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Монографии, изданные в издательстве Российской Академии Естествознания

Major depression

Most of us have experienced mild dissociation, which is like daydreaming or getting lost in the moment while working on a project. However, dissociative identity disorder is a severe form of dissociation, a mental process, which produces a lack of connection in a person’s thoughts, memories, feelings, actions, or sense of identity. Dissociative identity disorder is thought to stem from trauma experienced by the person with the disorder. The dissociative aspect is thought to be a coping mechanism – the person literally dissociates himself from a situation or experience that’s too violent, traumatic, or painful to assimilate with his conscious self.

What Are the Symptoms of Dissociative Identity Disorder?

Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person’s behavior. With dissociative identity disorder, there’s also an inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness. With dissociative identity disorder, there are also highly distinct memory variations, which fluctuate with the person’s split personality.

The “alters” or different identities have their own age, sex, or race. Each has his or her own postures, gestures, and distinct way of talking. Sometimes the alters are imaginary people; sometimes they are animals. As each personality reveals itself and controls the individuals’ behavior and thoughts, it’s called “switching”. Switching can take seconds to minutes to days. When under hypnosis, the person’s different “alters” or identities may be very responsive to the therapist’s requests.

Along with the dissociation and multiple or split personalities, people with dissociative disorders may experience any of the following symptoms:

- Depression

- Mood swings

- Suicidal tendencies

- Sleep disorders (insomnia, night terrors, and sleep walking)

- Anxiety, panic attacks, and phobias (flashbacks, reactions to stimuli or “triggers”)

- Alcohol and drug abuse

- Psychotic-like symptoms (including auditory and visual hallucinations)

- Eating disorders

Other symptoms of dissociative identity disorder may include headache, amnesia, trances, and “out of body experiences”. Some people with dissociative disorders have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed). As an example, someone with dissociative identity disorder may find themselves doing things they wouldn’t normally do such as speeding, reckless driving, or stealing money from their employer or friend, yet they feel they are being compelled to do it. Some describe this feeling as being a passenger in their body rather than the driver. In other words, they truly believe they have no choice.

What’s the Difference Between Dissociative Identity Disorder and Schizophrenia?

Schizophrenia and dissociative identity disorder are often confused, but they are very different.

Schizophrenia is a severe mental illness involving chronic (or recurrent) psychosis, characterized mainly by hearing or seeing things that aren’t real (hallucinations) and thinking or believing things with no basis in reality (delusions). People with schizophrenia do not have multiple personalities. Delusions are the most common psychotic symptom in schizophrenia; hallucinations, particularly hearing voices, are apparent in about half of people.

Suicide is a risk with both schizophrenia and dissociative identity disorder, although patients with multiple personalities have a history of suicide attempt more often than other psychiatric patients.

How Does Dissociation Change the Way a Person Experiences Life?

There are several main ways in which the psychological processes of dissociative identity disorder change the way a person experiences living, including the following:

- Depersonalization. This is a sense of being detached from one’s body and is often referred to as an “out-of-body” experience.

- Derealization. This is the feeling that the world is not real or looking foggy or far away.

- Amnesia. This is the failure to recall significant personal information that is so extensive it cannot be blamed on ordinary forgetfulness. There can also be micro-amnesias where the discussion engaged in is not remembered, or the content of a meaningful conversation is forgotten from one second
to the next.

- Identity confusion or identity alteration. Both of these involve a sense of confusion about who a person is. An example of identity confusion is when a person sometimes feels a thrill while engaged in an activity (such as reckless driving, DUI, alcohol or drug abuse) which at other times would be revolting. In addition to these apparent alterations, the person may experience distortions in time, place, and situation.

It is now acknowledged that these dissociated states are not fully-mature personalities, but rather they represent a disjointed sense of identity. With the amnesia typically associated with dissociative identity disorder, different identity states remember different aspects of autobiographical information. There is usually a host personality within the individual, who identifies with the person’s real name. The host personality is usually unaware of the presence of other personalities.

What Roles Do the Different Personalities Play?

The distinct personalities may serve diverse roles in helping the individual cope with life’s dilemmas. For instance, there’s an average of two to four personalities present when the patient is initially diagnosed. Then there’s an average of 13 to 15 personalities that can become known over the course of treatment. While unusual, there have been instances of dissociative identity disorder with more than 100 personalities. Environmental triggers or life events cause a sudden shift from one alter or personality to another.

Who Gets Dissociative Identity Disorder?

While the causes of dissociative identity disorder are still vague, research indicates that a combination of environmental and biological factors work together to cause it. As many as 98 to 99 % of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood (usually before age 9). Dissociation may also happen when there has been insistent neglect or emotional abuse, even when there has been no overt physical or sexual abuse. Findings show that in families where parents are frightening and unpredictable, the children may become dissociative.

How Is Dissociative Identity Disorder Diagnosed?

