Dissociative Disorders

1. DissociativeDisorders Chapter 9

2. Introduction • Dissociative disorders are defined by a disruption in the usually integrated functions of consciousness, memory, identity, or perception. • Dissociative disorders are thought to be quite rare, but when they do occur they may present a very dramatic clinical picture of severe disturbance in normal personality functioning. • There is an increase in reported cases of amnesia.

3. Amnesia: Assessment • Localized amnesia • Inability to recall all incidents associated with the traumatic event for a specific time period following the event. • Selective amnesia • Inability to recall only certain incidents associated with a traumatic event for a specific period after the event. • Continuous amnesia • Inability to recall events occurring after a specific time up to and including the present. • Generalized amnesia • Rare phenomenon of not being able to recall anything that has happened during the person’s entire lifetime, including his or her personal identity • Systematized amnesia • Person cannot remember events that relate to a specific category of information, such as one’s family or on particular person or event.

4. Localized amnesia • Assessment • Nursing Diagnosis • Nursing Intervention • Patient and family Education

5. Selective amnesia • Assessment • Nursing Diagnosis • Nursing Intervention • Patient and family Education

6. Continuous amnesia • Assessment • Nursing Diagnosis • Nursing Intervention • Patient and family Education

7. Generalized amnesia • Assessment • Nursing Diagnosis • Nursing Intervention • Patient and family Education

8. Systematized amnesia • Assessment • Nursing Diagnosis • Nursing Intervention • Patient and family Education

9. Dissociative Fugue: Assessment • Characteristic feature of dissociative fugue is a sudden, unexpected travel away from home or customary workplace • A person in a fugue state unable to recall personal identity, and assumption of a new identity is common

10. Nursing Process • Nursing Diagnosis • Planning/Implementation • Outcomes • Evaluation

11. Dissociative Identity Disorder: Assessment • Characterized by the existence of two or more personalities within a single individual • Transition from one personality to another is usually sudden, often dramatic, and usually precipitated by stress

12. Nursing Process • Nursing Diagnosis • Planning/Implementation • Outcomes • Evaluation

13. Predisposing Factors • Biological Theories • Genetics • Possible hereditary factor • Organic • Certain neurological conditions may predispose individuals to DID • Psychological Influences:History of Traumatic Experience • Sexual abuse, Psychological abuse andPhysical abuse

14. Depersonalization Disorder • Assessment: Characterized by a temporary change in the quality of self-awareness that often takes the form of: • Feelings of unreality • Changes in body image • Feelings of detachment from the environment • Sense of observing oneself from outside the body

15. Symptoms of depersonalization disorder are often accompanied by: • Anxiety • Fear of going insane • Depression • Obsessive thoughts • Somatic complaints • Disturbance in the subjective sense of time • Physiological theory • Neurophysiological basis • Psychodynamic theory • Emphasizes the psychological conflict and disturbances of ego structure in the predisposition to depersonalization disorder

16. Nursing Process • Nursing Diagnosis • Planning/Implementation • Outcomes • Evaluation • Client/Family Education

17. Treatment Modalities • Dissociative amnesia • Remove from stress • Intravenous amobarbital • Supportive psychotherapy • Dissociative fugue • Cognitive therapy • Group therapy • Family therapy

18. Treatment Modalities • Dissociative identity disorder • Intense long-term psychotherapy • Depersonalization disorder • Various regimens have been tried, although none has proved widely successful.