Dissociative Disorders Professor Name Class and Section Number

Dissociative Disorders [Professor Name] [Class and Section Number]

Learning Objectives 1. Define the basic terminology and historical origins of dissociative symptoms and dissociative disorders. 2. Describe the posttraumatic model of dissociation and the sleep-dissociation model, and the controversies and debate between these competing theories. 3. What is the innovative angle of the sleep-dissociation model? 4. How can the two models be combined into one conceptual scheme?

Warm Up Activity On a sheet of paper, write about the last time you were daydreaming. § Describe the place were you imagining. § Describe how you were you feeling. § What snapped you out of this fantasy? § What if you couldn’t snap out of it?

Warm Up Activity Discussion: § Were there similarities across your stories? § In particular, how did your partner feel about the idea of not being able to end their fantasy?

Overview • • History of Dissociative Disorders Defining Dissociative Disorders Measuring Dissociation and Trauma • Causality and Evidence • Dissociation and Sleep • Sleep Problems • Studying the Relationship between Dissociation and Sleep • Inducing and Reducing Sleep Problems • Implications and Conclusions

History of Dissociative Disorders § An array of symptoms § Formerly known as Multiple Personality Disorder. § Rarely diagnosed until the 1980 s.

Overview • • History of Dissociative Disorders Defining Dissociative Disorders Measuring Dissociation and Trauma • Causality and Evidence • Dissociation and Sleep • Sleep Problems • Studying the Relationship between Dissociation and Sleep • Inducing and Reducing Sleep Problems • Implications and Conclusions

Defining Dissociative Disorders § The DSM-5 definition of dissociation § Differences between “trait” and “state”, and the continuum § Types of dissociative disorders § Dissociative symptom clusters

“The Woman with 7 Personalities”

Overview • • History of Dissociative Disorders Defining Dissociative Disorders Measuring Dissociation and Trauma • Causality and Evidence • Dissociation and Sleep • Sleep Problems • Studying the Relationship between Dissociation and Sleep • Inducing and Reducing Sleep Problems • Implications and Conclusions

Measuring Dissociation The Dissociative Experiences Scale (DES) § Example of items § Suitable only for screening Structured Clinical Interview for DSM-5

Measurement Approaches TPS § Identify and write down three strengths of the Dissociation Scale (Bernstein & Putnam, 1986) questions (2 mins) § Identify and write down three weaknesses of the Dissociation Scale (2 mins) § Share with class or with partner (3 mins) § Consider why the Dissociation Scale alone cannot be used to diagnose dissociative disorder.

Measurement Approaches TPS 1. Some people have the experience of driving a car and suddenly realizing that they don't remember what has happened during all or part of the trip. Mark the line to show what percentage of the time this happens to you. 0%------100% 2. Some people find that sometimes they are listening to someone talk and they suddenly realize that they did not hear part or all of what was just said. Mark the line to show what percentage of the time this happens to you. 0%-----100% 3. Some people have the experience of finding themselves in a place and having no idea how they got there. Mark the line to show what percentage of the time this happens to you. 4. Some people have the experience of finding themselves dressed in clothes that they don't remember putting on. Mark the line to show what percentage of the time this happens to you. 0% ----- 100%

Measurement Approaches TPS 5. Some people have the experience of finding new things among their belongings that they do not remember buying. Mark the line to show what percentage of the time this happens to you. 0% ----- 100% 6. Some people sometimes find that they are approached by people that they do not know who call them by another name or insist that they have met them before. Mark the line to show what percentage of the time this happens to you. 0% ----- 100% 7. Some people sometimes have the experience of feeling as though they are standing next to themselves or watching themselves do something and they actually see themselves as if they were looking at another person. Mark the line to show what percentage of the time this happens to you. 0% ----- 100%

Measurement Approaches TPS 8. Some people are told that they sometimes do not recognize friends or family members. Mark the line to show what percentage of the time this happens to you. 0% ----- 100% 9. Some people find that they have no memory for some important events in their lives (for example, a wedding or graduation). Mark the line to show what percentage of the important events in your life you have no memory for. 0% ----- 100% 10. Some people have the experience of being accused of lying when they do not think that they have lied. Mark the line to show what percentage of the time this happens to you. 0% ----- 100%

CAT: The Muddiest Point § What was the muddiest point in today’s class? § Write down what concept you are still struggling to understand.

Revisiting The Muddiest Point § Many of you seemed to struggle with… § How would you respond to this muddiest point?

Overview • • History of Dissociative Disorders Defining Dissociative Disorders Measuring Dissociation and Trauma • Causality and Evidence • Dissociation and Sleep • Sleep Problems • Studying the Relationship between Dissociation and Sleep • Inducing and Reducing Sleep Problems • Implications and Conclusions

Dissociation and Trauma The Posttraumatic Model (PTM) § The most widely held perspective on dissociative symptoms § Symptoms are defensive response to highly aversive events

The Posttraumatic Model (PTM) § Symptoms are a reflection of strategies to cope with highly aversive experiences. § Dissociation as a means of escape from painful memories. § Vermetten and colleagues (2006) example

Causality and Evidence Trauma Dissociative Symptoms Three main limitations: § based on cross-sectional designs § self-report measure § cognitive failures/high dissociation

Causality and Evidence Three main limitations: § based on cross-sectional designs § self-report measure § cognitive failures/high dissociation Discussion Activity: Now take turns with the person next to you and share your explanations

