dissociative disorders DSM-5-TR NIMH clinical overview

"Dissociative Disorders"[MeSH Terms]

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https://www.psychiatry.org/patients-families/dissociative-di…

clinical infographic diagram dissociation depersonalization derealization trauma mental health

mkdir -p "/tmp/workspace/dissociative-disorders-ppt/src" "/tmp/workspace/dissociative-disorders-ppt/output" && python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/dissociative-disorders-ppt/src/create_deck.py') p.write_text(r''' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.text import MSO_AUTO_SIZE OUT='/tmp/workspace/dissociative-disorders-ppt/output/Dissociative_Disorders.pptx' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(21,42,68); TEAL=RGBColor(28,133,139); MINT=RGBColor(220,242,239) SKY=RGBColor(231,242,249); GOLD=RGBColor(238,181,83); CORAL=RGBColor(216,106,92) INK=RGBColor(35,48,62); MUTED=RGBColor(92,108,122); WHITE=RGBColor(255,255,255); PALE=RGBColor(247,250,252); LINE=RGBColor(207,218,227) def rect(s,x,y,w,h,color,rad=False,line=None): sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if rad else MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h)) sh.fill.solid(); sh.fill.fore_color.rgb=color sh.line.color.rgb = line or color if rad: sh.adjustments[0]=0.12 return sh def text(s,txt,x,y,w,h,size=20,color=INK,bold=False,align=PP_ALIGN.LEFT,font='Aptos',val=MSO_ANCHOR.TOP): tb=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=tb.text_frame tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Pt(0); tf.margin_top=tf.margin_bottom=Pt(0); tf.vertical_anchor=val p=tf.paragraphs[0]; p.alignment=align r=p.add_run(); r.text=txt; r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return tb def bullet(s,items,x,y,w,h,size=18,color=INK,accent=TEAL,spacing=8): tb=s.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); tf=tb.text_frame; tf.clear(); tf.word_wrap=True tf.margin_left=Pt(4);tf.margin_right=Pt(2);tf.margin_top=Pt(2);tf.margin_bottom=Pt(2) for i,item in enumerate(items): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=item; p.font.name='Aptos'; p.font.size=Pt(size);p.font.color.rgb=color;p.level=0 p.space_after=Pt(spacing); p.bullet=True return tb def header(s,title,kicker,number): rect(s,0,0,13.333,0.21,TEAL) text(s,kicker.upper(),0.65,0.43,8.7,0.28,10,TEAL,True) text(s,title,0.65,0.72,11.6,0.55,27,NAVY,True) text(s,f'{number:02d}',12.05,0.48,0.6,0.35,12,TEAL,True,align=PP_ALIGN.RIGHT) def footer(s,source='Educational summary | Not a substitute for clinical assessment'): rect(s,0.65,7.08,12.03,0.01,LINE) text(s,source,0.65,7.16,10.8,0.18,8,MUTED) def label(s,txt,x,y,w,color=TEAL): rect(s,x,y,w,0.34,color,True) text(s,txt,x,y+0.055,w,0.18,9,WHITE,True,align=PP_ALIGN.CENTER) def arrow(s,x1,y1,x2,y2,color=TEAL): ln=s.shapes.add_connector(1, Inches(x1), Inches(y1), Inches(x2), Inches(y2)); ln.line.color.rgb=color; ln.line.width=Pt(2); ln.line.end_arrowhead=True # 1 cover s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY); rect(s,8.9,0,4.433,7.5,TEAL) # stylised fragmented portrait for x,y,w,h,c in [(9.55,1.1,2.15,2.15,MINT),(10.05,3.0,2.25,1.25,SKY),(9.35,4.5,1.35,1.35,GOLD),(11.2,4.7,1.1,1.1,CORAL)]: rect(s,x,y,w,h,c,True) text(s,'DISSOCIATIVE\nDISORDERS',0.8,1.45,7.7,1.6,36,WHITE,True) text(s,'Clinical overview: recognition, assessment and care',0.83,3.35,6.4,0.4,18,RGBColor(210,230,239)) rect(s,0.83,4.2,2.55,0.43,TEAL,True); text(s,'PSYCHIATRY',0.83,4.29,2.55,0.18,10,WHITE,True,align=PP_ALIGN.CENTER) text(s,'Prepared for teaching and discussion',0.83,6.75,5.4,0.25,11,RGBColor(190,211,223)) # 2 definition s=prs.slides.add_slide(blank); header(s,'What is dissociation?','Core concept',2) rect(s,0.65,1.55,5.7,4.9,PALE,True,LINE); label(s,'WORKING DEFINITION',0.95,1.85,1.9) text(s,'A disruption in the usual integration of:',0.95,2.45,4.9,0.35,20,NAVY,True) bullet(s,['consciousness and attention','memory and identity','emotion, perception and behaviour','body experience and