bates motel and did (2)
TRANSCRIPT
Bates Motel
&
Dissociative Identity Disorder
By: Samantha Stiles
Soap NoteDate: 3/5/14
Time: 7:20 PM
Name: Norman Bates
Significant Events: Two days ago Norman Bates murdered his father.
Subjective (S): Patient states he has trouble sleeping and has frequent nightmares. Appetite is normal, concentration/energy have decreased while anxiety has increased. Patient complains of migraine like headaches. His only request was to have his mother present at all times.
Objective (O): Patients vital signs: Temperature: 98.1, Pulse: 73,
Respiration: 18, Blood Pressure: 140/60. Physical exam was normal, but labs showed a minor electrolyte imbalance. MRI results were negative as well.
Mental Status Exam: Patient smells of AXE, grooming is clean and clothing is neat. Patient is behaving in a calm manner, not much movement, and sits with an upright posture. Patient’s speech is slow, clear, and medium toned, while answers are short and delayed. Patient quotes, “I feel fine”. The patients affect is not congruent with his answers. Patients thought process is tight. Whenever asked questions, his answers are thought about longer than normal. Patient is experiencing nightmares, extended periods of dissociation, and amnesia. Patient has a limited amount of insight and has poor decision making skills
Patient Profile: Caucasian 17 year old male. Reports he is single and attends high school.Diagnosis: Dissociative Identity DisorderPrognosis: Poor. Patient is resistant to treatment because of denial.
Axis 1: Dissociative Identity Disorder
Axis 2: Not Applicable
Axis 3: Migraines
1. Dissociative Identity DisorderA. Start Prozac for Depression and Buspirone for Anxiety
B. Schedule outpatient appointment with therapist and psychiatrist.
C. Family Counseling
Plan:
Frances GraySamantha Stiles
(300.14)
What is dissociative identity disorder?“A dramatic dissociative disorder in which a patient manifests two or more distinct identities that alternate in some way in taking control of behavior. An inability to recall important personal information that cannot be explained by ordinary forgetting. Each identity may appear to have a different personal history, self-image, and name, although there are some identities that are only partially distinct and independent from other identities”. (p. 241)
Host Identity: “The one identity that is most frequently encountered and carries the persons real name.” (p. 241)
Alter Identities: “May differ in striking ways involving gender, age, handedness, handwriting, sexual orientation, prescription for eyeglasses, predominant affect, foreign languages spoken, and general knowledge”. (p. 241)
Criteria
A. Presence of two or more distinct identities, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and the self.
B. At least two of the identities recurrently take control of the person’s behavior.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
History of dissociative identity disorderWho: “Eberhardt Gmelin is sometimes credited as being the first to report a case of “multiple personality”.
When: Beginning in the 18th century, during the French Revolution.
“Until relatively recently DID was extremely rare-or at least rarely diagnosed- in clinical practice”. (pg. 243)
Post-traumatic theory“According to this view, DID starts from the child’s attempt to cope with an overwhelming sense of hopelessness and powerlessness in the face of repeated traumatic abuse. Lacking other resources or routes of escape, the child may dissociate and escape into a fantasy, becoming someone else”. (pg. 246)
Leading Cause: Child abuse (physical, sexual, emotional)
Norman BatesCasual: He is emotionally abused by his mother and witnesses his mom being abused.
Precipitating: Once the abuse occurs, Norman self-hypnosis himself and goes into a blackout. The blackout is usually silent and lasts a few minutes even after his dissociation.
Maintaining: Norman’s life is maintained because the disorder is sheltered by his mom which enforces his denial of the disorder.
Contributory: The contributing factor of this disorder is the abuse towards him and his mom.
Treatment OptionsFor
Dissociative Identity Disorder
Psychotherapy
Psychotherapy is the treatment of choice for individuals suffering from any type of dissociative disorder. Approaches vary widely, but generally take an individual modality (as opposed to family, group or couples therapy) and emphasize the integration of the various personality states into one, cohesive whole personality.
Group TherapyGroup Therapy should be used to teach client’s new skills, such as, containment imagery, progressive muscle relaxation, and effective communication. Group Therapy SHOULD NOT be used to discuss trauma because it can be triggering for the individual and the individual’s parts.
Dialectical Behavioral Therapy(DBT)
Cognitive Behavioral Therapy(CBT)
Self-HelpReading Materials Online: http://www.soulselfhelp.on.ca/
Journaling: Levels One through Four
Artwork
Healthy Eating Patterns
Healthy Exercise Routine
Self-Care
Sleep Hygiene
Personal Hygiene
Relaxation Techniques
MedicationsThe use of medication, except for the treatment of acute, specific concurrent Axis I disorders, is not recommended. Maintenance and effective use of prescriptions given the multiple personality states is difficult to attain. If medication is prescribed, it should be carefully monitored.
Prognosis
Research indicates that people with dissociative identity disorder have their best opportunity for living a well-adjusted life if they receive comprehensive treatment for their multiple symptoms. However, differences in how practitioners diagnose and treat this illness make it difficult to quantify outcomes.
Strengths and Weaknesses of the Movie’s Portrayal
Strengths WeaknessesMemory loss Clear cause and effect of the disorder
Pseudo seizures Inaccurate display of the disorder
Headaches before brief episodes of amnesia. Derealization
Mood Shifts Depersonalization
Relationship Instability Identity Alteration
Most importantly, the television series increases the stigma towards people who suffer from Dissociative Identity Disorder.
Works Cited
Butcher, J. N., Mineka, S., & Hooley, J.M. (2008). Abnormal Psychology: Core Concepts. Boston, MA:Pearson Allyn and Bacon.
A History of Dissociative Identity Disorder. History of Dissociative Identity Disorder. Retrieved March 12, 2014, from http://www.fortea.us/English/psiquiatria/history
Diagnostic and Statistical Manual of Mental Disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
Bates Motel. YouTube. Retrieved March 12, 2014 from http://www.youtube.com/
Cuse, C. (Director). (2013). Bates Motel [Motion Picture]. Canada: A&E Television