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Samenvatting Thema 4 Personality Disorders (Master Clinical Psychology)
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Thema 4 Blok 4.3 Personality Disorders (Master Clinical Psychology)
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Thema 4Welke dissociatieve stoornissen zijn er, hoe ontstaan ze en welke behandeling zijn er?
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.
Inleiding
Dissociative disorders are characterized by a disruption of and/or discontinuity in the normal
integration of consciousness, memory, identity, emotion, perception, body representation, motor
control, and behaviour. Dissociative symptoms are experienced as (1) unbidden intrusions into
awareness and behaviour, with accompanying losses of continuity in subjective experience (i.e.,
"positive" dissociative symptoms such as fragmentation of identity, depersonalization, and
derealization) and/or (2) inability to access information or to control mental functions that normally
are readily amenable to access or control (i.e., '"negative" dissociative symptoms such as amnesia).
Ontstaan vaak als een middel om traumatische ervaringen te ‘vergeten’. Acute stressstoornis en PTSS
bevatten ook elementen van een dissociatieve stoornis.
Dissociative Identity Disorder
A. Disruption of identity characterized by two or more distinct personality states, which may be
described in some cultures as an experience of possession. The disruption in identity involves
marked discontinuity in sense of self and sense of agency, accompanied by related alterations in
affect, behaviour, consciousness, memory, perception, cognition, and/or sensory-motor functioning.
These signs and symptoms may be observed by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, important personal information, and/ or traumatic
events that are inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In
children, the symptoms are not better explained by imaginary playmates or other fantasy play.
E. The symptoms are not attributable to the physiological effects of a substance (blackouts or chaotic
behaviour during alcohol intoxication) or medical condition (complex partial seizures).
Informatie
The 12-month prevalence was 1.5%. The prevalence across genders was 1.6% for males and 1.4% for
females. Dissociative identity disorder is associated with overwhelming experiences, traumatic events,
and/or abuse occurring in childhood. The full disorder may first manifest at almost any age (from
earliest childhood to late life). Sudden changes in identity during adolescence may appear to be just
adolescent turmoil or the early stages of another mental disorder. Older individuals may present to
treatment with what appear to be late-life mood disorders, OCD, paranoia, psychotic mood disorders,
or even cognitive disorders due to dissociative amnesia. In some cases, disruptive affects and
memories may increasingly intrude into awareness with advancing age. Over 70% of outpatients with
dissociative identity disorder have attempted suicide; multiple attempts are common, and other self-
injurious behaviour is frequent. Assessment of suicide risk may be complicated when there is amnesia
for past suicidal behaviour or when the presenting identity does not feel suicidal and is unaware that
other dissociated identities do. Hoge overlap met PTSD en andere stress-gerelateerde stoornissen.
Dissociative amnesia
A. An inability to recall important autobiographical information, usually of a traumatic or stressful
nature, that is inconsistent with ordinary forgetting. Note: Dissociative amnesia most often consists
of localized or selective amnesia for a specific event or events; or generalized amnesia for identity
and life history.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
C. The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other
drug of abuse, a medication) or a neurological or other medical condition (e.g., partial complex
seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, other
neurological condition).
D. The disturbance is not better explained by dissociative identity disorder, PTSD, acute stress
disorder, somatic symptom disorder, or major or mild neurocognitive disorder.
, Specify if; with dissociative fugue: Apparently purposeful travel or bewildered wandering that is
associated with amnesia for identity or for other important autobiographical information.
Amnesia
- Localized amnesia, a failure to recall events during a circumscribed period of time, is the most
common form of dissociative amnesia. Localized amnesia may be broader than amnesia for a
single traumatic event (e.g., months or years associated with child abuse or intense combat). In
selective amnesia, the individual can recall some, but not all, of the events during a circumscribed
period of time. Thus, the individual may remember part of a traumatic event but not other parts.
Some individuals report both localized and selective amnesias.
- Generalized amnesia, a complete loss of memory for one's life history, is rare. Individuals with
generalized amnesia may forget personal identity. Some lose previous knowledge about the world
(i.e., semantic knowledge) and can no longer access well-learned skills (i.e., procedural
knowledge). Generalized amnesia has an acute onset; the perplexity, disorientation, an4
purposeless wandering of individuals with generalized amnesia usually bring them to the
attention of the police or psychiatric emergency services.
Informatie
The 12-month prevalence was 1.8% (1.0% for males; 2.6% for females). Onset of generalized amnesia
is usually sudden. Less is known about the onset of localized and selective amnesias because these
amnesias are seldom evident, even to the individual. Individuals may report multiple episodes of
dissociative amnesia. A single episode may predispose to future episodes. In between episodes of
amnesia, the individual may or may not appear to be acutely symptomatic. The duration of the
forgotten events can range from minutes to decades. Some episodes of dissociative amnesia resolve
rapidly (e.g., when the person is removed from combat or some other stressful situation), whereas
other episodes persist for long periods of time. Dissociative amnesia has been observed in young
children, adolescents, and adults. Children may be the most difficult to evaluate because they often
have difficulty understanding questions about amnesia, and interviewers may find it difficult to
formulate childfriendly questions about memory and amnesia. Suicidal and other self-destructive
behaviors are common in individuals with dissociative amnesia. Suicidal behavior may be a particular
risk when the amnesia remits suddenly and overwhelms the individual with intolerable memories.
Comorbiditeit met verschillende depressieve stoornissen.
Depersonalization/Derealization Disorder
A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both:
1. Depersonalization: experiences of unreality, detachment, or being an outside observer with
respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations,
distorted sense of time, unreal or absent self, emotional and/ or physical numbing).
2. Derealization: experiences of unreality or detachment with respect to surroundings
(individuals/objects are experienced as unreal, dreamlike, foggy, lifeless, visually distorted).
B. During the depersonalization or derealization experiences, reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse,
medication) or another medical condition (e.g., seizures).
E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic
disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another
dissociative disorder.
Informatie
In general, approximately one-half of all adults have experienced at least one lifetime episode of
depersonalization/derealization. However, symptomatology that meets full criteria for
depersonalization/derealization disorder is markedly less common than transient symptoms. Lifetime
prevalence is approximately 2% (range of 0.8% to 2.8%). The gender ratio for the disorder is 1:1. Less
than 20% of individuals experience onset after age 20 years and only 5% after age 25 years. Onset in
the fourth decade of life or later is highly unusual. Onset can range from extremely sudden to gradual.
Duration of depersonalization/derealization disorder episodes can vary greatly, from brief (hours or
days) to prolonged (weeks, months, or years). Given the rarity of disorder onset after age 40 years, in
such cases the individual should be examined more closely for underlying medical conditions (e.g.,
brain lesions, seizure disorders, sleep apnea). Comorbidity met unipolair depressief en angst.
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