sense of self'],1.0,3.0,4.85,2.55,19) rect(s,6.75,1.55,5.9,4.9,SKY,True,LINE); text(s,'Clinical spectrum',7.05,1.88,3.2,0.35,21,NAVY,True) for i,(a,b,c) in enumerate([('Everyday','absorption / “zoning out”',MINT),('Symptoms','detachment, unreality, memory gaps',GOLD),('Disorder','distress or impaired functioning',CORAL)]): yy=2.6+i*1.05; rect(s,7.05,yy,1.55,0.64,c,True); text(s,a,7.18,yy+0.17,1.28,0.22,12,INK,True,align=PP_ALIGN.CENTER); text(s,b,8.9,yy+0.14,3.15,0.3,16,INK) footer(s,'American Psychiatric Association, patient overview, reviewed Oct 2024') # 3 classification s=prs.slides.add_slide(blank); header(s,'DSM-5-TR dissociative disorders','Classification',3) text(s,'Three principal diagnoses',0.65,1.45,4.2,0.35,20,MUTED) items=[('Dissociative identity disorder','Identity disruption plus recurrent memory gaps',TEAL),('Dissociative amnesia','Inability to recall important autobiographical information',GOLD),('Depersonalization / derealization disorder','Persistent or recurrent detachment from self and/or surroundings',CORAL)] for i,(t,d,c) in enumerate(items): y=2.0+i*1.34; rect(s,0.72,y,11.95,1.02,WHITE,True,LINE); rect(s,0.72,y,0.16,1.02,c); text(s,t,1.15,y+0.18,5.2,0.25,18,NAVY,True); text(s,d,6.05,y+0.2,5.85,0.42,15,MUTED) text(s,'Other specified and unspecified dissociative disorders may be used when presentations are clinically significant but do not fully meet criteria.',0.85,6.25,11.25,0.38,14,MUTED) footer(s,'DSM-5-TR categories summarized from APA patient information') # 4 types s=prs.slides.add_slide(blank); header(s,'Key clinical presentations','Recognize the pattern',4) cols=[(0.65,'DID',TEAL,['Discontinuity in sense of self or agency','Recurrent gaps in recall of everyday or autobiographical events','Symptoms cause distress or impairment']), (4.55,'AMNESIA',GOLD,['Usually trauma-related autobiographical memory loss','May be localized, selective or generalized','Dissociative fugue can occur as a specifier']), (8.45,'DP/DR',CORAL,['Depersonalization: detached from body or mental processes','Derealization: surroundings feel unreal or dreamlike','Reality testing remains intact'])] for x,t,c,pts in cols: rect(s,x,1.75,3.55,4.75,PALE,True,LINE); rect(s,x,1.75,3.55,0.65,c,True); text(s,t,x+.22,1.96,3.1,.25,18,WHITE,True,align=PP_ALIGN.CENTER); bullet(s,pts,x+.25,2.65,3.02,3.25,16,INK,c,10) footer(s,'Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, Dissociative Disorders chapter') # 5 clinical features s=prs.slides.add_slide(blank); header(s,'Symptoms and clues in practice','Clinical recognition',5) left=['Memory gaps beyond ordinary forgetting','Feeling detached from body, thoughts or emotions','Experiences of unreality in surroundings','Identity confusion or marked shifts in self-experience','Trance-like states or internal voices'] rect(s,.65,1.55,5.8,4.95,PALE,True,LINE); text(s,'Reported experiences',.98,1.9,3.5,.3,21,NAVY,True); bullet(s,left,.96,2.45,5.0,3.5,17) rect(s,6.85,1.55,5.8,4.95,SKY,True,LINE); text(s,'Important clinical notes',7.18,1.9,4.2,.3,21,NAVY,True) bullet(s,['Presentations may be subtle, not dramatic.','Symptoms commonly coexist with trauma-related symptoms, anxiety, depression or substance use.','Ask respectfully, without leading questions.','Assess current safety, self-harm and functional impact.'],7.15,2.45,4.98,3.5,17) footer(s,'Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, pp. 5748-5749') #6 etiology model s=prs.slides.add_slide(blank); header(s,'How might symptoms develop?','Biopsychosocial formulation',6) text(s,'Association does not equal inevitability: use an individualized, culturally informed formulation.',.65,1.4,11.5,.3,15,MUTED,False) parts=[('Predisposing','developmental adversity, temperament, attachment difficulties',MINT),('Precipitating','acute stress, reminders, interpersonal conflict',SKY),('Perpetuating','avoidance, sleep disruption, comorbidity, unsafe environment',RGBColor(255,243,219)),('Protective','safety, supportive relationships, coping skills, treatment