Download Mental Health

Mental
Health
Overview
 Nationwide
50 million Americans suffer
from a mental illness in a given year
 Mental Illness is more common than:



Cancer
Diabetes
Heart Disease
 Psychiatric
disorders are the number 1
reason for hospital admissions nationwide
 Mental illness is treatable
Causes
 Biological






Causes
Biochemical Disturbances
Genetics
Infections- can cause brain damage
Brain defects or injury
Prenatal damage
Poor nutrition, exposure to toxins

Psychological
Causes




Severe
psychological
trauma suffered as
a child, such as
emotional, physical
or sexual abuse
An important early
loss, such as the
loss of a parent
Neglect
Poor ability to relate
to others
Causes
 Environmental
 Death
Factors
or divorce
 A dysfunctional family life
 Living in poverty
 Feelings of inadequacy, low self-esteem, anxiety,
anger or loneliness
 Changing jobs or schools
 Social or cultural expectations (For example, a
society that associates beauty with thinness can be
a factor in the development of eating disorders.)
 Substance abuse by the person or the person's
parents
Stress
 Academic
 Homesickness
 Peer
relationships
 Family
 Identity
 Work
 Illness
Stigmization
 35%
of people with diagnosable disorders
seek treatment
 The single most common barrier to
seeking treatment is Shame
Types of Mental Illness
 Mood
Disorders
 Anxiety Disorders
 Psychotic Disorders
 Personality Disorders
 Impulse Control and Addictive Disorders
 Eating Disorders/Body Image
 Other ( Adjustment Disorders, Dissocative
Disorders, Factitious Disorders, Sexual and
Gender Disorders, Somotoform Disorders,
Mental Retardation)
DSM

The Diagnostic and
Statistical Manuals of
Mental Health (DSM)
are handbooks
developed by the
American Psychiatric
Association

These manuals contain
listings and descriptions
of psychiatric
diagnoses, analogous
to the International
Classification of
Diseases manual (ICD)
DSM-I and DSM-II
 The
DSMs have changed as the prevailing
concepts of mental disorders have
changed
 DSM-I
(1952) reflected Adolf
Meyer’s influence on psychiatry,
and classified mental disorders
as various “reactions” to
stressors
 DSM-II (1968) dropped the
reactions concept, but
DSM-I and DSM-II
Both
the DSM-I and DSM-II
had problems with reliability
in diagnosing mental illness
Both
lacked standardized
diagnostic criteria and
assessment instruments
(Frances, Mack, Ross, First, 2000)
DSM-III
 DSM-III
(1980) – A watershed event
American psychiatry
It
outlined a research-based, empirical,
and phenomenologic approach to
diagnosis, which attempted to be
atheoretical with regard to etiology
DSM-IV
 DSM-IV
continues the DSM-III
tradition
It
is characterized as the
“biologic” approach to
diagnosis
It contains listings and
descriptions of psychiatric
diagnoses
DSM-IV
The
DSM-IV serves as:
Guide
for clinical practice
Facilitates research and improved
communication between clinicians
and researchers
Is a tool used to teach
psychopathology
DSM-V
DSM-V
is currently being developed
and is tentatively due for
publication in 2013
 What
does the term mental disorder imply?
 Is
there really a distinction between mental
disorders and physical disorders?
“…there is much “physical in “mental” disorders and
much “mental” in “physical” disorders.”
(DSM-IV Introduction, p. xxi)
 The
DSM does not classify people; it
classifies disorders (i.e., an individual with
schizophrenia vs. “the schizophrenic”)
 People
classify people
Mental Disorders
A
clinically significant behavioral or psychological
syndrome or pattern



