Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

TABLE 16-11. Summary of Dissociative Disorders ( continued ) Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder

Depersonalization Disorder Although pure disorder rare, intermittent episodes of depersonalization common Rare over age 40 May be more common in women Severe stress, anxiety, depression increase vulnerability Rule out medical causes.

Epidemiology Most common dissociative disorder More common following

Rare More common following disasters or during war Variable sex ratio and age of onset

Not nearly as rare as once thought Affects as many as 5% of psychiatric patients Adolescence-young adulthood (although may begin much earlier) Female > male Increased in first-­ degree relatives Severe sexual and psychological abuse in childhood Lack of support from significant others Epilepsy may be involved Rule out medical causes.

disasters or during war

Female > male Adolescence, young adulthood

Etiology

Precipitating emotional trauma (eg, domestic violence) Rule out medical causes.

Precipitating emotional trauma Heavy alcohol abuse may predispose. Borderline, histrionic, schizoid personality disor ders predispose Rule out medical causes. Usually brief, hours or days Can last months and involve exten sive travel Recovery generally spontaneous and rapid Recurrences rare

Most severe and chronic of dissociative disorders Incomplete recovery

Onset usually sudden Tends to be chronic

Course and prognosis

Abrupt termination Few recurrences

For a more detailed discussion of this topic, see Chapter 20, Dissociative Disorders, Chapter 20, p. 1866, in CTP/X.

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