Dissociative Disorders

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Dissociative Disorders

• Chapter 9

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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.

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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 persons
  entire lifetime, including his or her personal
  identity
• Systematized amnesia
• Person cannot remember events that relate to a
  specific category of information, such as ones
  family or on particular person or event.

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Localized amnesia

• Assessment
• Nursing Diagnosis
• Nursing Intervention
• Patient and family Education

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Selective amnesia

• Assessment
• Nursing Diagnosis
• Nursing Intervention
• Patient and family Education

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Continuous amnesia

• Assessment
• Nursing Diagnosis
• Nursing Intervention
• Patient and family Education

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Generalized amnesia

• Assessment
• Nursing Diagnosis
• Nursing Intervention
• Patient and family Education

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Systematized amnesia

• Assessment
• Nursing Diagnosis
• Nursing Intervention
• Patient and family Education

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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

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Nursing Process

• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation

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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

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Nursing Process

• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation

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Predisposing Factors

• Biological Theories
• Genetics
• Possible hereditary factor
• Organic
• Certain neurological conditions may predispose
  individuals to DID
• Psychological InfluencesHistory of Traumatic
  Experience
• Sexual abuse, Psychological abuse andPhysical
  abuse

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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

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• 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

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Nursing Process

• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation
• Client/Family Education

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Treatment Modalities

• Dissociative amnesia
• Remove from stress
• Intravenous amobarbital
• Supportive psychotherapy
• Dissociative fugue
• Cognitive therapy
• Group therapy
• Family therapy

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Treatment Modalities

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