Individual is experiencing present distress or disability
(i.e., significant impairment of functioning)
Individual has a significantly increased risk of suffering
death, pain, disability, or an important loss of freedom
The syndrome is not an expected cultural response
(DSM-IV Introduction, xxii)
DSM-IV Multiaxial System
The
five-axis classification system
 Axis
I: Clinical disorders
 Axis II: Personality disorders, mental
retardation
 Axis III: General medical conditions
 Axis IV: Psychosocial and environmental
problems
 Axis V: Global assessment of functioning
DSM-IV Multiaxial System
Axis
I
Clinical
syndromes that generally
develop in late adolescence or
adulthood
Ex: schizophrenia, bipolar disorder,
panic disorder, posttraumatic stress
disorder, alcohol abuse, major
depression
Axis I conditions are considered
DSM-IV Multiaxial System
Axis
II: personality disorders
and mental retardation
Also
used to note
maladaptive personality
traits and behavior problems
DSM-IV Multiaxial System
Axis
III
Medical
conditions which play a role
in the development, continuance, or
exacerbation of Axis I and II Disorders
Examples:
Asthma
in patients with anxiety
AIDS in a patient with new-onset psychosis
(brain lesions)
Cirrhosis of the liver in a patient with
alcohol dependence
DSM-IV Multiaxial System
Axis
IV
Psychosocial
stressors
encountered by the patient within
the previous 12 months that have
contributed to:
Development
of a new mental
disorder
Recurrence of a previous mental
DSM-IV Multiaxial System
Psychosocial
stressors include
problems with:
Primary support group
Social environment
Education
Occupation
Housing
Economic
Access to health care services
Interaction with the legal system
Environmental problems
Psychosocial
stressors should
be described in as much detail
as needed to indicate how it
affects the patient’s
functioning
Even
mild stressors should be
noted if they figure into the
clinical presentation
DSM-IV Multiaxial System
Axis
V
Patient’s global level of functioning both
at the time of evaluation and during the
past year
Clinician consults the Global Assessment
of Functioning scale to determine the
level of functioning (See DSM-IV)
The GAF is based on 0-100 scale
Mental Health Diagnosis
 Example:





A
Axis I: Bipolar disorder, most recent episode manic,
296.44
Axis II: No diagnosis
Axis III: No diagnosis
Axis IV: Loss of important relationship
Axis V: Global assessment of function = 60
patient may have a diagnosis in all five of the
axes
Anxiety Disorders
 Panic
Disorder
 Obsessive Compulsive Disorder
 Post Traumatic Stress Disorder
 Social Anxiety Disorder
 Specific Phobias
 Generalized Anxiety Disorder
Symptoms of Anxiety
Disorders














Feelings of panic, fear and uneasiness
Uncontrollable, obsessive thoughts
Repeated thoughts or flashbacks of traumatic experiences
Nightmares
Ritualistic behaviors, such as repeated hand washing
Problems sleeping
Cold or sweaty hands
Shortness of breath
Palpitations
An inability to be still and calm
Dry mouth
Numbness or tingling in the hands or feet
Nausea
Muscle tension
How Common Are Anxiety
Disorders?
 Anxiety
disorders affect about 19
million adult Americans.
 Most anxiety disorders begin in
childhood, adolescence and early
adulthood.
 They occur slightly more often in
women than in men, and occur with
equal frequency in Caucasians, blacks
and Hispanics.
Treatment of Anxiety
Disorders



Medication-Medicines used to reduce the symptoms
of anxiety disorders include anti-depressants and
anxiety-reducing medications.
Psychotherapy (a type of counseling) addresses the
emotional response to mental illness. It is a process in
which trained mental health professionals help people
by talking through strategies for understanding and
dealing with their disorder.
Cognitive-behavioral therapy: People suffering from
anxiety disorders often participate in this type of
psychotherapy in which the person learns to recognize
and change thought patterns and behaviors that lead to
troublesome feelings.
Types of Depression
 Situational/Adjustment
 Bereavement
 Seasonal
 Clinical
Depression
 Psychotic Depression
 Bipolar (Manic-Depressive Illness)
 Dysthymia
 Post-Partum Depression
Situational/Adjustment
 Variable




mood correlated to circumstances
Minimal change in sleep, appetite, energy
No change in self-attitude
Suicidal thought unlikely
Typically lasts less than one month
Seasonal



Seasonal depression, called seasonal affective disorder (SAD), is a
depression that occurs each year at the same time, usually starting in
fall or winter and ending in spring or early summer. It is more than
just "the winter blues" or "cabin fever."
Symptoms of winter SAD may include the seasonal occurrence of:
Fatigue






Increased need for sleep
Decreased levels of energy
Weight gain
Increase in appetite
Difficulty concentrating
Increased desire to be alone
Dysthmia


Dysthymia, sometimes referred to as chronic
depression, is a less severe form of depression but the
depression symptoms linger for a long period of time,
perhaps years. Those who suffer from dysthymia are
usually able to function normally, but seem consistently
unhappy.
Symptoms of dysthymia include:







