Dissociative Disorder

A i.e. Conversion reaction

La belle indifferenceQ is in-appropiate attitude of calm or lack of concern about one’s disability. It is seen in conversion (dissociative) disorderQ (but not specific), physical illness etc.

D i.e. Dissociative disorder

It is characterizedby- 1) Sudden onset & recovery 2) Disturbance in consciousness, identity & memory, 3) Precipitated by stress or secondary gain 4) Physical examination & investigation normal

Dissociative Amnesia Q                                                        Dissociative disorders not otherwise specified

Most common type of dissociative disorder Dissociative stupor

Most common type is circumscribed amnesia which is- Dissociative hallucinosis

characterized by sudden inability to recall importantDissociation following torture or political

personal information particularly concerning stressful or indoctrination

traumatic life events.Q – Somnambulism

– Patient is aware of amnesiaQ. – ‘Out of body’ experiences

Dissociative Fugue Q Trance/Possession disorder

Characterized by episodes of: Characterized by control of person by a spirit,

Wandering away from home Q usually the person is aware of existence of other assumption of purposeful new identity with complete

amnesia for earlier life & absence of awareness of amnesia Q

Onset & termination are abrupt

After termination, there is amnesia for Fugue episodes &

recovery of memory of earlier life.

Dissociative Identity Ganser’s SyndromeQ/Hysterical

(Multiple Personality disorder) Pseudo-dementiaQ

–  Person is dominated by two or more personalities.Common in Prison Inmates

–  Only one is being manifested at a time. Characterized by Vorbeireden or Approximate

– One personality is not aware of existence of other.Q  answers

B i.e. Dissociative disorder

• Amnesia is seen in dissociative disorders and Conversion disorder presents with anesthesia (sensory dysfunction) voluntary motor dysfunction or hysterical fits.Q.

Autonomic system is characteristically not involved in conversion disorderQ

Ans. is ‘c’ i.e., Dissociative disorder

Dissociative disorder

• The essential feature of the dissociative disorder is a disruption in the usually integrated functions of consciousness, memory, identity or perception of the environment. Dissociative disorder are :-

1. Dissociative (psychogenic) amnesia :- It is the most common type of dissociative disorder. Dissociative amnesia is characterized by retrograde amnesia (inability to retrieve stored memories and events leading up to onset of amnesia) and absence of antegrade amnesia (inability to form new long term memories).
2. Dissociative fugue :- A dissociative fugue may be present when a person impulsively wanders or travels away from home and upon arrival in the new location is unable to remember his/her past (i.e., amnesia for early life). There is loss of personal identity and the person assumes a new identity. There is absence of awareness of amnesia during fugue episode, i.e., Patient denies any memory loss during fugue state. On recovery there is amnesia for fugue episodes and recovery of memory of earlier life (i.e., before the episode of fugue).
3. Dissociative identity disorder (multiple personality disorder) :- More than one personality appears to possess the individuals, Showing their characteristic behavior. At any instance behavior and memories of one personality is exhibited, patient then is unaware of the other’s existance.
4. Depersonalization disorder : – Feeling of detachment from self is referred to as depersonalization. Individuals with this disorder will report feeling as if they are living in a dream or watching themselves on movie screen i.e., feeling detached from self and as if one is an outside observer of oneself. People with this disorder feel like they are “going crazy” and they frequently become anxious and depressed
5. Dissociative disorders not otherwise specified :- These are the disorders that are characterized by dissociative response that do not meet diagnostic criteria for one of the other dissociative disorder. Important ones are :-

• Dissociative Trance (Possession) disorders :- There is temporary exchange of person’s personality by a new personality usually attributed to a spirit or divine power. Usually the person is aware of the existance of the other, i.e., possessor (unlike dissociative identity disorder).
• Ganser’s syndrome : – Also known as syndrome of approximate answers. This is characterized by giving approximate answers together with a clouding of consciousness, and frequently accompanied by hallucinations and other dissociative, somatoform or conversion symptoms.

Ans:D.) Dissociative Disorder.

Electroconvulsive therapy is shown in the image.

ECT

• It is used with informed consent in treatment-resistant major depressive disorder, treatment-resistant catatonia, or prolonged or severe mania, and in conditions where “there is a need for rapid, definitive response because of the severity of a psychiatric or medical condition (e.g., when illness is characterized by stupor, marked psycho-motor retardation, depressive delusions or hallucinations, or life-threatening physical exhaustion associated with mania)

Ans. A. Depersonalization disorder

Depersonalization:

• Depersonalization is a sense of unreality or strangeness concerning the self, manifested by feeling detached from and being an outside observer of one’s mental processes or body.
  • A patient who experiences depersonalization may describe feeling like things “I have stepped outside of myself and am watching myself doing things”.

Derealization:

• Derealization  refers to feeling detached from one’s environment so that the sense  of the reality of the external world is lost.

• E.g, I feel as if everything is unreal and those around me are actors in a play or two dimensional cardboard figures.