderيتجول around and are often confused and dissociative .
This phase last from minute to hours followed by the awareness that they don’t remember what has transpiredالذي ظهر او حصلover period of time and some time they don’t -------

Etiology of dissociative amnesia

1- several type of traumatic like
a- life threating situation e.g war , physical abuse , sexual abuse
b- actual loss of an important person.
c-involvement in ego – dystonic - homicidal
e- suicide
f - sexual impulsive are all association with onset of disorder .
2- uses of repressionالقمع defense to banishأبعاد unacceptable or unbearable thought and feeling from conscious

Differential diagnosis:

1- Dissociative amnesia usually occur in people 30 to 40 yearsunlikeamnesia that is due to organic mental disorder like dementia which occur later in life( above 65 s)( gradually growing )
2- post head injury amnesia is retrograde( amnesia for event before trauma ) where are in dissociative amnesia is usually anterograde for event after traumatic events .
3- dissociative Identify disease>>>prolong and recurrent alteration of conscious whilediss. Amnesia is single episode .


Treatment :
- high percentage of diss. Amnesia resolve spontaneously and no. specific treatment is required
-hypnosis ----- has been useful for patient to recover lost information .
- gentle exploration will often help patient to recall dissociative material
- psychotherapy is important to understand conflict .

Dissociative fugueالهيام التصدعي

it involve amnesia combined with physical flight usually from an intolerable situation .
the individual travelled away from home and is unable to recall his or her previous identity .
the phenomenon generally is short lived and involve minimal amount of travel
however sometime it is quite prolong and may in the assumption of an entirely new life in another location ( e.g amen may leave his family , move to another city , get new job , and make a new set of friends ) .
more often no clear identity replace old one .
little known about prevalence of dissociative Fugue but it is thought to be uncommon .
more common among people who were exposed to major trauma such as natural disaster or war .
some clinician report preexisting psychopathology and history of growing up in family may predispose to fugue .
many patient has separation anxiety and suicidal , homosexual impulses
response to stressful event ---- several hours ----- several days .
Temporal lobe epilepsy can involve diss. Experience including amnesia and travel , but doesn’t involve identity confusion .
recovery usually occur as abrupt as the onset and recurrence are rare .
patient seldom remain in fugue state by time come to attention of physician psychodynamics therapy may be needed to help person under of intra suicidal …………………………………….
dissociative identity disorder of formerly multiple identity disorder
it involve the presence within the individual of two or more distinct identities , each with its Owen unique set of memories , attributes and social relationship.
each personality dominant and determines the individual Behavior's at different time ,
transmission from one person to another is often abrupt .
e.g ----- an individual may have one shy and inhibited personality , another that gregarious اجتماعي and promiscuous مختلط, and the third that hostile and suspicious ,
the personality may call themselves by different names , the personality has different voice , mannerismتصنع وتشكيل , facial expression and handedness , they may have different allergic and response , allergy to medication different pyscho. Test
increase number of diagnosis of dissociative Identity disorder due to heightenedمتصاعد awareness of the disorder .
Similarity to PSTD
high incidence of childhood sexual and physical abuse
wax and wane over time .
3\4 are female at middle age .
some are function well. Other are severely impaired
- complication : including suicidal, self-mutilationتشويه ذاتي literature ( the three faces of evil and devil )


Etiology of multiple personality disease :
- 98% have history of childhood sexual and physical abuse
-familial association.
-trauma is transmitted from one generation to another .
-unimpaired parents are unable to protect children from abuse by others .
- many children mention abuse by their parent >
DDX : -
dissociative amnesia
TLE ,
schizophrenia ,
4. malingering
- diagnosis of identity is difficult .
- patient May have variety of somatic symptoms but not give history of multiple personality disease .
- Rorsach test ( projective test ) is important in certain behavior or time , discovery of objective or handwriting in patients possession .
- many patient hear voice that realize coming from their own head but that are perceived alien غريب.hearing voice might be confused with auditory hallucination and in DDx of schizophrenia
a- Temporal Lobe Epilepsy .
b- dissociative identity ------- repeated slight in indentity , but single diss. Episode .
c- malingering ------ information of friend relationship are helpful .
d- PTS .
e- borderline personality disorder


TREATMENT :
psychodynamic psychotherapy is treatment of choice for different personality to ------------
Depersonalization disorder
involve recurrent or persistent episode of depolarization , during which people feel that they are detached observer of their own mental process or bodies that are automation or they are in dream .
patient feel that they are not in control of their action and feeling of losing their society .
however reality test of them remain intact e.g knowing that one is not literally an automation )
the disorder often chronic , commonly waxing and waning according to severity of anxiety and depression .
episode of depolarization occur in 30% – 70 % of healthy young adult particularly during time of stress MCQ.
-it may associate with other disorder like schizo. , anxiety , B.P.D , TLE , DEP
-Depersonalization is diagnosed by exclusion , screening of toxin and EEG

Treatment :

hypnosis ( self- hypnosis and chemical hypnosis ) .
may learnpatient Who to deflect يحرف او يسيطر علىdepersonalization Symptom's and relapsing them by pleasant imaging .
other relaxation technique ( biological back )
Drugs like antianxiety , antidepressant and ………