Psychosocial Aspects of Health, Disability and

Physical Therapy
3rd Sem | BSPT 2-1

OUTLINE
I. Definition of Terms Etiology AND EPIDEMIOLOGY
II. Etiology and Epidemiology
III. Pathophysiology DISSOCIATIVE AMNESIA
IV. Clinical Manifestations
V. Differential Diagnosis ETIOLOGY
VI. Intervention
● psychosocial environment
○ can cause conflicts which leads to
DEFINITION OF TERMS the patient experiencing intolerable
emotions such as shame, guilt,
DISSOCIATION despair, rage, and desperation
○ These usually result from conflicts
● The unconscious defense mechanism over unacceptable urges or impulses,
involves the segregation of any group of such as intense sexual, suicidal, or
mental or behavioral processes from the rest violent compulsions.
of the person's psychic activity. ● intolerable emotions
○ Dissociative was discussed as a ○ shame, guilt, despair, rage, and
defense mechanism wherein a desperation
person, they tend to detach or ● traumatic experiences (betrayal)
disconnect from oneself as an
escape from a distressing, traumatic EPIDEMIOLOGY
event.
● Disruption in one or more mental functions, ● Approx. 2%-6% of general population
such as memory, identity, perception, ● No known dif­ference is seen in incidence
consciousness, or motor behavior. Which can between men and women
potentially disrupt every area of mental ● Occurs in late adolescence and adulthood
functioning. ● Dissociative amnesia can be especially
● It may be sudden or gradual, transient or difficult to assess in preadolescent children
chronic, and the signs and symptoms of the because of their more limited ability to
disorder are often caused by psychological describe subjective experience
trauma.
○ Dissociative Disorders include:
DISSOCIATIVE IDENTITY DISORDER
○ Dissociative Amnesia
○ Depersonalization/derealization
ETIOLOGY
disorder ● Strongly linked to severe experiences of
○ Dissociative Fugue early childhood trauma (maltreatment)
○ Dissociative Identity Disorder ● Physical and social abuse
○ Other unspecified or specified ○ considered the most frequent cause
dissociative disorder of childhood trauma
● Contribution of genetic factors
AMNESIA ○ still being assessed but based on
● Different between intrapsychic conflict from preliminary studies, there was no
amnesia by medical condition (encephalitis) evidence found for the relation of
○ DSM-5 (Diagnostic and Statistical genetic factors to the disease.
Manual for Mental Disorders)
neurocognitive disorder due to EPIDEMIOLOGY
medical condition ● Based on clinical studies from female to
○ Thus, dissociative amnesia male, is between 5 to 1 and 9 to1 for
discusses neurocognitive disorders diagnosed cases.
brought on by another medical ● female: most affected
condition [ amnestic disorder] ● Based on studies, about 1-2% of the global
population is affected with this disorder
 Psychosocial Aspects of Health, Disability, and Physical
Therapy | PHD 2301-1
3rd Sem | BSPT 2-1

DEPERSONALIZATION-DEREALIZATION DISORDER EPIDEMIOLOGY

● Rare disorder, with a prevalence of 0.2% in
ETIOLOGY
the general population
● Psychodynamic ● Occurs often in men
○ Disintegration of the ego is a ● Also occurs in adolescence and early
response from an overwhelming, adulthood
painful experiences or conflictual ● Onset: sudden, and often related to
impulses as triggering events. traumatic or stressful life events
● Traumatic Stress
○ Stress and Fatigue PATHOPHYSIOLOGY
● Neurobiological Theories ● Dissociative disorders usually develop as a
○ SSRIs (selective serotonin reuptake reaction to trauma and help keep difficult
inhibitors) like marijuana and d/t memories at bay. It has been studied that
migraine are responses to the alternate identities result from the inability
degeneration of glutamate receptor of many traumatized children to develop a
unified sense of self that is maintained
EPIDEMIOLOGY across various behavioral states, particularly
if the traumatic exposure first occurs before
● Third most commonly reported psychiatric the age of 5.
symptoms after depression and anxiety ● How overt the different identities vary. They
● Two or four times more common in women tend to be more overt when people are under
than in men extreme stress. Symptoms — ranging from
● Prevalence of 19% in the general population amnesia to alternate identities — depend
● Occurs in: partly on the type of dissociative disorder you
○ Seizure pt have. Signs of a switch to an altered state
○ Migraine sufferers include trance-like behavior, eye blinking,
○ Use of psychedelic drugs (marijuana) eye-rolling, and changes in posture.
○ Side effect of medications
CLINICAL MANIFESTATIONS
Signs and symptoms depend on the type of dissociative
DISSOCIATIVE FUGUE disorders you have, but may include:

ETIOLOGY ● Memory loss (amnesia) of certain time

periods, events, people and personal
● Associated with: information
○ traumatic circumstances ● A sense of being detached from yourself and
■ history of child abuse your emotions
■ natural disasters, wartime, or ● A perception of the people and things around
times of major social you as distorted and unreal
dislocation and violence ● A blurred sense of identity
○ current severe distress ● Significant stress or problems in your
○ neuropsychological cognitive relationships, work or other important areas
dysfunctions of your life
■ Studies also state that this ● Inability to cope well with emotional or
disorder can comorbid with professional stress
bipolar disorder, major ● Mental health problems, such as
depressive disorder, depression, anxiety, and suicidal thoughts
schizophrenia, PTSD, and behaviors
substance-related disorders,
panic disorder, anxiety
disorders, eating disorders
and somatoform disorders ,
etc.
○ genetic factors

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 Psychosocial Aspects of Health, Disability, and Physical
Therapy | PHD 2301-1
3rd Sem | BSPT 2-1

There are three major dissociative disorders defined in ● May have experiences of depersonalization,
the Diagnostic and Statistical Manual of Mental Disorders derealization or both.
(DSM-5), published by the American Psychiatric ● Symptoms, which can be profoundly
Association: distressing, may last only a few moments or
come and go over many years.
1. DISSOCIATIVE AMNESIA

DEFINITION
DISSOCIATIVE FUGUE
● The main symptom is memory loss that's
more severe than normal forgetfulness DEFINITION
● Failure to recall information about yourself or
events and people in your life, especially from ● Not a major diagnostic in DSM-5
a traumatic time. ○ Considered as a subtype or specifier
● Can be specific to events in a certain time, of dissociative amnesia
such as intense combat, or more rarely, can ○ Can also be seen in patients with
involve complete loss of memory about both dissociative amnesia and
yourself. dissociative identity disorder
● May sometimes involve travel or confused ● characterized as sudden, unexpected, and
wandering away from your life (dissociative purposeful travel away from home or one's
fugue). customary place of daily activities, with
● Occurs suddenly and may last minutes, inability to recall some or all of one's past
hours, or rarely, months or years. ● Accompanied by confusion about personal
identity or even the assumption of a new
identity.
○ The disturbance is not due to the
2. DISSOCIATIVE IDENTITY DISORDER direct physiological effects of a
substance or a general medical
DEFINITION condition.
● Formerly known as multiple personality ● The symptoms must cause clinically
disorder significant distress or impairment in
● Characterized by "switching" to alternate social, occupational, or other important
identities. You may feel the presence of two or areas of functioning
more people talking or living inside your
OTHER SPECIFIED OR UNSPECIFIED DISSOCIATIVE DISORDER
head, and you may feel as though you're
possessed by other identities.
● Each identity may have a unique name, DISSOCIATIVE TRANCE DISORDER
personal history and characteristics, ● Temporary, marked alteration in the state of
including obvious differences in voice, consciousness or by loss of the customary
gender, mannerisms and even such physical sense of personal identity without the
qualities as the need for eyeglasses. replacement by an alternate sense of identity
● People with dissociative identity disorder ● Narrowing of awareness of immediate
typically also have dissociative amnesia and surrounding or in environmental stimuli
often have dissociative fugue.
POSSESSION TRANCE
3. DEPERSONALIZATION-DEREALIZATION DISORDER ● This is seen in horror movies where the
person is being possessed
DEFINITION ● They are controlled or have the feeling of
being controlled by a possessive agent
● ongoing or episodic sense of detachment or
● They are stereotyped and culturally
being outside yourself — observing your
determined behaviors.
actions, feelings, thoughts and self from a
distance as though watching a movie BRAINWASHING
(depersonalization). ● Subjected to period of prolonged and intense
● Other people and things around you may feel coercive persuasion.
detached and foggy or dreamlike, time may
be slowed down or sped up, and the world
may seem unreal (derealization).
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 Psychosocial Aspects of Health, Disability, and Physical
Therapy | PHD 2301-1
3rd Sem | BSPT 2-1