Difficulty sleeping
Loss of interest or the ability to enjoy oneself
Excessive feelings of guilt or worthlessness
Loss of energy or fatigue
Difficulty concentrating, thinking or making decisions
Changes in appetite
Thoughts of death or suicide
Clinical Depression
 An
illness, not a weakness
 Serious disturbances in work, social, and
physical functioning including suicidal thought
 Not relieved by circumstances
 May last for months or years untreated
 Persistent and intense mood change
Clinical Depression
Who and When
 1.5
million young adults in US each year
 Fewer than half seek treatment
 1 of 4 women and 1 of 10 men develop
depression during their lifetime
 Often begins in early adult years
 Family history, substance abuse, and stress
increase risk
Clinical Depression
Signs and Symptoms
 Extreme
sadness, guilt, shame
 Decreased concentration, poor
academic performance or work
performance
 Decreased interest/enjoyment in daily
activities
 Increased irritability, arguments
 Change in sleep, appetite, energy
 Social withdrawal
Clinical Depression
Treatment
 Anti-Depressant
medications
(effective,improved safety & tolerability, not
habit forming)
 Psychotherapy (individual, group, cognitive
behavioral,self-help)
 Day treatment, hospitalization
 Exercise, sleep hygiene, light therapy, ECT
http://www.youtube.com/watch?v=
F5YubjEqbZ8
Psychotic Depression


Roughly 25% of people who are admitted to the hospital for
depression suffer from what is called psychotic depression.
What Are the Symptoms of Psychotic Depression?







Anxiety (fear and nervousness)
Agitation
Paranoia
Insomnia (difficulty falling and staying asleep)
Physical immobility
Intellectual impairment
Psychosis
Bipolar Disorder
 2%
general population over a lifetime
 Half of cases begin before age 20
 Episodic extremes between states


depressed state and excitable,
euphoric/irritable, impulsive state
 Strong
family linkage
 Occurs equally in men and women
Symptoms of Bipolar
Disorder
 Symptoms










of mania ("the highs"):
Excessive happiness, hopefulness, and excitement
Sudden changes from being joyful to being irritable, angry,
and hostile
Restlessness
Rapid speech and poor concentration
Increased energy and less need for sleep
High sex drive
Tendency to make grand and unattainable plans
Tendency to show poor judgment, such as deciding to quit a
job
Drug and alcohol abuse
Increased impulsivity


Some people with bipolar disorder can become psychotic, seeing
and hearing things that aren't there and holding false beliefs from
which they cannot be swayed.
During depressive periods ("the lows”) symptoms include:













Sadness
Loss of energy
Feelings of hopelessness or worthlessness
Loss of enjoyment from things that once were pleasurable
Difficulty concentrating
Uncontrollable crying
Difficulty making decisions
Irritability
Increased need for sleep
Insomnia
A change in appetite causing weight loss or gain
Thoughts of death or suicide
Attempting suicide
Bipolar Disorder
Treatment
 Mood
stabilizer medication
 Psychotherapy
 May require emergency hospitalization
http://www.youtube.com/watch?v=h5aSa4tmVNM
http://www.youtube.com/watch?v=65RgUquD7zA
http://www.youtube.com/watch?v=8Ki9dgG3P5M
Facts About Suicide
 3rd
leading cause of death in 15-24
year olds
 Men 4 times more than women
 Highest rate in white men over 65
 Alcoholism associated with up to half of
all suicides
 Mood disorders account for 60-80% of
suicides
 50-75% seek help before suicide but
50% have never seen a psychiatrist
Risk for Suicide
 History





of attempt
Males>Females
Family history of suicide
Native American
Mood Disorder or Substance Abuse
White>Black
Social/Environmental Factors
Can Increase Risk for Suicide
 Humiliating
life events
 Loss
 History
of childhood abuse
 Interpersonal discord
 Social isolation
What to Do?
Listen For:
 Life
isn’t worth living
 I feel my family would be better off
without me.
 Suicide is the only way out.
 Take my (something); I don’t need it
anymore.
 Ending the pain is all I care about.
 Next time, I’ll take enough pills to do it
right.
How to Help
 Do



Voice concerns
Get professional
help immediately
Tell someone or call
the police
 Don’t






