Dissociative (conversion) disorders
manifested various physical mental symptoms. These symptoms are also characterized by temporary and sudden change or loss of certain functions that is the cause of psychological conflict. Also mental symptoms such as the Ganser syndrome, are inextricably linked to conflict, they can be characterized by rapidity of occurrence and reversibility.
Under the conversion means the replacement of the alarm, various somatic symptoms, which often can be signs of neurological disease. Dissociation means that the symptoms come from incorrect interaction between the different functions of the mental nature and are the result of certain violations. Also this kind of disorder can be called hysteria.
There are two major problems in the case of diagnosis of such disorders.
Early in the development of diseases such as the syndrome of depersonalization, exclude somatic pathology not. Often requires long observation of the patient, conducting many of the procedures that allows you to make an accurate diagnosis. If the case is doubtful, we focus on the diagnosis of dissociative disorders, that does not exclude the presence of severe disease of somatic nature.
Sometimes very difficult to determine these symptoms conscious or unconscious. In many cases, the simulation occurs in those who are deprived of freedom or wants to avoid conscription to the army. Often patients tend to exaggerate their symptoms, however, diagnosis, in any case, it is assumed the existence of a component of the unconscious of the nature involved in the origin of symptoms.
Disorders of this kind are divided into motor, sensory and dissociate dissociative disorders who have certain psychological symptoms.
Very often patients, without realizing it, begin to imitate the symptomatic manifestations which they observed in others. Thus, they draw Parallels between themselves and these people. Also common are cases when after his father died, the adult daughter may suffer
which clinical picture is similar to that observed in the father before he died.
Initial benefit is that through processes of dissociation and conversion, the patient may subconsciously prevent internal conflicts of a psychological nature, for example, when
from the memoirs of patient can appear the most pleasing to him.
Secondary or social benefit is that the results of the disease can become for the patient a clear advantage. They can prevent the difficult and mandatory everyday situations, as patients do much forgiven. They constantly receive support and adequate level of attention from others, you can manipulate it and apply it to achieve personal goals. Despite the fact that secondary benefits may be obvious, it may not be used for hundred percent accurate diagnosis.
In fact, the occurrence of such symptoms is not intentional and deliberate, but they are formed under the influence the patient himself is the disease. As already mentioned, patients often tend to make their symptoms of exaggerated importance, but the disease are the unconscious mechanisms of psychological nature. Patients suffering from this disorder may not be aware of their actions and not to control them. It is also clear that such disorders are the expression of an emotional conflict, they have a close relationship with stress and develop suddenly.
There is a lack of organic etiological factors. If in the present or the past, there were true violations, neurological or systemic diseases that affect the Central nervous system, disorder was present in 40% of patients. Conversive and dissociative symptoms is often very difficult to distinguish from neurological or somatic disorders, especially in those patients who are well informed about the clinical picture and course of such diseases. However, medical examination and inspection of the identified violations. It is important to remember and understand that the diagnosis can be established only in the absence of violations of physical and neurological characters or no explicit connection with these violations.
The clinical picture does not match the pattern of the disorder and similar disease. Manifestations of disorders do not correspond to the manifestations of these neurological disorders, reflecting naive patients relative to anatomical innervation. This discrepancy is extremely important in case you need further diagnosis.
In almost all cases, the biggest problems were caused by organic diseases of the CNS. For example, a clear weakness is seen in
can be mistaken for
. Signs and symptoms that do not correspond to anatomical structures or known mechanisms of pathophysiological nature, were likely to be due to a dissociative kind of disorder and not somatic diseases. That is, in all situations you need to conduct a thorough physical and neurological examination of the patient. The symptoms of such problems as dissociative identity disorder, which may disappear under the influence of hypnosis, of suggestion, or the introduction of certain drugs, most likely, also are psychogenic.
In the event of differential diagnosis of disorders need to implement the following features
- age manifestations of the disease generally, dissociative disorders are found in the age of 40 years
- symptoms – they are manifested under the action of stress. If this type of situation are not present, the diagnosis is questionable. But by themselves, stressful situations are not evidence of a dissociative disorder, as they often precede somatic diseases.
- the secondary benefits mentioned above. If it is absent, the diagnosis of disorders should be reconsidered.
When the objective of treatment of dissociative disorders in the first place, it is very important to eliminate the circumstances that might injure the patient or to minimize their impact. Often, a positive effect is achieved due to the change of environment. The main place in the treatment of such problems rests on the shoulders of psychotherapy, including the rational. The patient is very important to explain the fact that the cause is not illness, and psychological reasons, therefore, psychological therapy is recommended in this situation. Convincing regular conversations with patients to help to develop the right attitude to this issue and reasons which become the factors of its development.
Doctors advise to use psychoanalytic psychotherapy. In certain cases, have good effect of hypnosis and psychotherapy behavioral in nature. A very important condition of treatment is the study of the situation of the patient in social terms, which gives the ability to eliminate secondary gain of illness.
Drug therapy does not play a fundamental role in this situation, in addition to those cases, when such disorders appear secondary and are the result of a depressive illness. In the case of severe anxiety is shown taking tranquilizers and antidepressants.
Almost all patients on background treatment is evident improvement. In the absence of the results of therapy need to exclude the possibility of somatic disease. For the treatment of dissociative disorders are short and Directive psychotherapeutic methods. And the more time the patient remains in the role of the patient, the worse the effects of therapy.
The prognosis is generally favorable. In almost all cases, symptoms of short duration, they abruptly begin and end. Diseases that are long-recurring and is combined with a specific benefit, therapy may be hard. Dissociative amnesia, which is the sudden end of the disorder, rarely has relapses. Dissociative Fugue is a short-term disorder in which relapses are rare, the recovery appears quickly and unexpectedly. Dissociative identity disorder the most severe disorder of all, it is likely chronic. Patients who have dissociative identity disorder like derealization and depersonalization, may occur throughout life. Thus patients remain perfectly healthy in appearance, but may suffer from depressive States of nature.