Making the diagnosis of dissociative identity disorder takes time. It’s estimated that individuals with dissociative disorders have spent seven years in the mental health system prior to accurate diagnosis. This is common, because the list of symptoms that cause a person with a dissociative disorder to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who have dissociative disorders also have secondary diagnoses of depression, anxiety, or panic disorders.

The DSM-IV provides the following criteria to diagnose dissociative identity disorder:

1. Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.

2. At least two of these identities or personality states recurrently take control of the person’s behavior.

3. The person has an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

4. The disturbance is not due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures).

What’s the Recommended Treatment Plan for Dissociative Identity Disorder?

While there’s no “cure” for dissociative identity disorder, long-term treatment is very successful, if the patient stays committed. Effective treatment includes talk therapy or psychotherapy, medications, hypnotherapy, and adjunctive therapies such as art or movement therapy.

Because often the symptoms of dissociative disorders occur with other disorders, such as anxiety and depression, dissociative disorder may be treated using the same drugs prescribed for those disorders. A person in treatment for a dissociative disorder might benefit from antidepressants or anti-anxiety medication.

Match the terms with their definitions

abuse

improper, incorrect, or excessive use; misuse; maltreatment of a person; injury

coping

The human behavioral process for dealing with demands, both internal and external, in situations that are perceived as threats.

Mood swing

An extreme or rapid change in mood

hallucination

the alleged perception of an object when no object is present, occurring under hypnosis, in some mental disorders, etc

split personality

a mental disorder in which an individual’s personality appears to have become separated into two or more distinct personalities, each with its own complex organization

delusion

a belief held in the face of evidence to the contrary, that is resistant to all reason

recurrent

happening or tending to happen again or repeatedly

amnesia

a defect in memory, esp one resulting from pathological cause, such as brain damage or hysteria

antidepressant

any of a class of drugs used to alleviate depression

thrill

an abnormal slight tremor associated with a heart or vascular murmur, felt on palpation

Say if these statements are true or false

true

false

Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person’s behavior.

Schizophrenia and dissociative identity disorder are similar

As many as 98 % to 99 % of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood

Nobody who has dissociative disorders also has secondary diagnoses of depression, anxiety, or panic disorders.

When under hypnosis, the person’s different “alters” or identities may be very responsive to the therapist’s requests.

Environmental triggers or life events cannot cause a sudden shift from one alter or personality to another.

People with schizophrenia do not have multiple personalities.

Build word partnerships

Suicide, panic, drug sleep, mood multiple, visual,

Attack, swings, terrors, personality, walking, hallucinations , attempt , abuse

Major depression

Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.

True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer.

Causes, incidence, and risk factors

The exact cause of depression is not known. Many researchers believe it is caused by chemical changes in the brain. This may be due to a problem with your genes, or triggered by certain stressful events. More likely, it’s a combination of both.

Some types of depression run in families. But depression can also occur if you have no family history of the illness. Anyone can develop depression, even kids.

The following may play a role in depression: Alcohol or drug abuse; Certain medical conditions, including underactive thyroid, cancer, or long-term pain; Certain medications such as steroids; Sleeping problems; Stressful life events, such as: Breaking up with a boyfriend or girlfriend; Failing a class; Death or illness of someone close to you; Divorce; Childhood abuse or neglect; Job loss; Social isolation (common in the elderly)

Symptoms

Depression can change or distort the way you see yourself, your life, and those around you.

People who have depression usually see everything with a more negative attitude. They cannot imagine that any problem or situation can be solved in a positive way.

Symptoms of depression can include: Agitation, restlessness, and irritability; Becoming withdrawn or isolated; Difficulty concentrating; Dramatic change in appetite, often with weight gain or loss; Fatigue and lack of energy; Feelings of hopelessness and helplessness; Feelings of worthlessness, self-hate, and guilt; Loss of interest or pleasure in activities that were once enjoyed; Thoughts of death or suicide; Trouble sleeping or too much sleeping; Depression can appear as anger and discouragement, rather than feelings of sadness.

If depression is very severe, there may also be psychotic symptoms, such as hallucinations and delusions.

Signs and tests

Your health care provider will ask questions about your medical history and symptoms. Your answers and certain questionnaires can help your doctor diagnose depression and determine how severe it may be.

Blood and urine tests may be done to rule out other medical conditions with symptoms similar to depression.

Treatment

In general, treatments for depression include: Medications called antidepressants; Talk therapy, called psychotherapy

If you have mild depression, you may only need one of these treatments. People with more severe depression usually need a combination of both treatments. It takes time to feel better, but there are usually day-to-day improvements.

If you are suicidal or extremely depressed and cannot function you may need to be treated in a psychiatric hospital.

MEDICATIONS FOR DEPRESSION

Drugs used to treat depression are called antidepressants. Common types of antidepressants include:

- Selective serotonin re-uptake inhibitors (SSRIs), including fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro).

- Serotonin norepinephrine reuptake inhibitors (SNRIs), including desvenlafaxine (Pristiq), venlafaxine (Effexor), and duloxetine (Cymbalta).

