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The relationship between this dissociative response and the degree and nature of the dissociation seen in dissociative disorders is not yet adequately understood breast cancer ultrasound imaging cheap provera online. For example women's health clinic london ontario king street purchase provera online, Putnam (1989) described them as "highly discrete states of consciousness organized around a prevailing affect, sense of self (including body image), with a limited repertoire of behaviors and a set of state dependent memories" (p. It functions both as a recipient, processor, and storage center for perceptions, experiences, and the processing of such in connection with past events and thoughts, and/or present and anticipated ones as well. It has a sense of its own identity and ideation, and a capacity for initiating thought processes and action. These include personality, personality state, self-state, disaggregate self-state, alter, alter personality, alternate identity, part, part of the mind, part of the self, dissociative part of the personality, and entity, among others (see Van der Hart & Dorahy, 2009). Patients commonly refer to themselves as having parts, parts inside, aspects, facets, ways of being, voices, multiples, selves, ages of me, people, persons, individuals, spirits, demons, others, and so on. These include differences in visual acuity, medication responses, allergies, plasma glucose levels in diabetic patients, heart rate, blood pressure readings, galvanic skin response, muscle tension, laterality, immune function, electroencephalography and evoked potential patterns, functional magnetic resonance imaging activation, and brain activation and regional blood flow using single photon emission computed tomography and positron emission tomography among others (Loewenstein & Putnam, 2004; Putnam, 1984, 1991b; Reinders et al. These differences involved subjective sensorimotor and emotional reactions, psychophysiological reactions such as pulse and blood pressure, as well as patterns of regional cerebral blood flow measured with positron emission tomography. These psychobiological differences were not found for the two different types of alternate identities as each identity in turn listened to a neutral, nontraumatic, autobiographical memory script. Briefly, many experts propose a developmental model and hypothesize that alternate identities result from the inability of many traumatized children to develop a unified sense of self that is maintained across various behavioral states, particularly if the traumatic exposure first occurs before the age of 5. These difficulties often occur in the context of relational or attachment disruption that may precede and set the stage for abuse and the development of dissociative coping (Barach, 1991; Liotti, 1992, 1999). Fragmentation and encapsulation of traumatic experiences may serve to protect relationships with important (though inadequate or abusive) caregivers and allow for more normal maturation in other developmental areas, such as intellectual, interpersonal, and artistic endeavors. Severe and prolonged traumatic experiences can lead to the development of discrete, personified behavioral states. Secondary structuring of these discrete behavioral states occurs over time through a variety of developmental and symbolic mechanisms, resulting in the characteristics of the specific alternate identities. The identities may develop in number, complexity, and sense of separateness as the child proceeds through latency, adolescence, and adulthood (R. The secondary structuring of the alternate identities may differ widely from patient to patient. Instead, they focus on the cognitive, affective, and psychodynamic characteristics embodied by each identity while simultaneously attending to identities collectively as a system of representation, symbolization, and meaning. This theory suggests that dissociation results from a basic failure to integrate systems of ideas and functions of the personality. Following exposure to potentially traumatizing events, the personality as a whole system can become divided into an "apparently normal part of the personality" dedicated to daily functioning and an "emotional part of the personality" dedicated to defense. Defense in this context is related to psychobiological functions of survival in response to life threat, such as fight/flight, not to the psychodynamic notion of defense. It is hypothesized that chronic traumatization and/or neglect can lead to secondary structural dissociation and the emergence of additional emotional parts of the personality. Assessment for dissociation should be conducted as a part of every diagnostic interview, given the fact that dissociative disorders are at least as common, if not more common, than many other psychiatric disorders that are routinely considered in psychiatric evaluations. At a minimum, the patient should be asked about episodes of amnesia, fugue, depersonalization, derealization, identity confusion, and identity alteration (Steinberg, 1995). Additional useful areas of inquiry include questions about spontaneous age regressions; autohypnotic experiences; hearing voices (Putnam, 1991a); passive-influence symptoms such as "made" thoughts, emotions, or behaviors. Kluft, 1987a); and somatoform dissociative symptoms such as bodily sensations related to strong emotions and past trauma (Nijenhuis, 1999). Clinicians should also be alert to behavioral manifestations of dissociation, such as posture, presentation of self, dress, fixed gaze, eye fluttering, fluctuations in style of speech, interpersonal relatedness, skill level, and sophistication of cognition (Armstrong, 1991, 2002; Loewenstein, 1991a). Traumatized patients may be very reluctant to reveal an inner, hidden world to a clinician who may be seen as such a figure (Brand, Armstrong, & Loewenstein, 2006). In short, many dissociative patients are understandably reluctant or unable to acknowledge and reveal their inner experiences. Unless clinicians take the time to develop a collaborative relationship based on increased levels of trust, the data from diagnostic interviews and self-report measures are unlikely to yield valid, useful information (Armstrong, 1991; Brand, Armstrong, et al.
Syndromes
- The person begins to rub or scratch the itchy area. Constant scratching causes the skin to thicken.
- Cortisol
- Kidney tumor
- Nezelof syndrome
- Chronic pulmonary coccidioidomycosis
- Heart defects (electrocardiographic conduction)
- Exposure to a higher altitude
- Birth defect of the brain
- Weight gain or loss
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