Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Course and prognosis Symptoms tend to appear suddenly, most often between 15 and 30 years of age and in more than 50% of cases the disorder is long lasting. Approximately one-third of patients experience discrete episodes while the experience is continuous for another one-third. For the final third, the experience begins as episodic and becomes continuous. Treatment Patients usually respond to anxiolytics and to both supportive and insight-oriented therapy. As anxiety diminishes, episodes of depersonalization/derealization de crease as well. Other Specified or Unspecified Dissociative Disorder Dissociative disorders not otherwise specified are disorders in which the predom inant feature is a dissociative symptom, such as a disruption in consciousness or memory, but the symptom does not meet the criteria for a specific dissociative disorder. In order for a patient to be diagnosed with unspecified dissociative dis order, they must present with dissociative symptoms but fail to meet the criteria for acute stress disorder, PTSD, or somatization disorder, all of which include dissociative symptoms within their diagnostic criteria. Ganser syndrome is a rare condition with dissociative features and is char acterized by odd behavior, confusion, hallucinations, making absurd statements, amnesia, with spontaneous and sudden recovery. It may mimic other serious conditions like schizophrenia and is seen in patients with stroke or head injury. Cases have been reported in a variety of cultures, but the overall frequency of such reports has declined with time. Genderwise, men outnumber women by approximately 2 to 1. Three of Ganser’s first four cases were convicts, leading some authors to consider it to be a disorder of penal populations and, thus, an indicator of potential malingering. Some case reports identify precipitating stressors, such as personal conflicts and financial reverses, whereas others note organic brain syndromes, head inju ries, seizures, and medical or psychiatric illness. Psychodynamic explanations are common in the older literature, but organic etiologies are stressed in more recent case studies. It is speculated that the organic insults may act as acute stressors, precipitating the syndrome in vulnerable individuals. Some patients have reported significant histories of childhood maltreatment and adversity. Chronic and recurrent syndromes of mixed dissociative symptoms This category is dedicated to patients who do not meet Criterion A for DID, as the discontinuities in identity are incomplete and without report of dissociative amnesia. Identity disturbance due to prolonged and intensive coercive persuasion More popularly known as “brainwashing,” this category refers to persons who have spent weeks, months, or years being coerced by cultists, terrorists, or other extremists, oftentimes under harsh conditions. It implies that under conditions of

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