access',RGBColor(235,244,230))] for i,(t,d,c) in enumerate(parts): x=.75+i*3.15; rect(s,x,2.2,2.6,2.75,c,True,LINE); text(s,t,x+.2,2.55,2.2,.28,18,NAVY,True,align=PP_ALIGN.CENTER); text(s,d,x+.25,3.15,2.1,1.1,14,INK,align=PP_ALIGN.CENTER) if i<3: arrow(s,x+2.65,3.58,x+3.06,3.58,TEAL) rect(s,2.25,5.5,8.8,.55,NAVY,True); text(s,'Goal: understand symptoms in context, while avoiding assumptions about trauma history.',2.5,5.67,8.3,.2,14,WHITE,False,align=PP_ALIGN.CENTER) footer(s,'APA patient overview; Kaplan & Sadock’s Comprehensive Textbook of Psychiatry') #7 assessment s=prs.slides.add_slide(blank); header(s,'Assessment: a safe, structured approach','Diagnosis',7) steps=[('1','Engage','Validate distress. Establish privacy, consent and immediate safety.'),('2','Clarify','Onset, triggers, memory gaps, self-experience, functioning.'),('3','Screen','Trauma symptoms, mood, anxiety, substance use, sleep and self-harm.'),('4','Rule out','Neurologic conditions, seizures, delirium, substances, psychosis and malingering/factitious presentations.'),('5','Formulate','Use DSM-5-TR criteria, cultural context and longitudinal information.')] for i,(n,t,d) in enumerate(steps): y=1.55+i*0.98; rect(s,.9,y,.55,.55,TEAL,True); text(s,n,.9,y+.13,.55,.2,13,WHITE,True,align=PP_ALIGN.CENTER); text(s,t,1.7,y+.05,1.1,.25,17,NAVY,True); text(s,d,2.85,y+.06,8.95,.36,15,INK) footer(s,'Clinical diagnosis requires a qualified mental-health professional') #8 differentials s=prs.slides.add_slide(blank); header(s,'Differential diagnosis','Do not anchor too early',8) headers=['Condition','Features that help distinguish'] rect(s,.7,1.6,11.95,.58,NAVY,True); text(s,headers[0],.95,1.77,3.2,.2,15,WHITE,True); text(s,headers[1],4.05,1.77,7.8,.2,15,WHITE,True) rows=[('PTSD / acute stress','Intrusions, avoidance and hyperarousal may coexist with dissociation.'),('Psychotic disorders','Evaluate reality testing, thought disorder and external versus internal voice experiences.'),('Neurologic conditions','Consider seizure disorders, head injury, delirium and other causes of altered cognition.'),('Substance-related states','Timing with intoxication, withdrawal or medication effects is informative.'),('Malingering / factitious disorder','Look for inconsistency, context and incentives; avoid accusatory assumptions.')] for i,(a,b) in enumerate(rows): y=2.2+i*.78; rect(s,.7,y,11.95,.75,PALE if i%2==0 else WHITE,False,LINE); text(s,a,.95,y+.19,2.75,.28,15,NAVY,True); text(s,b,4.05,y+.14,7.85,.35,14,INK) footer(s,'Kaplan & Sadock’s Synopsis of Psychiatry, Dissociative Disorders section') #9 management s=prs.slides.add_slide(blank); header(s,'Treatment principles','Phase-oriented, individualized care',9) ph=[('1. Safety & stabilization','Risk management, grounding, emotion regulation, sleep and coping skills',TEAL),('2. Trauma processing','Only when stable and appropriate; paced to prevent overwhelm',GOLD),('3. Integration / rehabilitation','Improve continuity of self, relationships, functioning and quality of life',CORAL)] for i,(t,d,c) in enumerate(ph): x=.75+i*4.15; rect(s,x,1.85,3.58,3.1,WHITE,True,LINE); rect(s,x,1.85,3.58,.16,c); text(s,t,x+.28,2.25,2.95,.58,20,NAVY,True,align=PP_ALIGN.CENTER); text(s,d,x+.35,3.25,2.85,.8,15,INK,align=PP_ALIGN.CENTER) if i<2: arrow(s,x+3.62,3.4,x+4.07,3.4,TEAL) rect(s,1.5,5.55,10.35,.7,SKY,True); text(s,'Psychotherapy is the main treatment. No medicine directly treats dissociation, but medication may treat co-occurring depression, anxiety, sleep problems or other conditions.',1.8,5.75,9.75,.28,15,INK,align=PP_ALIGN.CENTER) footer(s,'APA patient overview, reviewed Oct 2024; Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, p. 5909') #10 nursing s=prs.slides.add_slide(blank); header(s,'Supportive care and communication','Practical response',10) DO=['Use calm, simple language and orient to the present.','Offer grounding: name objects, notice feet on floor, slow breathing.','Ask what helps and respect preferences.','Document observations