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Cureus Nov 2023Dissociative identity disorder (DID), commonly known as multiple personality disorder (MPD), is a contentious mental health condition that typically arises as a result... (Review)
Review
Dissociative identity disorder (DID), commonly known as multiple personality disorder (MPD), is a contentious mental health condition that typically arises as a result of traumatic events to help people avoid unpleasant memories. To completely comprehend the complexity and nuance of DID, this study investigates its symptomatology, diagnostic criteria, therapeutic modalities, and historical controversies. Patients with DID frequently have two or more distinct personality identities, each with its memories, characteristics, and attributes. Ten personality disorders are listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), but DID, formerly known as MPD, is not one of those personality disorders. Nevertheless, myths and misunderstandings cloud our knowledge of the disease, and some critics attribute the condition's emergence to therapy rather than trauma. This study emphasizes the possibilities for recovery and fulfilling life for persons affected by DID by attempting to provide a comprehensive understanding of DID, debunk myths and misconceptions, and throw light on effective therapy methods. It accomplishes this by carefully examining the body of literature and existing studies. The DID study used a systematic strategy to obtain a thorough grasp of the causes, diagnosis, symptoms, and therapies of the disorder. It employed precise keywords and Boolean operators across four databases, prioritized current peer-reviewed English-language publications, and enforced strict exclusion standards. While admitting potential biases and limits in the databases used, the research intended to maintain methodological transparency and robustness, helping to provide an accurate and up-to-date picture of DID.
PubMed: 38116333
DOI: 10.7759/cureus.49057 -
Psychiatria Danubina Oct 2023The Dissociative Identity Disorder has undergone significant transformations over the years. Once regarded as a rare condition, it gained popularity in the 1980s in the...
The Dissociative Identity Disorder has undergone significant transformations over the years. Once regarded as a rare condition, it gained popularity in the 1980s in the United States following the publication of a book on the subject, only to subsequently wane due to extensive controversies. Presently, we are witnessing a resurgence of adolescents who believe they may be afflicted by this disorder. This article delves into the changes that have occurred since the initial surge in 1980, with a particular focus on the role of social media in the dissemination of Dissociative Identity Disorder. The concepts of Mass Social Media-Induced Illness and Munchausen's by Internet are explored to elucidate this phenomenon. Additionally, we examine the criteria essential for distinguishing imitative Dissociative Identity Disorder from genuine cases, with the aim of aiding accurate diagnosis by psychiatrists. Mental health professionals may encounter new challenges when assessing young adults whose presentations are influenced by social media, necessitating awareness of the impact of social media on the dissemination of certain disorders.
Topics: Adolescent; Humans; Dissociative Identity Disorder; Psychiatry; Dissociative Disorders
PubMed: 37800227
DOI: No ID Found -
World Psychiatry : Official Journal of... Feb 2024Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The...
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
PubMed: 38214629
DOI: 10.1002/wps.21156 -
Current Neuropharmacology 2024Post-traumatic stress disorder (PTSD) is a mental health condition that can occur following exposure to a traumatic experience. An estimated 12 million U.S. adults are... (Review)
Review
Post-traumatic stress disorder (PTSD) is a mental health condition that can occur following exposure to a traumatic experience. An estimated 12 million U.S. adults are presently affected by this disorder. Current treatments include psychological therapies (e.g., exposure-based interventions) and pharmacological treatments (e.g., selective serotonin reuptake inhibitors (SSRIs)). However, a significant proportion of patients receiving standard-of-care therapies for PTSD remain symptomatic, and new approaches for this and other trauma-related mental health conditions are greatly needed. Psychedelic compounds that alter cognition, perception, and mood are currently being examined for their efficacy in treating PTSD despite their current status as Drug Enforcement Administration (DEA)- scheduled substances. Initial clinical trials have demonstrated the potential value of psychedelicassisted therapy to treat PTSD and other psychiatric disorders. In this comprehensive review, we summarize the state of the science of PTSD clinical care, including current treatments and their shortcomings. We review clinical studies of psychedelic interventions to treat PTSD, trauma-related disorders, and common comorbidities. The classic psychedelics psilocybin, lysergic acid diethylamide (LSD), and N,N-dimethyltryptamine (DMT) and DMT-containing ayahuasca, as well as the entactogen 3,4-methylenedioxymethamphetamine (MDMA) and the dissociative anesthetic ketamine, are reviewed. For each drug, we present the history of use, psychological and somatic effects, pharmacology, and safety profile. The rationale and proposed mechanisms for use in treating PTSD and traumarelated disorders are discussed. This review concludes with an in-depth consideration of future directions for the psychiatric applications of psychedelics to maximize therapeutic benefit and minimize risk in individuals and communities impacted by trauma-related conditions.
Topics: Adult; Humans; Hallucinogens; Stress Disorders, Post-Traumatic; Lysergic Acid Diethylamide; Psilocybin; N-Methyl-3,4-methylenedioxyamphetamine; N,N-Dimethyltryptamine
PubMed: 38284341
DOI: 10.2174/1570159X22666231027111147 -
BJPsych Open Jul 2023Dissociative symptoms present transdiagnostically and are related to poor clinical outcome. Research into the biological correlates of dissociation remains limited. This...