RECOVERED MEMORY SYNDROME SEIZURE DISORDER

● This occurs during hypnosis or ● In most seizure cases, the clinical
psychotherapy wherein the pt. may recall the presentation differs significantly from that of
painful experienced repressed in their dissociative amnesia, with clear-cut ictal
unconscious minds events and sequelae. Patients with
pseudoepileptic seizures may also have
GANSER SYNDROME dissociative symptoms, such as as amnesia
● Giving of approximate answers (paralogia) and an antecedent history of psychological
together with a clouding of consciousness, trauma. Rarely, patients with recurrent,
and frequently accompanied by complex partial seizures present with
hallucinations and other dissociative, ongoing bizarre behavior, memory problems,
somatoform, or conversion symptoms. irritability, or violence, leading to a
differential diagnostic puzzle. In some of
OTHER SPECIFIED OR UNSPECIFIED DISSOCIATIVE DISORDER these cases, the diagnosis can be clarified
only by telemetry or ambulatory
Ordinary Forgetfulness and Nonpathological Amnesia. electroencephalographic (EEG) monitoring.
● Ordinary forgetfulness is a phenomenon that
is benign and unrelated to stressful events. SUBSTANCE-RELATED AMNESIA
In dissociative amnesia, the memory loss is ● A variety of substances and intoxicants have
more extensive than in nonpathological been implicated in the production of
amnesia. Other nonpathological forms of amnesia.
amnesia have been described, such as
infantile and childhood amnesia, amnesia TRANSIENT GLOBAL AMNESIA
for sleep and dreaming, and hypnotic ● Transient global amnesia can be mistaken
amnesia. for a dissociative amnesia, especially
because stressful life events may precede
Dementia, Delirium, and Amnestic Disorders due to Medical either disorder. In transient global amnesia,
Conditions however, there is the sudden onset of
complete anterograde amnesia and learning
● In patients with dementia, delirium, and
abilities; pronounced retrograde amnesia;
amnestic disorders due to medical
preservation of memory for personal identity;
conditions, the memory loss for personal
anxious awareness of memory loss with
information is embedded in a far more
repeated, often perseverative, questioning;
extensive set of cognitive, language,
overall normal behavior; lack of gross
attentional, behavioral, and memory
neurological abnormalities in most cases;
problems. Loss of memory for personal
and rapid return of baseline cognitive
identity is usually not found without
function, with a persistent short retrograde
evidence of a marked disturbance in many
amnesia. The patient usually is older than 50
domains of cognitive function. Causes of
years of age and shows risk factors for
organic amnestic disorders include
cerebrovascular disease, although epilepsy
Korsako:trs psychosis, cerebral vascular
and migraine have been etiologically
accident (CVA), postoperative amnesia,
implicated in some cases.
postinfectious amnesia, anoxic amnesia, and
transient global amnesia. Electroconvulsive DISSOCIATIVE IDENTITY DISORDERS
therapy (ECT) may also cause a marked
● Patients with dissociative identity disorder
temporary amnesia, as well as persistent
can present with acute forms of amnesia and
memory problems in some cases.
fugue episodes. These patients, however, are
Posttraumatic AmnesiA characterized by a plethora of symptoms,
only some of which are usually found in
● In posttraumatic amnesia caused by brain
patients with dissociative amnesia. With
injury, a history of a clear-cut physical
respect to amnesia, most patients with
trauma, a period of unconsciousness or
dissociative identity disorder and those with
amnesia, or both is usually seen, and there is
dissociative disorder not otherwise specified
objective clinical evidence of brain injury.
with dissociative identity disorder features
report multiple forms of complex amnesia,
including recurrent blackouts, fugues,

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 Psychosocial Aspects of Health, Disability, and Physical
Therapy | PHD 2301-1
3rd Sem | BSPT 2-1

unexplained possessions, and fluctuations DIALECTIC BEHAVIOR TREATMENT (DBT)

in skills, habits, and knowledge. ● DBT is a type of treatment that combines
individual counseling with group skill
Acute Stress Disorder, Posttraumatic Stress Disorder, and training. It emphasizes the development of
Somatic Symptom Disorder emotional control, distress tolerance,
● Most forms of dissociative amnesia are best interpersonal effectiveness, and mindfulness
conceptualized as part of a group of trauma abilities.
spectrum disorders that includes acute
stress disorder, posttraumatic stress
disorder (PTSD), and somatic symptom Eye Movement Desensitization and Reprocessing Therapy
disorder. Many patients with dissociative (EDMR)
amnesia meet full or partial diagnostic ● Temporary, marked alteration in the state of
criteria for those acute stress disorders or a consciousness or by loss of the
combination of the three. Amnesia is a
criterion symptom of each of the latter
disorders.

Malingering and Factitious Amnesia

● No absolute way exists to differentiate
dissociative amnesia from factitious or
malingered amnesia. Malingerers have been
noted to continue their deception even Additional treatments that can help include:
during hypnotically or barbiturate-facilitated
interviews. A patient who presents to
HYPNOSIS
psychiatric attention seeking to recover
● The state of hypnosis (hypnotherapy) is one
repressed memories as a chief complaint
of profound relaxation and concentrated
most likely has a factitious disorder or has
attention. This strong degree of attention and
been subject to suggestive influences. Most
focus when under hypnosis helps to
of these individuals actually do not describe
disregard common distractions and be more
bona fide amnesia when carefully
open to guided recommendations to make
questioned, but are often insistent that they
adjustments to enhance health.
must have been abused in childhood to
explain their unhappiness or life dysfunction.
DISSOCIATIVE TRANCE DISORDER
INTERVENTION ● Clinicians may prescribe an antidepressant
The treatment of dissociative disorders typically involves a medication, like a selective serotonin
combination of psychotherapy (talk therapy), medication, reuptake inhibitor (SSRI).
and support. However, to name some specific interventions ● Examples are:
used for Dissociative Disorders include: ○ fluoxetine (Prozac)
○ sertraline (Zoloft)
COGNITIVE BEHAVIORAL THERAPY (CBT) ● Anti-anxiety meds may also be
● CBT assists people in identifying and recommended, depending on the symptoms.
challenging problematic thinking patterns ● Lastly, If psychosis is present, an
and behaviors related to dissociation. It antipsychotic medication might help you
focuses on the development of coping manage symptoms and feel more in control.
methods and the enhancement of
problem-solving abilities.
Contributors
MACARAIG MARIANO
RICOHERMOSO GARCIA

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