Other medicines used to treat depression include: Tricyclic antidepressants; Bupropion (Wellbutrin); Monoamine oxidase inhibitors

If you have delusions or hallucinations, your doctor may prescribe additional medications.

WARNING: Children, adolescents, and young adults should be watched more closely for suicidal behavior, especially during the first few months after starting medications.

If you do not feel better with antidepressants and talk therapy, you may have treatment-resistant depression. Your doctor will often prescribe higher (but still safe) doses of an antidepressant, or a combination of medications. Lithium (or other mood stabilizers) and thyroid hormone supplements also may be added to help the antidepressants work better.

St. John’s wort is an herb sold without a prescription. It may help some people with mild depression. However, it can change the way other medicines work in your body, including.

CHANGES IN MEDICATIONS

Sometimes, medications that you take for another health problem can cause or worsen depression. Talk to your doctor about all the medicines you take. Your doctor may recommend changing your dose or switching to another drug. Never stop taking your medications without first talking to your doctor.

TALK THERAPY

Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them.

Types of talk therapy include:

- Cognitive behavioral therapy teaches you how to fight off negative thoughts. You will learn how to become more aware of your symptoms and how to spot things that make your depression worse. You’ll also be taught problem-solving skills.

- Psychotherapy can help you understand the issues that may be behind your thoughts and feelings.

- Joining a support group of people who are sharing problems like yours can also help. Ask your therapist or doctor for a recommendation.

OTHER TREATMENTS FOR DEPRESSION

- Electroconvulsive therapy (ECT) is the single most effective treatment for severe depression and it is generally safe. ECT may improve mood in people with severe depression or suicidal thoughts who don’t get better with other treatments. It may also help treat depression in those who have psychotic symptoms.

- Transcranial magnetic stimulation (TMS) uses pulses of energy to stimulate nerve cells in the brain that are believed to affect mood. There is some research to suggest that it can help relieve depression.

- Light therapy may relieve depression symptoms in the winter time. However, it is usually not considered a first-line treatment.

Support Groups

You can often ease the stress of illness by joining a support group whose members share common experiences and problems.

Expectations (prognosis)

Some people with major depression may feel better after taking antidepressants for a few weeks. However, many people need to take the medicine for 4–9 months to fully feel better and prevent the depression from returning.

People who have repeated episodes of depression may need quick and ongoing treatment to prevent more severe, long-term depression. Sometimes people will need to stay on medications for long periods of time.

Complications

People who are depressed are more likely to use alcohol or illegal substances.

Complications of depression also include: Increased risk of health problems; Suicide

Prevention

Do not drink alcohol or use illegal drugs. These substances can make depression worse and might lead to thoughts of suicide.

Take your medication exactly as your doctor instructed. Ask your doctor about the possible side effects and what you should do if you have any. Learn to recognize the early signs that your depression is getting worse.

The following tips might help you feel better: Get more exercise; Maintain good sleep habits; Seek out activities that bring you pleasure; Volunteer or get involved in group activities; Talk to someone you trust about how you are feeling; Try to be around people who are caring and positive

Match the terms with their definitions

Blue

melancholy state of mind; depression

Down in the dumps

depressed, moody, or unhappy

Depression

a mental disorder characterized by extreme gloom, feelings of inadequacy, and inability to concentrate

Trigger

to give rise (to); set off

Mood

a temporary state of mind or temper

Frustration

the prevention or hindering of a potentially satisfying activity

irritability

an excessive response to stimuli. It may be demonstrated in behavioral responses to both physiological and behavioral stimuli including environmental, situational, sociological, and emotional stimuli.

guilt

the fact or state of having done wrong or committed an offence

discouragement

a feeling of having lost hope or confidence 

Talk therapy

an alternate name for the various forms of psychotherapy that emphasize the importance of the client or patient speaking to the therapist as the main means of expressing and resolving issues

Match the beginning and the end of the phrase

Talk therapy is counseling to talk about your feelings and thoughts,

that may be behind your thoughts and feelings

Cognitive behavioral therapy teaches you

how to fight off negative thoughts

Never stop taking your medications

without first talking to your doctor

Sometimes, medications that you take for another health problem

can cause or worsen depression

Electroconvulsive therapy may also help treat depression in those

who have psychotic symptoms.

Psychotherapy can help you understand the issues

and help you learn how to deal with them

Blood and urine tests may be done

to rule out other medical conditions with symptoms similar to depression

People with more severe depression usually

need a combination of both treatments

Fill in the table

Risk factors

symptoms

prevention

Fatigue and lack of energy (2); Alcohol or drug abuse (1); Feelings of worthlessness (2); Feelings of hopelessness (2); Sleeping problems (1); Social isolation (1); Certain medications (1); Maintain good sleep habits (3); Irritability (2); Becoming withdrawn (2); Dramatic change in appetite (2); Get more exercise (3); Difficulty concentrating (2);


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