Assume the
situation will take
care of itself
Leave the person
alone
Be sworn to secrecy
Act shocked
Challenge or dare
Argue or debate
moral issues
Suicide Prevention
 Decrease
social isolation
 Identify victimization, rejection, mental
illness,and substance abuse
 Treat depression
 Reduce hopelessness
 Skill building around mood regulation
 Secure or remove firearms
 Decrease barriers around help seeking
Post Traumatic Stress



Can develop after a person has experienced or
witnessed a traumatic or terrifying event in which
serious physical harm occurred or was
threatened.
PTSD is a lasting consequence of traumatic
ordeals that cause intense fear, helplessness, or
horror, such as a sexual or physical assault, the
unexpected death of a loved one, an accident,
war, or natural disaster.
Families of victims can also develop posttraumatic
stress disorder, as can emergency personnel and
rescue workers.
http://www.youtube.com/watch?v=JBUjLXtedfc
Symptoms of PTSD
 Symptoms
of PTSD most often begin
within three months of the event.
 In some cases, however, they do not
begin until years later.
 The severity and duration of the illness
vary. Some people recover within six
month, while others suffer much longer.
 Symptoms of PTSD often are grouped
into three main categories, including:reliving, avoiding, and increased arousal
Symptoms of PTSD



Re-living: may include flashbacks, hallucinations and
nightmares. They also may feel great distress when
certain things remind them of the trauma, such as the
anniversary date of the event.
Avoiding: may avoid people, places, thoughts or
situations that may remind him or her of the trauma.
Have feelings of detachment and isolation from family
and friends
Increased arousal: excessive emotions; problems
relating to others, including feeling or showing affection;
difficulty falling or staying asleep; irritability; outbursts of
anger; difficulty concentrating; and being "jumpy" or
easily startled. The person may also suffer physical
symptoms, such as increased blood pressure and heart
rate, rapid breathing, muscle tension, nausea and
diarrhea.
Who can suffer from PTSD?


Victims of trauma related to physical and sexual assault face the
greatest risk for PTSD.
How Common Is PTSD?
 About 3.6% of adult Americans
 about 5.2 million people
 suffer from PTSD during the course of a year, and an
estimated 7.8 million Americans will experience PTSD at
some point in their lives.
 PTSD can develop at any age, including childhood.
 Women are more likely to develop PTSD than are men. This
may be due to the fact that women are more likely to be
victims of domestic violence, abuse and rape.
Treatment
 Treatment
for PTSD may involve psychotherapy (a
type of counseling), medication or both.
 Therapy




Cognitive-behavior therapy, which involves learning to recognize
and change thought patterns that lead to troublesome emotions,
feelings and behavior.
Psychodynamic therapy focuses on helping the person examine
personal values and the emotional conflicts caused by the traumatic
event.
Family therapy may be useful because the behavior of the person
with PTSD can have an affect on other family members.
Group therapy may be helpful by allowing the person to share
thoughts, fears and feelings with other people who have
experienced traumatic events.
Obsessive Compulsive
Disorder
 Common
obsessions include:
 Fear of dirt or contamination by germs.
 Fear of causing harm to another.
 Fear of making a mistake.
 Fear of being embarrassed or behaving in a
socially unacceptable manner.
 Fear of thinking evil or sinful thoughts.
 Need for order, symmetry or exactness.
 Excessive doubt and the need for constant
reassurance
Treatment
 Medication
 Therapy:
Various types of psychotherapy,
including individual, group and family therapy
Hoarding
 OCD
tendencies to keep all belongs
 Persistent difficulty discarding or parting
with personal possessions, even those of
apparently useless or limited value, due to
strong urges to save items, distress, and/or
indecision associated with discarding.
Symptoms
 The
symptoms cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning (including maintaining a safe
environment for self and others).
 The hoarding symptoms are not restricted
to the symptoms of another mental
disorder
Hoarding
Personality Disorders



Personality disorders: People with personality
disorders have extreme and inflexible personality
traits that are distressing to the person and/or
cause problems in work, school or social
relationships.
In addition, the person's patterns of thinking and
behavior significantly differ from the expectations
of society and are so rigid that they interfere with
the person's normal functioning.
Examples include antisocial personality disorder,
obsessive-compulsive personality disorder and
paranoid personality disorder.
Psychotic Disorders


