copyright 2008 Cheryl K. Hosken, BSN, MS Psych.
Dissociative Disorders
To dissociate means to become "separate from" or "to escape". The underlying theme of dissociative disorders is that a person seeks to escape from some aspect of life or personality. These two things are seen as the source of stress, discomfort, or anxiety. These disorders can be dramatic and are often the subject of novels, movies, or T.V. shows.
Meditate Word By Word On These Verses:
Isaiah 35:3-6.
Dissociative Amnesia
Dissociative amnesia is the inability to recall important personal information - an inability too extensive to be explained by ordinary forgetfulness. What is forgotten is usually some traumatic incident and some of all of the experiences that led up to or followed the incident. As you may suspect, there is no medical explanation for this loss of memory. The extent of forgetting associated with this type of amnesia varies greatly. In some cases, a person may "lose" entire days and weeks at a time; in other cases only specific details cannot be recalled. Not surprisingly, cases of this disorder tend to be more common in wartime when traumatic experiences occur.
Question:
1. What is the major symptom of dissociative amnesia?
Dissociative Fugue
Occasionally, forgetfulness caused by amnesia is accompanied by a change of location. For example, a person finds himself in a strange and different place with no reasonable explanation of how he got there. This is a disorder called dissociative fugue. A typical example is Carol who was found wandering around the business district of a large city, inappropriately dressed for the cold temperatures. A police officer saw her and asked if he could help her. As he talked with her, it was apparent that she did not know where she was, so he took her to a hospital. It was discovered that she had no memory of where she had been or what she had been doing for the last two weeks. She had no idea of how she had gotten 350 miles from home. Both dissociative amnesia and fugue disorder are like the somatoform disorders in that they involve escape from stressful situation. In conversion disorder, for example, a person may escape from stress by taking on the symptoms of a major physical illness. With amnesia and fugue, escape is more literal. People escape by forgetting, or they avoid stress by psychologically or physically running away.
Question:
2. What happens to a person with dissociative fugue?
(Select the best answer.)
He or she travels to strange, unfamiliar places.
He or she does not dress for cold temperatures.
He or she has amnesia and ends up in a strange location.
Dissociative Identity Disorder
This disorder is commonly known as multiple personality disorder. The major symptom of this disorder is the existence within the same person of two or more distinct personalities or personality traits. The disorder has been very rare, although for unknown reasons incidence of this disorder has been increasing.
The very idea of two or more personalities inhabiting the same person is difficult to imagine. Perhaps it will help to contrast this disorder with a typical behavior pattern. We all change our behaviors, and in a small way, our personalities change every day depending on the situation. We do not act, think, or feel exactly the same way at school, at work, at a party, or in a church service. We modify our behaviors to fit the circumstances. But these changes do not qualify as an identity disorder. What is the difference?
The differences are significant. Someone with this dissociative identity disorder has changes in personality that are dramatic and extreme. They do not slightly alter their behavior: they have two or more distinct personalities, implying a change in underlying consciousness. Another difference is that when we change our behaviors, we change them in response to situational cues. This is not the case for a person with dissociative identity disorder. Changes in personality can take place without warning. The third major difference involves control. When we change our behaviors, we do so intentionally. The person with the dissociative identity disorder can seldom control or predict which of their personalities are dominant at any one time. Persons diagnosed with this disorder have often been victims of child abuse or sexual abuse. This problem affects females more than males because females are more often abused than males. Females also have a greater number of different personalities than do males.
Question:
3. Have you known of any person with these disorders? Describe.
Personality Disorders
The psychological disorders we have read about thus far are those that afflict persons who were one time normal and undisturbed. In most cases, the person did not always have the symptoms of this disorder. This is not true with personality disorders because these people have a long history of symptoms. Personality Disorders are long-lasting changes in perceiving, relating to, and thinking about the environment and oneself. The thought processes are maladaptive, inflexible, and cause impaired functioning or distress. Individual personality is defined by attitudes, behaviors, and traits that persist in many situations over long periods of time. With a personality disorder, the traits and habits that constitute one's personality are damaging. These problems are apparent by the time a person is an adolescent. However, doctors usually wait until the age of 18 before giving a definite diagnosis.
