Sunita has frequent memory gaps and cannot account for her whereabouts during certain periods of time. While being interviewed by a clinical psychologist, she began speaking in a childlike voice; she claimed that she was only six years old. Moments later, she seemed to revert to her adult voice and had no recollection of speaking in a childlike voice or claiming that her name was Munita. It is a?

1. A

   Somatoform disorder

2. B

   Dissociative disorder

3. C

   Hypochondriacs

4. D

   Depersonalisation disorder

Appeared in: AIIMS Delhi NO - 2017

Explanation

• Dissociative disorder because the patient's presentation aligns with the core features of this category of mental illness.
• The key symptoms described—significant memory gaps, loss of time, and the presence of a distinct alternate personality state ('Munita', the six-year-old)—are classic signs of Dissociative Identity Disorder (DID).
• DID is the most severe form of dissociative disorder and is characterized by these very features: identity fragmentation and amnesia.
• The amnesia is not simple forgetfulness; it is a profound inability to recall personal information, events, or the actions of other identity states.

Why Other Options Were Wrong

• Option A: Somatoform disorders (now known as Somatic Symptom and Related Disorders) are characterized by physical symptoms that suggest a medical illness but are not fully explained by a medical condition. The patient's symptoms are psychological (memory, identity), not physical.
• Option C: Hypochondriasis (now primarily termed Illness Anxiety Disorder) involves a preoccupation with and fear of having a serious, undiagnosed medical illness. The patient's symptoms are not centered on fear of illness.
• Option D: Depersonalisation disorder involves persistent or recurrent feelings of being detached from one's own mental processes or body (depersonalization) or from one's surroundings (derealization). While it is a dissociative disorder, it does not involve the formation of distinct alternate identities with amnesia between them.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Identification of Dissociative Disorders based on clinical presentation helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Nurses must approach patients with suspected dissociative disorders with a non-judgmental and supportive attitude, as these conditions are often rooted in severe trauma.
• A primary nursing concern is patient safety. Due to memory gaps and unpredictable behavior of different identity states, patients may be at risk for self-harm or placing themselves in dangerous situations without awareness.
• What if the patient only reported memory gaps but no change in identity? In that case, the diagnosis might be Dissociative Amnesia, another type of dissociative disorder where the primary symptom is an inability to recall important autobiographical information, usually of a traumatic or stressful nature.

How to Approach the Question

• First, break down the clinical scenario into key symptoms. In this case: 1) memory gaps/lost time, 2) switching to a different persona (childlike), and 3) amnesia for the switch.
• Next, evaluate each option against these core symptoms.
• Eliminate Somatoform disorder and Hypochondriasis as they relate to physical symptoms and illness anxiety, respectively, which are not the primary features here.
• Differentiate between the remaining dissociative options. Depersonalisation involves a feeling of detachment, not a full switch to another identity with its own behaviors and voice.
• Conclude that the combination of identity alteration and amnesia is the hallmark of a more profound dissociative disorder, making 'Dissociative disorder' the best-fitting category provided.

Concept Tested & Keywords

• Concept Tested: Identification of Dissociative Disorders based on clinical presentation.
• Stem keywords: frequent memory gaps, cannot account for her whereabouts, childlike voice, no recollection
• Lead-in keywords: It is a?
• Clinical cues: The presence of distinct identity states (adult vs. child) coupled with amnesia is a key diagnostic clue.

Question ID

Q0DLejF9G0zN-EK7nqbiUZ

Copy ID

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 1413-1415, 1416-1418

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 6314-6316