Dissociative Disorders: The Daily PANCE Blueprint
A 32-year-old male with a history of trauma and abuse presents to your clinic explaining that he feels “off.” He says that he feels like is detached from himself and the world. He says it’s like he is an outside observer looking at his own life. It’s making it hard for him to work. Which of the following is the best initial management option for the most likely diagnosis?
A. Lithium
B. Talk therapy
C. Lamotrigine
D. Olanzapine
E. Exposure therapy
Answer and topic summary
The answer is B. Talk therapy
A dissociative disorder is a disorder characterized by disruption of normal integration of consciousness, memory, emotion, identity, perception, body representation, and behavior. It can include depersonalization, when one feels detached from self and/or derealization, when one is detached from the world. Most people have transient episodes of depersonalization/derealization, but when it starts to negatively impact a person’s life this is when it can be classified as a disorder per DSM V. Risk factors include childhood trauma, domestic violence, unexpected death in family/friend, stress, drug use, etc. Management is mainly talk therapy (either cognitive behavioral or psychodynamic therapy) and medications as needed (i.e. lamictal). Reassure the patient that they aren’t crazy and make sure they avoid exacerbating the dissociations with substance abuse. These patients have an extremely high suicide risk too (one of the highest out of ALL psychiatric disorders), so make sure to screen appropriately.
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Covered under ⇒ PANCE Blueprint Psychiatry ⇒
