Transcript Dissociative Disorders Disorders in which conscious awareness

Dissociative Disorders
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Disorders in which conscious awareness becomes
separated (dissociated) from previous memories, thoughts,
and feelings.
An example is the fugue state, where someone can walk out
of their life, and suddenly aware months or years later, with
no memory of the intervening time. (Stone, 2006).
Note there is no mention of repressed memories.
Facing trauma, dissociative detachment may actually protect
a person from being overwhelmed by emotion.
The Japanese medieval samurai had a saying for combat:
“Assume that you have already been killed in battle,
therefore nothing worse can happen to you. Then get on
with your duty as a samurai.” (from the movie Shogun, 1981)
Dissociative Disorders
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DID: two or more distinct identities are said to alternately
control the person's behaviour.
The Hillside Strangler was supposedly a classic case of a
good and a bad identity. During a hypnosis section, Dr. John
Watkins (1984) called forth a hidden personality. This was all
a ruse, Bianchi was a practiced liar.
Are clinicians who discover multiple personalities merely
triggering role playing in fantasy-prone people? (Spanos,
1996)
Or is it cultural? Once DID was included in the DSM, the
number of reported cases exploded to more than 20,000
(McHugh, 1995).
Rather than being provoked by trauma, DID symptoms tend
to be exhibited by the fantasy-prone. (Giesbrecht et al.,
2010)
DID cont'd
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But..handedness switches with personality changes.
(Henninger, 1992)
Opthamologists have detected shifting visual acuity and eyemuscle balance as patients switched personalities, changes
that did not occur among controls trying to simulate DID.
(Miller et al., 1991)
DID patients exhibit heightened activity in brain areas
associated with the control and inhibition of traumatic
memories. (Elzinga et al., 2007)
Is it a form of PTSD? One study of 12 murderers diagnosed
with DID, 11 had suffered severe tortuous child abuse.
(Lewis et al., 1997)
Can such recollections simply be attributed to vivid
imagination and/or therapists' suggestions? (Kihlstrom,
2005)
Personality Disorders
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Characterized by inflexible and enduring behaviour patterns
that impair social functioning.
Avoidant: fearful sensitivity to rejection that predisposes
withdrawal.
Schizoid: emotionless disengagement.
Histrionic: attention-getting dramatic or impulsive behaviours
that intimidate or manipulate others.
Narcissistic personality: the Joker from Batman (says it all).
These categories are not sharply distinguished, and will be
changed in the DSM-5 (Holden, 2010).
Antisocial Personality Disorder
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Typically a male whose lack of conscience becomes plain
before age 15, as he begins to lie, steal, fight, and or display
unrestrained sexual behaviour. (Cale & Lillienfeld, 2002).
Despite their remorseless and sometimes criminal
behaviour, criminality is not an essential component of
antisocial behaviour. (Skeem & Cooke, 2010).
Antisocial personalities behave impulsively, and then feel
and fear little. (Fowles & Dindo, 2009).
Twins and adoptions studies reveal that biological relatives
of those with the disorder are at increased risk. (Livesley &
Jang, 2008).
Fig. 51.1 Stress hormone levels were lower than average
before committing any crime. (Magnusson, 1990).(m668
c643 15.11)
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ASPD cont'd
Boys who later become aggressive or antisocial adolescents
tended to be impulsive, uninhibited, unconcerned with social
rewards, and low in anxiety. (Caspi et al., 1996)
The genes that put them at risk for antisocial behaviour also
put people at risk for dependence on alcohol or other drugs,
which helps explain why these disorders often appear in
combination. (Dick, 2007).
Fig. 51.2 (m669 c644 15.12)The
top-facing PET scans illustrate
reduced activation (less red & yellow) in a murderer's frontal
cortex--a brain area that helps brake impulsive, aggressive
behaviour.
In one study, violent repeat offenders had 11% less frontal
lobe tissue than normal. (Raine, 2000).
ASPD exhibit marked deficits in frontal lobe cognitive
functions: planning, organization, inhibition. (Morgan &
Lillienfeld, 2000).
Biopsychosocial roots of crime
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Fig. 51.3 (m669 c644 15.13)Danish male babies whose
backgrounds were marked both by obstetrical complications
and social stresses associated with poverty were twice as
likely to be criminal offenders by age 20 to 22 as those in
either the biological or social risk groups. (Raine et al., 1996)
Two combined factors: childhood maltreatment and a gene
that altered neurotransmitter balance--predicted antisocial
problems. (Caspi et al., 2002)
ASPD display a hyper-reactive dopamine reward system
that predisposes their impulsive drive to something reward,
despite the consequences. (Buckholtz et al., 2010).
Note to remember: everything psychological is also
biological.
Eating Disorders
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Anorexia nervosa: a person (usually an adolescent female)
maintains a starvation diet despite being significantly (+15%)
underweight.
Bulimia nervosa: a person alternates binge eating (usually
high-calorie foods) with purging (by vomiting, laxatives, or
fasting).
Binge-eating: significant binge-eating episodes, followed by
distress, disgust or guilt, but without the compensatory
purging or fasting that marks bulimia nervosa.
Remember to measure underweight or overweight against
the Body Mass Index (BMI), not the gross weight on a scale.
Also, these disorders are not a telltale sign of childhood
sexual abuse.
Eating Disorders Cont'd
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Mothers of girls with eating disorders tend to focus on their
own weight and on their daughter's weight and appearance.
(Pike & Rodin, 1991).
Families of bulimics have higher-than-normal incidence of
childhood obesity and negative self-evaluation. (Jacobi et
al., 2004)
Familes of anorexics tend to be competitive, high-achieving,
and protective. (Pate et al., 1992)
Twins are more likely to share the disorder if they are
identical rather than fraternal. (Root et al., 2010).
The rise in eating disorders in N.A has coincided with a
dramatic increase in women having a poor body image.
(Feingold & Mazzella, 1998).