Dissociative Disorders for NCMHCE Study

Review of DSM5 Mental Disorders for NCMHCE Study

1. Dissociative identity disorder2. Depersonalization/derealization disorder3. Dissociative amnesia4. Other specified/unspecified dissociative disorder

AssessmentsMental Status ExamCambridge Depersonalization Scale CDS

Treatments 1. MedicationAntidepressants AnticonvulsantsAtypical anti-psychotics

2. Therapies Safety or Crisis Plan Psychodynamic Psychotherapy,

insight oriented Cognitive Behavioral Therapy, for

coping Hypnotherapy Relaxation Training REBT, disputing irrational beliefs

Diagnosis 1. Disruption of identity characterized by two or more distinct personality states Observed by others or reported by the individual2. Recurrent memory gaps of everyday events, personal information and/or traumatic events Not ordinary forgetting

ComorbidPTSDBorderline Personality DisorderAvoidant Personality DisorderSomatic Symptom DisorderEating disordersSubstance related disordersOCDSleep disorders

Rule OutPTSDSchizophreniaBipolar DisorderBorderline Personality Disorder

S1. Find OutDetailed historyMedical historyAffective functioningSuicide historyAnxiety Cognitive functioningTrauma and loss historyCurrent family and social environment (safety)Substance abuse history

S2. Refer & AssessPsychiatric evaluationBegin outpatient therapy and identify possible dissociated aspects

Verify alternate personalities

S4. Treatments 1. MedicationAntidepressants AnticonvulsantsAtypical anti-psychotics

2. Therapies Safety or Crisis Plan Psychodynamic Psychotherapy,

insight oriented Cognitive Behavioral Therapy, for

coping Hypnotherapy

S5. Monitoring 1. Follow through on referrals2. Medication compliance3. Journaling dissociative episodes and memory lapses 4. Self destructive behavior

S6. TerminationMedication monitoring for compliance, to reduce high rate of relapseReturn to therapy if relapseSupport group

Diagnosis IInability to recall important autobiographical informationusually of a traumatic or stressful nature outside of ordinary forgettingNot attributed to use of substances, medical or neurological condition

SpecifyWith/without dissociative fugue:Purposeful travel or bewildered wandering

Rule OutDissociative Identity DisorderPTSDAcute Stress Disorder Somatic Symptom Disorder

S1. Find OutDetailed historyMedical historyAffective functioningSuicide historyAnxiety Cognitive functioningTrauma and loss historyCurrent family and social environment (safety)Substance abuse history

S2. Refer & AssessPsychiatric evaluation

S4. Treatments 1. MedicationAntidepressants AnticonvulsantsAtypical anti-psychotics

2. Therapies Psychodynamic Psychotherapy,

insight oriented Cognitive Behavioral Therapy, for

coping Hypnotherapy

Diagnosis1. Persistent or recurrent experiences of depersonalization, derealization or bothDepersonalization:

Experience of unreality, detachment, or being an outside observer

In regards to one’s thoughts, feelings, sensations, body actions

Derealization: Experiences unreality or detachment

in regards to surroundings Objects or people are thought to be

unreal, dreamlike, foggy, lifeless or distorted

2. During these experiences reality testing remains intactOften associated with early trauma

Rule OutSchizophrenia

S1. Find OutCognitive functioningMental health historyWork functioningSubstance abuse historyAnxiety historyTrauma historySocial history

S2. Assess or ReferMental Status ExamCambridge Depersonalization Scale CDS

S4. Treatments 1. MedicationAntidepressants Anti anxiety

2. Therapies Psychoeducation Identifying stressors Relaxation Training REBT, disputing irrational beliefs

S5. MonitoringFrequency and intensity of depersonalization episodesAffective functioning

S6. TerminationContinue relaxation methodsKeep a journal to record potential stressors that trigger the symptomsJoin a meditation or relaxation group