Recap of Mood Disorders

1. Recap of Mood Disorders

2. Dissociative Disorders A Closer Look at Psychological Disorders

3. Dissociative Disorders • Individuals with dissociative disorders have in some way broken away from their sense of self – from their memories, thoughts, or feelings. • Symptoms: • Having a sense of being unreal • Being separated from the body • Watching yourself as if in a movie

4. Dissociative Disorders • Even though we may hear about them somewhat frequently, dissociative disorders are actually quite rare and usually represent a response to overwhelming stress. • Three specific forms are: a • Amnesia • Fugue State • Dissociative Identity Disorder.

5. Dissociative Amnesia • Remember that amnesia is memory loss. • Many things could cause amnesia – brain injury, drugs, etc. • Dissociative Amnesia: amnesia that has _______ biological explanation • This type of amnesia is a reaction to a specific, stressful event – a traumatic incident – like • For example, witnessing a terrible accident, surviving a natural disaster, etc. • If this gopher suddenly couldn’t remember who he was after a blow to the head, this would be plain old amnesia. • Dissociative amnesia does not have a biological explanation.

6. Dissociative Amnesia (cont.) • Case studies: • Combat soldiers may report losing their memories for hours or even days. • An 18 year old man was on a sailing cruise with friends when a storm came up. He was the only one to put on a life vest and tie himself to the boat, and he watched all of his friends get swept overboard by high waves. • He spent days waiting to be rescued, but remembered none of these events afterwards.

7. Dissociative Amnesia (cont.) • Freud labeled this type of psychologically based amnesia repression. • Sometimes, as in some cases of abuse, what people have experienced becomes too difficult for them to handle, so they “forget.”

8. Dissociative Amnesia (cont.) • Localized amnesiais present in an individual who has no memory of specific events that took place, usually traumatic. The loss of memory is localized with a specific window of time. • For example, a survivor of a car wreck who has no memory of the experience until two days later is experiencing localized amnesia. • Selective amnesiahappens when a person can recall only small parts of events that took place in a defined period of time. • For example, an abuse victim may recall only some parts of the series of events around the abuse. • Generalized amnesiais diagnosed when a person's amnesia encompasses his or her entire life. • Systematized amnesiais characterized by a loss of memory for a specific category of information. • A person with this disorder might, for example, be missing all memories about one specific family member.

9. Dissociative Fugue • The word fugue comes from the same root as fugitive. • Dissociative fugue serves the same psychological function as dissociative amnesia – escape from unbearable conflict or anxiety. • Dissociative fugue also involves memory loss, but unlike dissociative amnesia, the memory loss is alsoaccompanied by travel to a new location and the adoption of a new identity. • People may forget who they are, travel to a new place, make new friends, get a new job, remarry, etc. • A fugue state may last for days or even decades.

10. Watch an NBC News story about another real-life case here: http://www.nbcnews.com/id/15373503/ Dissociative Fugue (cont.) • Case studies: • John, a thirty year old computer executive, experienced dissociative fugue when his wife announced she was leaving him to go live with his younger brother. • John did not show up for work the next day, and was not found until two weeks later, when he was arrested for public drunkenness and assault in a town 300 miles away. • Police discovered that John had been living in a cheap motel under a different name and had been working selling tickets at a pornographic movie theater. He did not know his real name, couldn’t explain how he got to his new location, and could not remember much about the previous two weeks.

11. Etiology of Dissociative Amnesia and Fugue States • Psychodynamic: _________ of trauma or anxiety-producing memories • Behavioral: • Operant conditioning: forgetting leads to relief, which is reinforcing • State-dependent learning: memories are not recalled during normal arousal states • Self-hypnosis

12. Depersonalization Disorder • Marked by a feeling of detachment or distance from one's own experience, body, or self. • One can easily relate to feeling as they are in a dream, or being "spaced out.” • A person's experience with depersonalization can be so severe that he or she believes the external world is unreal or distorted. • Etiology of Depersonalization Disorder: • Psychodynamic: more extreme defense; disturbed ego functioning • Cognitive: difficulty attending to both internal and external events

13. Dissociative Identity Disorder • D.I.D.was formerly known as multiple personality disorder. • With this disorder, a person is said to exhibit two or more distinct and alternating personalities. • These sub-personalities can differ in age, sex, and self-perception of physical characteristics. • Some researches have even reported changes in brain function or handedness as a person switches from one personality to another. • Sometimes personalities seem to be aware of one another, and sometimes they do not.