Schizophrenia:
 People with this illness have changes in behavior
and other symptoms -- such as delusions and
hallucinations -- that last longer than six months,
usually with a decline in work, school and social
functioning.
Schizoaffective disorder:
 People with this illness have symptoms of
schizophrenia, as well as a serious mood or affective
disorder, such as severe depression, mania (a
disorder marked by periods of excessive energy) or
bipolar disorder (a disorder with cyclical periods of
depression and mania).
Psychotic Disorders


Schizophreniform disorder:
 People with this illness have symptoms of
schizophrenia, but the symptoms last less than six
months.
Brief psychotic disorder:
 People with this illness have sudden, short periods
of psychotic behavior, often in response to a very
stressful event, such as a death in the family.
Recovery is often quick -- usually less than a month.
Psychotic Disorders



Delusional disorder: People with this illness have
delusions involving real-life situations that could be true,
such as being followed, being conspired against or having a
disease. These delusions persist for at least one month.
Shared psychotic disorder: This illness occurs when a
person develops delusions in the context of a relationship
with another person who already has his or her own
delusion(s).
Substance-induced psychotic disorder: This condition is
caused by the use of or withdrawal from some substances,
such as alcohol and crack cocaine, that may cause
hallucinations, delusions or confused speech.
Psychotic Disorders
 Psychotic
disorder due to a medical
condition: Hallucinations, delusions or other
symptoms may be the result of another illness
that affects brain function, such as a head
injury or brain tumor
 Paraphrenia: This is a type of schizophrenia
that starts late in life and occurs in the elderly
population.
Symptoms of a Psychotic
Disorder

Hallucinations and delusions.
 Hallucinations are unusual sensory experiences or
perceptions of things that aren't actually present, such as
seeing things that aren't there, hearing voices, smelling odors,
having a "funny" taste in your mouth and feeling sensations on
your skin even though nothing is touching your body.
 Delusions are false beliefs that are persistent and organized,
and that do not go away after receiving logical or accurate
information. For example, a person who is certain his or her
food is poisoned, even if it has been proven that the food is
fine, is suffering from a delusion.
Psychotic Disorders

Other possible symptoms of psychotic illnesses
include:
 Disorganized or incoherent speech
 Confused thinking
 Strange, possibly dangerous behavior
 Slowed or unusual movements
 Loss of interest in personal hygiene
 Loss of interest in activities
 Problems at school or work and with relationships
 Cold, detached manner with the inability to express
emotion
 Mood swings or other mood symptoms, such as
depression or mania
How Common Are Psychotic
Disorders?
 About
1% of the population worldwide suffers
from psychotic disorders. These disorders
most often first appear when a person is in his
or her late teens, 20s or 30s. They tend to
affect men and women about equally.
Treatment
 Medication
 Psychotherapy:
Various types of
psychotherapy, including individual, group and
family therapy, may be used to help support
the person with a psychotic disorder.
 http://putlocker.bz/watch-a-beautiful-
mind-online-free-putlocker.html
Eating Disorders
 Eating
disorders involve extreme emotions,
attitudes and behaviors involving weight and
food. Anorexia nervosa, bulimia nervosa and
binge eating disorder are the most common
eating disorders.
Body Image &
Eating Disorders
Messages about Food
What messages have you received
(from parents, peers, media, etc.)
about food?
How are messages about food different
for women and men?
Some statistics





Eating disorders have
increased threefold in the last
50 years
10% of the population is
afflicted with an eating
disorder
90% of the cases are young
women and adolescent girls
Up to 21% of college women show sub-threshold symptoms
61% of college women show some sort of eating pathology
Three Types of Eating
Disorders



Anorexia nervosa- characterized by a
pursuit of thinness that leads to selfstarvation
Bulimia nervosa- characterized by a cycle
of bingeing followed by extreme behaviors
to prevent weight gain, such as purging.
Binge-eating disorder- characterized by
regular bingeing, but do not engage in
purging behaviors.
Anorexia Nervosa

Begins with individuals
restricting certain foods, not
unlike someone who is dieting


Restrict high-fat foods first
Food intake becomes severely
limited
More on anorexia nervosa

May exhibit unusual
behaviors with regards to
food.

preoccupied with thoughts of
food, and may show
obsessive-compulsive
tendencies related to food
 may
adopt ritualistic behaviors at
mealtime.
 may collect recipes or prepare
elaborate meals for others.
Bulimia Nervosa

Qualitatively distinct from
anorexia


A binge may or may not be
planned


characterized by binge eating
marked by a feeling of being out of
control
The binge generally lasts until
the individual is uncomfortably
or painfully full
Bulimia Nervosa

