BHS 499-07 Memory and Amnesia - PowerPoint PPT Presentation

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BHS 499-07 Memory and Amnesia

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BHS 499-07 Memory and Amnesia Functional Disorders of Memory Functional Disorders (Hysteria) Functional disorders are not disorders of structure but of function. – PowerPoint PPT presentation

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Title: BHS 499-07 Memory and Amnesia


1
BHS 499-07 Memory and Amnesia
  • Functional Disorders of Memory

2
Functional Disorders (Hysteria)
  • Functional disorders are not disorders of
    structure but of function.
  • Such disorders are classified as hysteria by the
    DSM (Diagnostic Statistical Manual).
  • They were the only disorders retaining a
    psychological explanation etiology, rather than
    being defined by symptoms.

3
Sources of Symptoms (Psychodynamic View)
  • Strangulated affect is converted into physical
    symptoms by the repressed memory called
    conversion symptoms.
  • Symptoms disappear if the repressed emotion
    associated with an event is released called
    abreaction.
  • Therapy is needed to overcome resistance to
    remembering and thereby relive the trauma.

4
History of Hysteria
  • In the mid-1800s hysteria was considered either
  • Irritation of the female sexual organs (floating
    womb)
  • Imaginary, play-acting by women
  • Charcot rejected both explanations, calling it a
    neurosis also shown by men.
  • Charcot thought it required hereditary brain
    degeneration.

5
Charcot shows colleagues a female hysteria
patient at Salpetriere Hospital (Paris). Freud
studied with Charcot in 1885.
6
History (Cont.)
  • Symptoms included
  • Paralysis
  • Convulsions, contractures (muscles wont relax),
    seizures arc de cercle (arching back in rigid
    posture)
  • Somnambulism (sleepwalking)
  • Hallucinations
  • loss of speech, sensation or memory
  • Charcot recognized parallels between hysteria and
    hypnosis and found he could remove symptoms using
    hypnosis.

7
Janets View of Hysteria
  • Symptoms arose from subconscious beliefs isolated
    and forgotten, thus disassociated from
    consciousness.
  • Memory pools are normally disconnected but become
    connected through mental effort.
  • Traumatic shock disrupts the mental effort needed
    to associate memory pools.

8
Janet (Cont.)
  • Memory pools may be associated with fixed ideas
    that motivate repeated actions.
  • These are seen in fugue states or sleepwalking or
    the emotions seen in multiple personality
    disorders alternative selves.

9
Freuds View of Hysteria
  • Freud studied with Charcot and later wrote
    Studies in Hysteria with Breuer, based on the
    case study of Anna O.
  • He thought hysterics suffer mainly from
    reminiscences
  • Traumatic memories are pathogenic
    (disease-creating)
  • Banishment of memories requires repression
  • Affect is damned up or strangled.

10
Freuds Seduction Theory
  • Repressed memories nearly always revealed
    seduction or sexual molestation by an adult.
  • The patient doesnt know what is repressed so the
    therapist must overcome resistance to uncover it.
  • Later, Freud decided that fantasies, impulses and
    wishes caused repression.

11
Classifications of Hysteria
  • Dissociative disorders
  • Posttraumatic stress disorder (PTSD)
  • Somatoform disorders
  • Sleep disorders

12
Dissociative Disorders
  • Disruption of the usually integrated functions of
    memory, consciousness, identity or perception of
    the environment.
  • These include
  • Dissociative amnesia
  • Dissociative fugue
  • Dissociative identity disorder (DID, also MPD)
  • Depersonalization disorder

13
Dissociative Amnesia
  • Impairment is reversible and usually reported
    retrospectively (in past tense).
  • Types of disturbance
  • Localized affects a few hours around a
    traumatic event.
  • Selective affects some but not all events
    during a period of time, or some categories.
  • Generalized affects entire past.
  • Continuous a specific time up to the present

14
Dissociative Fugue
  • Sudden, unexpected travel away from ones home or
    workplace with inability to recall the past.
  • The person may assume a new identity or be
    confused about his or her identity.
  • Wandering may be motivated by a fixed idea
    (repetition compulsion).
  • Return to pre-fugue state brings amnesia

15
Dissociative Identity Disorder (DID)
  • Also called multiple personality disorder (MPD).
  • Presence of two or more distinct identities or
    personality states with memory loss across
    states.
  • Failure to integrate identity, memory and
    personality.
  • Primary personality is passive, guilty,
    dependent, depressed. Alternates may be hostile,
    aggressive, controlling.