14. Dissociative Identity Disorder (cont.) • Examples of handwriting samples from a D.I.D. patient:

15. Dissociative Identity Disorder (cont.) • One of the most famous cases of D.I.D. is Eve White, the basis of the film The Three Faces of Eve. • Eve sought psychiatric treatment for severe headaches and blackouts. She was a conscientious, self-controlled, and shy person. However, during one of her therapy sessions, her expression – and her personality – suddenly changed. Eve White had become Eve Black – childlike, irresponsible, and fun-loving – the opposite of Eve White. • Eve Black was conscience of Eve White’s existence but considered her a separate person. Eve White did not know about Eve Black, however, nor did she know about Jane, a third personality that emerged during the course of therapy. • Eve White’s real name is Chris Costner Sizemore, and she released her story many years later when she published a book titled I’m Eve. • In her book, Sizemore** admits she ultimately had 22 separate personalities. Chris Sizemore (DID)

16. The Controversy Over DID • The diagnosis of this disorder is very controversial – many psychologists doubt it even exists. • In a recent survey, only ¼ of American psychiatrists in the sample indicated that they felt there was solid evidence for the scientific validity of DID. • Why? • Diagnosed cases of D.I.D. have increased dramatically in recent years. Prior to the 1970s, fewer than 100 cases had ever been reported. Then, in the 1980s alone, reports of more than 20,000 cases appeared, almost all of them in the U.S. • The average number of sub-personalities has also increased – from 3 to 12. In some cases, dozens or even 100 personalities have been reported. • One famous sufferer of D.I.D., Sybil Dorsett, is now believed to have been inappropriately influenced by her psychiatrist. • After the death of Sybil’s psychiatrist and the release of her records, experts have come to believe that by giving names to Sybil’s emotional states and asking her to take on these roles as part of the therapeutic process, the psychiatrist could have led Sybil to believe that she possessed multiple personalities.

17. Recent Controversial Cases • In 2001, former NFL football star Herschel Walker was diagnosed with D.I.D. by his psychiatrist. Watch these videos: • http://www.youtube.com/watch?v=YXuG2zI39yA (Part 1) • and http://www.youtube.com/watch?v=6XlKOC-WnZo&feature=related (Part 2) • or http://www.youtube.com/watch?v=bX3F-CkTaFU • What do you think?

18. Etiology of Dissociative Identity Disorder • Some people believe that DID is simply an exaggeration of normal human tendencies. For example, everyone is capable of behaving in different ways depending on the circumstances (rowdy in a bar, quiet in a museum). This variation may become so extreme that that a person feels, or is perceived by others, as a “different person.” • Behavioral • Operant conditioning: forgetting leads to relief, which is reinforcing • Sudden memory loss or unusual behavior may be rewarded by providing escape from unpleasant situations, responsibilities, or punishment for misbehavior. • State-dependent learning: different arousal states associated with different identities • Self-hypnosis 

19. Etiology of Dissociative Identity Disorder, (cont.) • Sociocognitive: due to clinician’s influence (iatrogenic – caused by the diagnosis, manner, or treatment of a physician) • Some theorists believe that people with DID are engaging in intentional role playing to use an exotic mental illness as a face-saving excuse for their personal failings and that therapists may play a role in their development of this pattern of behavior, others argue to the contrary. • Psychodynamic: • person disowns or denies unacceptable impulses, which are projected or displaced onto other identities • Massive repression of unwanted impulses or memories may be the basis for creating a “new person” who acts out otherwise unacceptable impulses or recalls otherwise unbearable memories. • DID is related to severe emotional trauma that occurred in childhood, although this link is not unique to DID, as a history of child abuse elevates the likelihood of many disorders, especially among females.

20. Recap