Tag Archives: Sexual abuse

Comparing and Contrasting Dissociative Identity Disorder (DID, Multiple Personality Disorder) with Conversion Disorder (CD)

Dissociative Identity Disorder and Conversion Disorder are similar in that they both stem from stressful events.  In Dissociative Identity Disorder a personality is formed when extreme child abuse or sexual abuse is experienced.  With Conversion Disorder it is a more recent event like a rape or physical or emotional abuse. Other than this similarity the two disorders are quite different.

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Dissociative Identity Disorder is a disorder in which the person affected suffers from as little as 2 distinct personalities and can suffer from as many as 100 or more.  Each personality has a very distinct identity, and will often take control of the person and how they act.  Because of the different identities taking over the people lose time.  They don’t remember the period of time that they were not in control and then have a hard time understanding why everything is different, especially in extreme cases when the other identity takes over for years at a time.  Usually an alternate identity takes over when the primary identity experiences something overly stressful.  It is common for people with this disorder to have other disorders or to have problems with substance abuse.  While DID has been known to last a lifetime, treatment can help.  Treatment usually involves psychotherapy and helps the person to integrate the identities into one.  It can be a painful process as well as time consuming, but according to people who have been able to achieve integration, it is definitely worth it.

Alternatively Conversion Disorder affects people in their sensory areas or physically where voluntary movement is concerned.  It is known to be a somatoform disorder and is said to be a large part of why people visit their primary care physicians.  Basically when people shove their emotions and stress too far inward they turn into physical symptoms.  This is called converting.  The conversion of these symptoms can cause a patient to contact their caregiver nine times as often.  The patient does not control the symptoms and can have a surprisingly painful beginning, and diagnosis can become complicated by a true physical illness.

Conversion Disorder has specific risk factors which include the fact that someone is female, men are less likely to receive this diagnosis.  This diagnosis is more common in the teen years, if there is someone in the family who is already receiving treatment for Conversion Disorder, it is likely to continue in the family line.

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Substance Abuse: Etiological Considerations

Historically speaking, I was intrigued by the suggestion that discovery of the New World opened up new vistas of experience alteration.  (Blaney & Millon, 2009, p. 254)  I was surprised that caffeine (specifically, coffee) was not addressed in more detail.  Overall, the historical precedent is clear… substance use and abuse has been prevalent for most of recorded human history.

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I would not have considered alcoholism to be under-diagnosed until reading this chapter.  I knew the efficacy of treatment was modest, but the distinct absence of evidence-based practices was rather disturbing.  I was under the impression that we were more knowledgeable regarding the etiological foundation of substance abuse.  Although it is difficult to refute, I am starting to equate words like multifactor, interactional, and interdependent as “we don’t really know.”

“Drug abuse begins with drug use, and one can neither try nor abuse that which is unavailable or unaffordable.”  (Blaney & Millon, 2009, p. 255)  Consumption is inexorably tied to availability.  Despite that admonition, societal control is easier said than done.

The statement “economic success stories (hence models for youths) are often individuals engaged in illegal activities, including the selling of drugs” is both true and unfortunate.  (Blaney & Millon, 2009, p. 256)  The media increasingly glamorizes the use, abuse, and sale of drugs.  While teaching in the public school system, I once made the statement “who’s a kid going to listen to, me (24k a year) or Notorious BIG (24k a day).”  “The current mass marketing of prescription, over-the-counter, and social libations all promote the theme that drugs solve problems and improve quality of life.”  (Blaney & Millon, 2009, p. 257)  I couldn’t have said it better myself.

I have issues with the gateway model whereby use and abuse of drugs is seen sequentially.  “Cigarettes, alcohol, marijuana, stimulants, depressants, hallucinogens, cocaine, and heroin are seen hierarchically.”  (Blaney & Millon, 2009, p. 258)  Without, peer groups play a major role in the introduction of substances into people’s lives… however; those same peers can have a reinforcing effect when it comes to the negative consequences of progression.  I think eventually everyone reaches a threshold of risk they are willing to assume when it comes to mind altering substances… everyone just has a different threshold or process of risk assessment.

Sexual abuse rears its ugly head, again.  “In any treatment population of alcoholic women, the rates of a history of sexual abuse range from 24% to 85%.”  (Blaney & Millon, 2009, p. 260)  By now it is self evident that if we could limit exposure to that single environmental factor we could have a tremendous impact on the mental health status of society as a whole.

The concept of assortative mating, or the tendency for alcoholics to marry alcoholics, is an interesting concept.  Perhaps we could conclude that “social drugs” like alcohol (and to a lesser extent, cigarettes) are going to continue to be serious social issues that continue to plague an increasingly distinct segment of the total population.

The biochemical level seems to be the most logical and most effective way to determine etiological foundations of substance abuse.  Dopamine, Serotonin, GABA, glutamate, opioid, cannaboid, and nicotine systems are all implicated in the development of recurrent substance abuse.  Differential dopamine release, for example, represents a “positive reinforcing situation” which may explain the increased risk of abuse.  (Blaney & Millon, 2009, p. 265)

“The decline in marijuana and cocaine use in the United States during the 1980s resulted from an increased perception of danger.”  (Blaney & Millon, 2009, p. 268)  There has to be a more effective way to combat drug use than with general educational drug prevention programs?

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Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.