Introduction to Psychopathology
Disorders of Memory and Identity
Breakdown in the integration, recognition and consistency of experience
- consciousness and self-cohesiveness
DSM IV Disorders
Dissociative Amnesia
Dissociative Fugue
Depersonalization Disorder
Dissociative Identity Disorder
Other Memory Disorders
DSM IV also includes memory disorders like the dementias and those arising from organic brain syndromes
Dissociative Amnesia
Sudden loss of memory, not attributable to an organic condition
Sub-types of Amnesia
Localized or circumscribed
Selective
Generalized
Continuous
Dissociative Fugue
Loss of autobiographical memory and flight to a new locale
- Acquisition of new identity
- Adopt new name, profession, etc.
- Aware that s/he has no past
Depersonalization Disorder
Depersonalization
Self or body feels "unreal" or foreign
External world (including other people) feel unreal or alien
Etiology
Behavioral models
View patient�s dissociation as a behavior
- One model: dissociation is learned through operant conditioning
- dissociation is repeated because it is reinforcing
Clinical Example
stress >>>> preoccupation >>> anxiety
thoughts stray >>> relief
drift is reinforcing >>> repeated
amnesia = solution
Psychodynamic model
Single instance of massive repression
Patient actively forgets b/c remembering brings mental pain
Treatment of Dissociative Disorders
All perspectives agree on central problem
- Agree on cure: Assist the patient to remember
Dissociative Identity Disorder
(Multiple Personality)
First identified 400 years ago
D.I.D.
Individual�s consciousness is divided among 2 or more distinct personalities
- Number of personalities varies
- Usual range = 2 - 60
- Mean = 15
D.I.D., etc.
Each personality appears to function as an autonomous individual
- different traits, talents, capacities
- different social networks
- different physical responses
Personality clusters
Core personalities
Alter personalities
Intermediary personalities
Interaction
Shifts between personalities are abrupt and spontaneous
Only one personality dominates consciousness at one time
- exception: automatic writing
Characteristics of DID pts
72 - 92% female
- age at diagnosis = 20�s and 30�s
- age range = 11 - 67 years
symptoms usually appeared in childhood and adolescence
Role of trauma and DID
Hx. of severe sexual abuse and trauma
- 55 - 90% sexually abused
- 60 - 90% physically abused
- 94 - 97% chronic trauma
- 45% witnessed the violent death of another
Medical Model
no biological explanation for DID
- response to extreme stress
1) How are dissociated selves similar to or different from "virtual selves?"
2) What is the relationship of the person to her selves?
Research question: Are the many personalities of a DID patient distinct and unique?
different rates of respiration, blood pressure, ANS activity and visual acuity
- Ludwig (1972)
- male patient with 4 personalities
- each personality chose two special meaning words (total N of 8 special meaning words)
- also used 12 neutral words
- patient attached to a device measuring his GSR (Galvanic Skin Response), a measure of ANS activity
- Results: Core responded to all 8 words; Alters responded to the words they had chosen; no personality responded to neutral words
Putnam (1984)
looked at EEG activity in 10 MPD patients with 4 personalities each (N=40 personalities)
EEG wave activity of each personality within each individual was as different as the EEG waves between the different individuals
- Confirmation of the validity of multiple personalities
Medical treatments for DID
Aim is to assist with memory recovery
- Use of barbiturate medications--Sodium Amytal or Sodium Phenobarbital ("truth serum")
State Dependent Learning
Reformulation of the problem
- Different personalities are actually different levels of arousal states within the same personality
State Dependent Learning
Animal models
- show that recall of information is facilitated if an animal is tested in the same state as when it was originally learned
State Dependent Human Memory
- Application to human psychology
research on learning and test taking
State dependent learning and DID
Different levels of arousal mimic different personalities
DID patients have rigid state-to-memory links than general population
Psychodynamics of DID
Hx. of trauma
Child goes inward for self-protection
Can�t take actual flight so she flees symbolically
"not me who is being hurt but her"
Another psychodynamic view
Abused child inevitably tries to explain why she was abused
Child accepts blame
Transfers blame onto another self
Dissociation as "self hypnosis"
Hypothesis: DID patients put themselves into a hypnotic trance
hypnotic state interrupts usual cognitive functioning
person may regard shifting states of mind as different personalities
Treatment of DID (Vitkus, 1993)
Assist the patient to recognize and control dissociations
use of hypnosis to help the patient remember the abuse and express old rages and fears directly
Set limits on self-destructive behavior
may behavioral contracts
Treatment
Focus on relationship between patient and therapist
given hx. of trauma, developing real trust in another is difficult
use the therapeutic relationship to help the person to distinguish people in the present from tormentors of the past
Treatment
Integrate personalities
teach the patient to value the hostile, disruptive aspects of herself that she has displaced onto others
Social skills training
help the patient "make up for lost time" with interpersonal relationships