Common triggers for a binge
dysphoric mood
 interpersonal stressors
 Intense hunger after a period of intense
dieting or fasting
 feelings related to weight, body shape,
and food are common triggers to binge
eating

Bulimia Nervosa

Feelings of being ashamed after a
binge are common


behavior is kept a secret
Tend to adhere to a pattern of
restricted caloric intake

usually prefer low-calorie foods during
times between binges
More on bulimia nervosa
Later age at the onset of the
disorder
 Are able to maintain a normal
weight
 Will not seek treatment until they
are ready

 Most
deal with the burden of hiding
their problem for many years,
sometimes well into their 30’s
Two subtypes

purging type


self-induced vomiting and laxatives as
a way to get rid of the extra calories
they have taken in
non-purging type

use a period of fasting and excessive
exercise to make up for the binge
Anorexia
Risk of Death:
The Deadliest of all
Psychological Disorders
Risk Factors for developing
an eating disorder
 Personality/psychological
 Family
factors
influence
 Media
 Subcultures
society
existing within our
Personality/Psychological
Factors
Sense of self worth based on weight
 Use food as a means to feel in control
 Dichotomous & rigid thinking
 Perfectionism
 Poor impulse control
 Inadequate coping skills

Protective personality
Factors
Nonconformity
 Having a feminist ideology
 High self-esteem
 Belief that body weight and shape
are out of one’s control
 Self-perception of being thin

Media and Cultural Factors

Culture bound syndrome

Belief that being thin is the answer to
all problems is prevalent in western
culture
Media and Cultural Factors

Bulimia can be influenced by
social norms


It can be seen as a behavior, which
is learned through modeling
Women who are seen as being
attractive by societies standards
can be very susceptible to eating
disorders as well
Media and Cultural Factors

Media images are inescapable


devastating when we see idealized images in
the media and feel they do not meet the
expectations of our society
Frequent readers of fashion magazines are
two to three times more likely than
infrequent readers to be dieting
Historical Beauty Ideals
The Celebrity Thin Ideal
The Unreal Ideal


http://homepage.mac.com/gapodaca/digital
/bikini/bikini1.html
http://demo.fb.se/e/girlpower/retouch/retouc
h/
Jamie Lee Curtis
The Thin-Ideal



The avg. model weighs 23%
less than the avg. American
woman
Longitudinal study from 19791988 showed that 69% of
playboy models and 60% of
Miss America contestants met
weight criteria for anorexia
Women’s bodies in the media
have become increasingly
thinner
The Impact on Women

One study showed that 55% of college
women thought that they were overweight
though only 6% were

94% of one sample of women wanted to be
smaller than they currently were

96% thought that they were larger than the
current societal ideal

Half the women in a study said they would
rather be hit by a truck than be fat
Challenges to treatment

Lack of motivation to change
intrinsically reinforced by the weight
loss, because it feels good to them
 may deny the existence of the
problem, or the severity of it

Lack of insight

Not really about food.
Impulse control and addiction
disorders:



People with impulse control disorders are unable
to resist urges, or impulses, to perform acts that
could be harmful to themselves or others.
Pyromania (starting fires), kleptomania (stealing)
and compulsive gambling are examples of
impulse control disorders.
Alcohol and drugs are common objects of
addictions. Often, people with these disorders
become so involved with the objects of their
addiction that they begin to ignore responsibilities
and relationships.
Adjustment Disorder
 Adjustment
disorder occurs when a
person develops emotional or
behavioral symptoms in response to a
stressful event or situation.
The stressors may include natural
disasters, such as an earthquake or
tornado; events or crises, such as a car
accident or the diagnosis of a major illness;
or interpersonal problems, such as a
divorce, death of a loved one, loss of a job
or a problem with substance abuse.
 Adjustment disorder usually begins within
three months of the event or situation and
ends within six months after the stressor
stops or is eliminated.