Question:
4. What are the defining characteristics of personality disorders?
(One or more of the following answers may be correct.)
The traits and habits that constitute one's personality are damaging.
The existence within the same person of two or more distinct personalities.
Long-lasting changes in perceiving, relating to, and thinking about the environment and oneself.
The thought processes are maladaptive, inflexible, and cause impaired functioning or distress.
There are 11 personality disorders categorized into three groups:
- Disorders that make a person odd or eccentric. They are difficult to live with.
- Disorders in which a person is overly dramatic, emotional, or erratic. These people are impulsive.
- Disorders that add fear or anxiety to the personality.
Below are some of the major characteristics of each group:
Group 1
Paranoid personality disorder is an extreme sensitivity, suspiciousness, envy, and mistrust of others. The actions of other people are interpreted as deliberately demeaning or threatening. The suspicious attitude is not justified. A person with this disorder shows a restricted range of emotional reactions, is humorless, and rarely seeks help. For example, a person may accuse his spouse of infidelity and every time the phone rings thinks that it was a call from the spouse's lover. However, a new immigrant in his new country may also have symptoms of paranoid personality disorder simply because he is in new and unfamiliar surroundings. This does not mean he has a personality disorder.
Schzoid personality disorder is the inability to form interpersonal relationships. A person with schzoid personality seems cold and aloof and often engages in excessive daydreaming. An example of this is a person who lives in a small apartment and goes out only to receive money from his pension and buy a few groceries.
Group 2
Histronic personality disorder is overly dramatic, reactive, and expresses emotions intensely. A person with this disorder is emotionally lively, draws attention to himself, and overreacts to matters of little significance. For example this type of woman may spend an inordinate amount of time on her appearance and call everyone "Darling." She constantly asks for feedback on her appearance and describes her activities as "wonderful" even when such experiences are mundane.
Narcissitic personality disorder is a grandiose exaggeration of self-importance, a need for attention or admiration, and a tendency to set unrealistic goals. Someone with this problem has few lasting friendships and their behavior is seen as childish. An example of this person is someone who must always be the center of conversation and rarely listens to what others say themselves.
Group 3
Avoidant personality disorder is an over-sensitivity to rejection by other people and an unwillingness to have friendships for fear of being rejected. This person is devastated by disapproval from others. For example, this may be a man with very few close friends, only talks with women who are older than himself, and does not think of marriage. He has worked for years at the same job and does not seek any challenges or promotions.
Dependent personality disorder allows others to dominate and assume responsibility for one's actions: a poor self-image and a lack of confidence. A person with this disorder sees himself as helpless and thus defers to others. This is often true of the woman who suffers physical abuse from her husband. Although she may report the abuse, she refuses to take an active role in finding help for herself or her husband. She says that it is her responsibility to please her husband and if she does not, she is guilty.
Question:
5. What are the three categories of personality disorders?
Most cases of personality disorder come to the attention of mental health professionals on referral from courts or because of related problems such as child abuse or alcoholism. Comorbidity with these disorders is another big obstacle to healing.
The prognosis for personality disorders is poor. The maladaptive behavior of personality disorders has usually taken a good part of early life to develop. Changing them is very difficult. Understanding what causes these disorders is important. We have a few hypotheses about some or all of these disorders based on medical research. They are:
- There is a high need in these people for attention from others in unusual ways.
- There is a genetic basis for some of these disorders.
- There is a high incidence of loss of parents in most of these cases, especially those abandoned by their parents.
- There has been a high level of physical and/or sexual abuse in childhood.
- There is lack of emotional bonding to parents at a young age.
- There is a biologically caused lack of emotion in some of these disorders.
Question:
6. How do you think the hundreds of thousands of orphans and homeless children in your country will eventually affect the nation?
(Only one of the following answers is correct.)
Positively.
Negatively.
Not at all.