16
DID (Cont.)
  • Frequent gaps in memory.
  • Amnesia may be asymmetrical
  • Passive identities have more constricted
    memories.
  • Active or protector identities have more complete
    memories.
  • Transitions triggered by stress.
  • May result from sexual abuse, results in a
    pattern of disruptive behavior in childhood
    continuing into adulthood.

17
Depersonalization Disorder
  • A feeling of detachment or estrangement from
    ones self.
  • A person may feel like an observer of their own
    mental processes or body.
  • Includes sensory anesthesia, lack of affect, a
    feeling of lack of control of ones actions.
  • Voluntarily induced in religious and trance
    experiences.

18
An Identity View of Dissociation
  • One function of consciousness is to construct a
    mind-space that includes
  • Space and time
  • Abstractions of meaning (gist) and making sense
    of what happens
  • A self, an imagined or idealized self,
    self-monitoring
  • Narratization (autobiography, hierarchical
    organization of life events).

19
Cultural Examples of Dissociation
  • All cultures have some kind of spirit possession
  • Amok syndrome
  • Historical examples of demonic possession
  • Current religious and spiritual possession
  • Amnesia is often associated with such possessions.

20
Social Construction of Dissociative States
  • Spanos considers possession to be a social
    construct
  • Society provides special status and historical
    factors affect its manifestation.
  • The possessed role is learned.
  • There are benefits to performing the possessed
    role and it is frequently acted by the powerless.
  • DID may be a socially constructed role.

21
Physiological Theories of Dissociation
  • Only a tiny percentage of individuals exposed to
    stressors or trauma show dissociative symptoms.
  • True cases of DID can be distinguished from
    socially constructed cases through childhood
    behavior.
  • True cases of DID, fugue or other amnesias
    usually show histories of early childhood brain
    injury or recent damage.

22
Repetition-Compulsion
  • PTSD is caused by close-calls rather than injury.
  • Repetition occurs in the form of intrusive
    memory.
  • Normally anxiety protects us from fright but with
    an unexpected shock there is no chance for
    anxiety.
  • Repetition creates retrospective anxiety which
    builds defenses after the event.

23
PTSD (Cont.)
  • Avoidance of reminders of the event can include
    amnesia for some aspect of the event.
  • Reexperiencing includes dreams and intrusive
    recollections.
  • Dreams and recollections are not factual but
    recreations of idealized or feared features of an
    event.
  • Content changes during therapy.

24
Somatoform Disorders
  • Unintentional symptoms of a medical disorder
    without a medical cause
  • Somatization disorder multiple symptoms
    (formerly just called hysteria)
  • Conversion disorder voluntary motor or sensory
    dysfunction with psychological cause.
  • Hypochondriasis fear of illness.
  • Pain disorder pain whose onset, severity and
    maintenance have a psychological cause.

25
Conversion Disorder
  • Pseudoneurological related to voluntary motor
    or sensory function.
  • Symptoms include impaired coordination or
    balance, paralysis, weakness, difficulty
    swallowing or lump in throat, double vision,
    blindness or deafness, seizures.
  • The more medically naïve the person, the more
    implausible the symptoms.

26
Conversion Disorder (Cont.)
  • The symptom represents a symbolic resolution of
    an unconscious conflict.
  • Primary gain is keeping the conflict out of
    awareness.
  • Secondary gain is external benefits and relief
    from responsibilities.
  • Neurological conditions such as MS can be
    misdiagnosed as conversion disorder.

27
Sleep Disorders
  • Dyssomnias sleep problems.
  • Parasomnias abnormal behavior associated with
    sleep.
  • Nightmares and sleep terrors nightmares are not
    memories, sleep terrors usually cannot be
    remembered.
  • Hypnagogic hallucinations occur at sleep onset,
    vivid, accompanied by wakefulness.

28
Sleepwalking Disorder (Somnambulism)
  • Repeated episodes of complex motor behavior
    initiated during sleep, with limited recall upon
    waking.
  • Difficulty being awakened, with confusion upon
    awakening.
  • As with fugue, the person may attempt to carry
    out a fixed idea.
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