Limitations of PTM continued § PTM does not tell us how trauma produces dissociative symptoms § The relation between highly aversive events and dissociative symptoms

Overview • • History of Dissociative Disorders Defining Dissociative Disorders Measuring Dissociation and Trauma • Causality and Evidence • Dissociation and Sleep • Sleep Problems • Studying the Relationship between Dissociation and Sleep • Inducing and Reducing Sleep Problems • Implications and Conclusions

Dissociation and Sleep § § Connections noted as early as 19 th century Experiencing self and observing self Amnesia Dream characters and alter personalities

Sleep Problems § Anecdotal evidence links sleep problems and dissociation § Patients often exhibit sleep abnormalities

Dissociation and Sleep § High prevalence of dissociative symptoms and sleep problems in American adults § Watson’s (2001) pioneering study

Inducing and Reducing Sleep Problems § Dissociative symptoms increase with sleep deprivation § Decrease in symptoms when sleep patterns improve § Cautious optimism regarding sleep deprivation and dissociative symptoms

Overview • • History of Dissociative Disorders Defining Dissociative Disorders Measuring Dissociation and Trauma • Causality and Evidence • Dissociation and Sleep • Sleep Problems • Studying the Relationship between Dissociation and Sleep • Inducing and Reducing Sleep Problems • Implications and Conclusions

Implications and Conclusions

Debate Activity Does DID really exist? 1. Write down what you think are 3 strongest arguments for you position 2. You have 2 -minutes to introduce your main arguments 3. And a 2 -minute rebuttal 4. Now write on a piece of paper: Vote which side you think “won” the debate 5. Reflect - what made you vote this way?

CAT: The One-Minute Paper § What was the most important thing you learned during this class? § What important question remains unanswered?

Photo Attribution Slide 1 Photo Credit: Blow Your Mind Camilo Rueda López https: //www. flickr. com/photos/kozumel/4918575268 https: //creativecommons. org/licenses/by-nd/2. 0/ Slides 3 & 4 Photo Credit: Daydreaming Kristaps Bergfelds https: //www. flickr. com/photos/narciss/2758571483 https: //creativecommons. org/licenses/by/2. 0/ Slide 6 Photo Credit: Depersonallization disorder Janine https: //www. flickr. com/photos/pinkcotton/6091633858 https: //creativecommons. org/licenses/by-nc-nd/2. 0/ Slide 8 Photo Credit: Psychosis Dave Emmett https: //www. flickr. com/photos/davemmett/342959835 https: //creativecommons. org/licenses/by-nc-sa/2. 0/ Slide 9 Photo Credit: dissociative identity disorder 1 hunnnterrr https: //www. flickr. com/photos/hunter-m/3561409383 https: //creativecommons. org/licenses/by/2. 0/ Slide 11 Photo Credit: Dissociation Phil Kreniske NOBA Images https: //creativecommons. org/licenses/by-nc-sa/4. 0/ Slide 12 Photo Credit: Ruler Clker. Free. Vector. Images https: //pixabay. com/en/ruler-straight-edge-maths-tool-307475/ https: //creativecommons. org/publicdomain/zero/1. 0/deed. en Photo Credit: Illustrated silhouette of a black cat nehtaeh 79 Slides 16 & 32 http: //www. freestockphotos. biz/stockphoto/16624 http: //creativecommons. org/publicdomain/zero/1. 0/ Slide 17 Photo Credit: bordeaux Jan. Dix https: //pixabay. com/en/bordeaux-dog-de-dogue-water-muddy-895827/ https: //creativecommons. org/publicdomain/zero/1. 0/deed. en Slide 19 Photo Credit: Lack of sleep. Angela Quitoriano. https: //www. flickr. com/photos/angehphotos/6774645159 https: //creativecommons. org/licenses/by/2. 0/ Slide 20 Photo Credit: experimenting Alessandra Celauro https: //www. flickr. com/photos/35794811@N 06/6804106610/ https: //creativecommons. org/licenses/by-nc/2. 0/

Photo Attribution Slide 22 Photo Credit: Questions 1 Grisel D´An https: //www. flickr. com/photos/128454566@N 06/15893429463 https: //creativecommons. org/licenses/by-nc/2. 0/ Slide 23 Photo Credit: Sad man holding pillow Vic https: //www. flickr. com/photos/59632563@N 04/6480297645 https: //creativecommons. org/licenses/by/2. 0/ Slide 25 Photo Credit: Sleep Mislav Marohnić https: //www. flickr. com/photos/mislav-marohnic/3406902041 https: //creativecommons. org/licenses/by/2. 0/ Slide 26 Photo Credit: RER D Mooglio https: //www. flickr. com/photos/59016395@N 00/5305648637/ https: //creativecommons. org/licenses/by-nc-nd/2. 0/ Slide 27 Photo Credit: Craig Mayhew and Robert Simmon, NASA GSFC. Visible Earth NASA http: //visibleearth. nasa. gov/view. php? id=55167 Slide 28 Photo Credit: Sleep Sano Rin https: //www. flickr. com/photos/112361276@N 07/19951907861/ https: //creativecommons. org/licenses/by-nc/2. 0/ Slide 30 Photo Credit: Man walking on the water - silent conversation Heidi & Matt https: //www. flickr. com/photos/heidiandmatt/183973465/ https: //creativecommons. org/licenses/by-nc-sa/2. 0/