Alzheimer's Dementia, Mood Disorders, and Schizophrenia
It may be inappropriate to classify some disorders as being more severe than others. If a person has a disorder, he may be suffering severely because of it. Most of the disorders we will read about now cause great difficulties in meeting the demands of everyday living. There may be loss of contact with the world as we know it. Most of these people require hospitalization and a protected environment.
Alzheimer's Dementia
Dementia is a condition of marked loss of intellectual abilities. One's attention may be intact, but the use of memory is poor and deteriorates. Judgment and impulse control may be negatively affected. A slow deterioration of one's intellectual functioning is the most common symptom associated with Alzheimer's. Problems with recent memory mark the early stages of the disease. Mild personality changes - apathy, withdrawal - soon follow.
This dementia was first described in 1907 by Alois Alzheimer and was thought to be the inevitable process of aging. The symptoms associated with this dementia are not normal, natural, or a necessary part of growing old. However, an acceptance of this reality did not occur until the 1970's. Alzheimer's has been diagnosed in persons younger than 65 years of age. If people live in countries where advanced age is normal, the chance of diagnosing Alzheimer's in women is 1 in 6 and in men, 1 in 11.
Question:
7. What is Alzheimer's dementia?
Although the symptoms of Alzheimer's are psychological, the disease is physical, caused by abnormal changes in the brain tissue. There is no reliable diagnostic test for Alzheimer's: it can be diagnosed with certainty only after death and an autopsy of the brain. There are four signs of Alzheimer's in the brain tissue:
- a spaghetti-like jumble of abnormal protein fibers;
- the presence of plaque or waste material, degenerated nerve fibers that wrap around a core of protein;
- the presence of small cavities that are filled with fluid and debris;
- a reduction of various structures of the brain.
Question:
8. How can we know that a person has Alzheimer's?
(Only one of the following answers is correct.)
Examine a blood sample under a microscope.
Perform an autopsy on the brain after the patient dies.
Test the patient's urine with certain chemical reagents.
Scientists continue to search for the cause of Alzheimer's. The basic problem is that nerve cells in the brains of Alzheimer's patients start to die off sooner than they should, resulting in tangles, plaques and other signs apparent at the time of autopsy. The crucial question is why these cells die.
As is often the case with psychological functioning, there is a genetic basis for Alzheimer's disease. There is no doubt that the disease is carried from one generation to another. Three genes associated with Alzheimer's have been discovered, but scientists do not know in which way they affect the process of the disease.
Another hypothesis about the cause of Alzheimer's is related to a particular protein molecule. This protein is a major part of the plaques found in the brains of Alzheimer's patients. Another hypothesis has to do with the levels of the neurotransmitter aceytlcholine. Alzheimer's patients have low levels of this neurotransmitter in their brains. We know that aceytlcholine is associated with memory so if there is a deficit, memory may be lost. There is also the possibility that Alzheimer's is the result of a poison or toxin take into the body. As of now, there are many questions about this disease, but no easy answers.
Question:
9. What are the possible causes for Alzheimer's?
(One or more of the following answers may be correct.)
A high level of sugar in the blood.
Certain genes that are inherited from one's ancestors.
A certain protein found in the plaque in the brain.
A low level of the neurotransmitter aceytlcholine in the brain.
Ten warning Signs of Alzheimer's Disease
Normal Possible Alzheimer's 1. Temporarily forgetting the name of a colleague Not being able to remember the name later 2. Forgetting prepared food on the stove until the meal has finished Forgetting the meal was prepared 3. Unable to find the right word, but able to use a good substitute Uttering incomprehensible sentences 4. Forgetting momentarily where you are going Getting lost on your own street 5. Talking on the phone and forgetting to watch a child Forgetting that a child is even there 6. Having trouble to calculate bills and payments Not knowing what numbers mean 7. Misplacing a watch and then retracing steps to where you left it Putting a wrist watch in the sugar bowl 8. Having a bad day Having rapid shift of mood 9. Gradual changes in personality with age Drastic personality changes 10. Tiring of repetitive household tasks, but finishing the tasks anyway Not knowing or caring that household work is not done
Question:
10. How does knowledge about Alzheimer's affect your thinking about elderly?