Dissociative symptoms present transdiagnostically and are related to poor clinical outcome. Research into the biological correlates of dissociation remains limited. This editorial summarises and discusses papers from this themed series of that contribute to unravelling the biological correlates of dissociative symptomatology with the aim of improving treatment and treatment outcome.
PubMed: 37395122
DOI: 10.1192/bjo.2023.511 -
Sleep Medicine Clinics Mar 2024In sleep-related dissociative disorders, phenomena of the psychiatrically defined dissociative disorders emerge during the sleep period. They occur during sustained... (Review)
Review
In sleep-related dissociative disorders, phenomena of the psychiatrically defined dissociative disorders emerge during the sleep period. They occur during sustained wakefulness, either in the transition to sleep or following an awakening from sleep. Behaviors during episodes vary widely, and can result in injury to self or others. Daytime dissociative episodes and a background of trauma are almost always present; there is typically major co-existing psychopathology. Diagnosis is based on both clinical history and polysomnography; differential diagnosis primarily involves other parasomnias and nocturnal seizures. Information available about treatment is limited; in a few reported cases, psychological interventions have proven effective.
Topics: Humans; Parasomnias; Sleep Wake Disorders; Dissociative Disorders; Sleep, REM; Sleep
PubMed: 38368062
DOI: 10.1016/j.jsmc.2023.10.003 -
Current Topics in Behavioral... May 2024Dissociative symptoms and disorders of dissociation are characterised by disturbances in the experience of the self and the surrounding world, manifesting as a breakdown...
Dissociative symptoms and disorders of dissociation are characterised by disturbances in the experience of the self and the surrounding world, manifesting as a breakdown in the normal integration of consciousness, memory, identity, emotion, and perception. This paper aims to provide insights into dissociative symptoms from the perspective of interoception, the sense of the body's internal physiological state, adopting a transdiagnostic framework.Dissociative symptoms are associated with a blunting of autonomic reactivity and a reduction in interoceptive precision. In addition to the central function of interoception in homeostasis, afferent visceral signals and their neural and mental representation have been shown to shape emotional feeling states, support memory encoding, and contribute to self-representation. Changes in interoceptive processing and disrupted integration of interoceptive signals into wider cognition may contribute to detachment from the body and the world, blunted emotional experience, and altered subjective recall, as experienced by individuals who suffer from dissociation.A better understanding of the role of altered interoceptive integration across the symptom areas of dissociation could thus provide insights into the neurophysiological mechanisms underlying dissociative disorders. As new therapeutic approaches targeting interoceptive processing emerge, recognising the significance of interoceptive mechanisms in dissociation holds potential implications for future treatment targets.
PubMed: 38755513
DOI: 10.1007/7854_2024_480 -
Neuroscience and Biobehavioral Reviews Nov 2023For the past decade, ketamine, an N-methyl-D-aspartate receptor (NMDAr) antagonist, has been considered a promising treatment for major depressive disorder (MDD). Unlike... (Review)
Review
For the past decade, ketamine, an N-methyl-D-aspartate receptor (NMDAr) antagonist, has been considered a promising treatment for major depressive disorder (MDD). Unlike the delayed effect of monoaminergic treatment, ketamine may produce fast-acting antidepressant effects hours after a single administration at subanesthetic dose. Along with these antidepressant effects, it may also induce transient dissociative (disturbing of the sense of self and reality) symptoms during acute administration which resolve within hours. To understand ketamine's rapid-acting antidepressant effect, several biological hypotheses have been explored, but despite these promising avenues, there is a lack of model to understand the timeframe of antidepressant and dissociative effects of ketamine. In this article, we propose a neurocomputational account of ketamine's antidepressant and dissociative effects based on the Predictive Processing (PP) theory, a framework for cognitive and sensory processing. PP theory suggests that the brain produces top-down predictions to process incoming sensory signals, and generates bottom-up prediction errors (PEs) which are then used to update predictions. This iterative dynamic neural process would relies on N-methyl-D-aspartate (NMDAr) and α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic receptors (AMPAr), two major component of the glutamatergic signaling. Furthermore, it has been suggested that MDD is characterized by over-rigid predictions which cannot be updated by the PEs, leading to miscalibration of hierarchical inference and self-reinforcing negative feedback loops. Based on former empirical studies using behavioral paradigms, neurophysiological recordings, and computational modeling, we suggest that ketamine impairs top-down predictions by blocking NMDA receptors, and enhances presynaptic glutamate release and PEs, producing transient dissociative symptoms and fast-acting antidepressant effect in hours following acute administration. Moreover, we present data showing that ketamine may enhance a delayed neural plasticity pathways through AMPAr potentiation, triggering a prolonged antidepressant effect up to seven days for unique administration. Taken together, the two sides of antidepressant effects with distinct timeframe could constitute the keystone of antidepressant properties of ketamine. These PP disturbances may also participate to a ketamine-induced time window of mental flexibility, which can be used to improve the psychotherapeutic process. Finally, these proposals could be used as a theoretical framework for future research into fast-acting antidepressants, and combination with existing antidepressant and psychotherapy.
Topics: Humans; Ketamine; Depressive Disorder, Major; Antidepressive Agents; Brain; Signal Transduction; Receptors, N-Methyl-D-Aspartate
PubMed: 37793581
DOI: 10.1016/j.neubiorev.2023.105410