dissociative disorders

Dissociative disorders
In DSM-IV , the essential feature of dissociative disorders is a disruption of the usually integrated functions of consciousness , memory , identity or perception . this disturbance may be sudden or gradual , transient or chronic .
Dissociative symptoms :
- Subjective numbing.
- Detachment .
- Reduced awareness of surroundings.
- Fragmentation or loss of memory.
- Derealization and depersonalization.
Classification of dissociative disorder ( DSM-IV):
- Dissociative amnesia .
- Dissociative fugue.
- Dissociative identity disorder.
- Depersonalization disorder.
- Dissociative disorder not otherwise specified.
Dissociative amnesia : the essential feature is an inability to recall important personal memories , usually of a stressful nature , that is to excessive to be explained by normal forgetfulness . dissociative amnesia must be distinguished from amnesia having a medical cause . it has been described in two forms :
- Circumscribed amnesia for s for a single recent traumatic event.
- Inability to recall long periods of childhood .
Dissociative fugue : is extremely rare . there is loss of memory coupled with wandering away from the person`s usual surroundings . these people usually deny all memory of their whereabouts during the period of wandering , and some deny knowledge of personal identity .

Dissociative identity disorder : widely known by the ICD-10 term multiple personality disorder , there are sudden alterations between two patterns of behavior , each of which is forgotten by the patient when the other is present .



Patients who meet the above criteria often meet the criteria for other diagnoses including schizophrenia , personality disorder and substance abuse.
Depersonalization disorder : is characterized by an unpleasant state in which external objects or parts of the body are experienced as changed in their quality and feel unreal or remote . the central features are a feeling of being unreal and unreal quality to perceptions . emotions seem dulled and actions feel mechanical . insight is retained into the subjective nature of their experiences. These symptoms may be intense and accompanied by déjà vu and by changes in the experience of passage of time . two thirds of the patients are women . the onset in adolescence or early adult life . the symptoms of depersonalization disorder occurs occasionally in association with other psychiatric disorders ( temporal lobe epilepsy , schizophrenia , depression , obsessional disorder , conversion disorder , migraine and also associated with the use of illicit drugs .

Additional conditions that may be a focus of clinical attention :
- Malingering : is the intentional production of false or grossly exaggerated physical or psychological symptoms , motivated by external incentives such as avoiding military duty , avoiding work , obtaining financial compensation , evading criminal prosecution or obtaining drugs .
Malingering should be strongly suspected if any combination of the following is noted :
1- Medicolegal context of presentation .
2- Evident discrepancy between the individual`s claimed stress or disability and the objective findings .
3- Lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen.
4- The presence of antisocial personality disorder.
Factors aiding in the differentiation between malingering and conversion disorder :
1- Malingerers are more likely to be suspicious , uncooperative , aloof an unfriendly ; patients with conversion disorder are more likely friendly , cooperative , appealing , dependant and clinging.
2- Malingerers may try to avoid diagnostic evaluations and refuse recommended treatments , patients with conversion disorder likely welcome evaluation and treatment .
3- Malingerers are more likely to provide extremely detailed and exacting descriptions of events precipitating their illness ; patients with conversion disorder are more likely to report historical gaps , inaccuracies and vagaries.
Treatment : if , at the conclusion of the diagnostic evaluation , malingering seems most likely , the patient should be tactfully , but firmly confronted with the apparent outcome. Coexisting psychiatric disorders should be thoroughly assessed .


























Dr.Waleed Al-Ameedy.