objectively and protect privacy.','Coordinate safety planning and referral.'] AV=['Do not confront, shame or force memory recovery.','Do not assume symptoms are fabricated or theatrical.','Do not use unmodified intensive trauma exposure when the person is unstable.','Do not overlook medical, substance-related or suicide risk.'] rect(s,.65,1.55,5.85,4.9,RGBColor(235,247,242),True,LINE); label(s,'DO',.95,1.85,.65,TEAL); bullet(s,DO,.95,2.45,4.95,3.5,17) rect(s,6.82,1.55,5.85,4.9,RGBColor(255,241,239),True,LINE); label(s,'AVOID',7.12,1.85,1.05,CORAL); bullet(s,AV,7.12,2.45,4.95,3.5,17,INK,CORAL) footer(s,'Teaching points based on phase-oriented trauma-informed care') #11 case s=prs.slides.add_slide(blank); header(s,'Brief case for discussion','Apply the framework',11) rect(s,.72,1.5,12.0,1.15,SKY,True,LINE); text(s,'A 24-year-old student reports “losing time,” feeling unreal during conflict, poor sleep and panic. Neurologic history is unremarkable, but alcohol use has increased.',1.02,1.82,11.35,.52,18,NAVY,True,align=PP_ALIGN.CENTER) qs=[('What are the immediate priorities?','Safety, intoxication/withdrawal, self-harm risk and basic orientation.'),('What else should be assessed?','Trauma symptoms, mood/anxiety, functional impact, collateral history and medical causes.'),('What is a helpful first response?','Validate distress, use grounding, avoid premature labels, and arrange appropriate evaluation.')] for i,(q,a) in enumerate(qs): y=3.05+i*1.0; rect(s,1.15,y,10.95,.75,PALE,True,LINE); text(s,q,1.45,y+.14,3.15,.22,15,TEAL,True); text(s,a,4.4,y+.14,7.2,.32,14,INK) footer(s,'Case is fictional and intended for education only') #12 recap ref s=prs.slides.add_slide(blank); header(s,'Take-home messages','Summary',12) rect(s,.65,1.45,6.0,4.85,PALE,True,LINE); text(s,'Remember',.98,1.85,2,.3,23,NAVY,True) bullet(s,['Dissociative symptoms affect integration of memory, identity and experience.','Three main DSM-5-TR diagnoses are DID, dissociative amnesia and DP/DR disorder.','Assessment must include safety, trauma-informed enquiry and medical/substance differentials.','Psychotherapy and stabilization are central; treat co-occurring conditions.'],.98,2.4,5.1,3.3,17) rect(s,7.0,1.45,5.65,4.85,SKY,True,LINE); text(s,'Selected sources',7.32,1.85,3,.3,22,NAVY,True) refs=['American Psychiatric Association. What Are Dissociative Disorders? Reviewed October 2024.','Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, 11th ed. Dissociative Disorders chapter.','American Psychiatric Association. DSM-5-TR. 2022.'] bullet(s,refs,7.32,2.4,4.7,2.45,14,INK,TEAL,12) text(s,'Thank you',7.32,5.5,2.3,.35,20,TEAL,True) footer(s,'References are included for teaching use') # slide notes sources are conveyed in footer, no placeholder prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/dissociative-disorders-ppt/src/create_deck.py" python - <<'PY' from pptx import Presentation p='/tmp/workspace/dissociative-disorders-ppt/output/Dissociative_Disorders.pptx' prs=Presentation(p) print('slides',len(prs.slides),'size',__import__('os').path.getsize(p)) for i,s in enumerate(prs.slides,1): txt=' '.join(sh.text for sh in s.shapes if getattr(sh,'has_text_frame',False)) print(i, len(txt), txt[:70].replace('\n',' / ')) PY

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/dissociative-disorders-ppt/output/Dissociative_Disorders.pptx') prs=Presentation(str(p)) assert len(prs.slides)==12 for idx, slide in enumerate(prs.slides, 1): texts=[sh.text.strip() for sh in slide.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()] assert texts, f'Empty slide {idx}' for sh in slide.shapes: assert sh.left >= 0 and sh.top >= 0, f'Negative placement slide {idx}' assert sh.left+sh.width <= prs.slide_width+1000, f'Overflow width slide {idx}' assert sh.top+sh.height <= prs.slide_height+1000, f'Overflow height slide {idx}' print(f'Validated {len(prs.slides)} slides; {p.stat().st_size:,} bytes') PY ls -lh "/tmp/workspace/dissociative-disorders-ppt/output/Dissociative_Disorders.pptx"