Dissociative
Disorders
Dissociation
 Psychogenic
disruption in conscious
awareness
 Complex mental activity that is
independent from or not integrated within
conscious awareness
Automatisms
 Accomplishing
a task with little or no
conscious awareness
 Much of our life involves non-conscious
mental activity (both perception and
memory)

Automatic, non-deliberate, not selfmonitored
When is Dissociation a
problem?
 Loss
of overall, integrative control
 Unable to access information
 Loss of a coherent sense of self
Dissociative Disorders
 Splitting
apart of components (identity,
memory, perception) of a persons
personality that are usually integrated
Types of Dissociative
Disorders
 Dissociative
Amnesia
 Dissociative Fugue
 Dissociative Identity Disorder
 Depersonalization Disorder
Dissociative Amnesia
 Partial
or total forgetting of past
experience without a biological cause
 Almost always anterograde – blocking out
a period of time after psychogenic cause
(e.g. stress / trauma)
 Memory loss is often selective
 Relative indifference to loss of memory
 Remain well oriented to time and place
Dissociative Amnesia:
Patterns of Memory Loss
 Localized

All events in a circumscribed period
 Selective

amnesia
amnesia
Forget only certain events that occur during
a circumscribed period
 Generalized
amnesia
 Continuous amnesia
 Systematized amnesia
Dissociative Fugue
 Amnesia
+ sudden, unexpected trip away
from home
 Often involves the creation of a new
identity
 Fugue state usually ends abruptly – then
amnesic for events during the fugue
Dissociative Identity
Disorder
 Sense
of self, or personality breaks up into
two or more distinct identities which take
turns “controlling” behaviour
 At least one “personality” is amnesic for
the experiences of the others
 “Alter” often coconscious with the host
Dissociative Identity
Disorder
 Identities
are often polarized
 Often each identity specializes in different
areas of functioning, encapsulates
different memories
 Very high proportion report significant
trauma in childhood – possible strategy
that children use to distance themselves
from trauma
Controversy re. cause of
DID
 Faking
- malingering
 Induced by therapy - iatrogenic
 Social Role
 Hypnotizability
 “False Memory Syndrome”
Depersonalization Disorder
 Disruption
in identity without amnesia
 Sense of strangeness or unreality in oneself
 Derealization
 Reduced emotional responsiveness
Explaining Dissociative
Disorders
 Most
theories assume that dissociation is a
way of escape from situations that are
beyond coping powers
Factitious disorders
 Conditions
in which physical and/or emotional
symptoms are experienced in order to place
the individual in the role of a patient or a
person in need of help.
Sexual and gender disorders
 Sexual
and gender disorders: These
include disorders that affect sexual desire,
performance and behavior. Sexual
dysfunction, gender identity disorder and the
paraphilias are examples of sexual and
gender disorders.
Somatoform disorders
 A person
with a somatoform disorder, formerly
known as psychosomatic disorder,
experiences physical symptoms of an illness
even though a doctor can find no medical
cause for the symptoms.
Characteristics
Somatic complains of major medical maladies
without demonstrable peripheral organ disorder
 Psychological problems and conflicts are
important in initiating, exacerbating and
maintaining the disturbance.
 Physical and laboratory examinations do not
explain the vigorous and sincere
patients´complaints.
 The morbid preoccupation interferes with and
anxiety are frequently present and may justify
specific treatment

Differential diagnosis
 Medical
conditions - multiple sclerosis,
brain tumour, hyperparathyroidism,
hyperthyroidism, lupus erythematosus
 Affective
(depressive)
and
anxiety
disorders – 1 or 2 symptoms of acute onset
and short duration
 Hypochondriasis - patient´s focus is on fear
of disease not focus on symptoms
 Panic disorder - somatic symptoms during
panic episode only
Differential diagnosis
 Conversion
disorder - only one or two
 Pain disorder - one or two unexplained
pain complaints, not a lifetime history of
multiple complaints
 Delusional disorders - schizophrenia with
somatic delusions or depressive disorder
with hypochondriac delusions, bizzare,
psychotic sy.
 Undifferentiated somatization disorder short duration (e.g. less than 2 years) and
less striking symptoms
Course of the illness
 Chronic
relapsing condition, the cause
remains unknown
 Onset from in adolescence to the 3th decade
of life.
 Psychosocial and emotional distress coincides
with the onset of new symptoms and health
care-seeking behavior
 Clinical practice showed that typical episodes
last 6 to 9 months with a quiescent time of 9 to
12 months..
Mental Retardation
 Condition
of limited mental ability

Low IQ on traditional test of intelligence

Difficulty adapting to everyday life

Onset of characteristics by age 18
 Some


causes include
Organic retardation
Cultural-familial retardation-IQ's 55-70result from growing up in a below
average intellectual environment