Dissociative Disorders Chapter 9

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.

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.

Localized amnesia Assessment Nursing Diagnosis Nursing Intervention Patient and family Education

Selective amnesia Assessment Nursing Diagnosis Nursing Intervention Patient and family Education

Continuous amnesia Assessment Nursing Diagnosis Nursing Intervention Patient and family Education

Generalized amnesia Assessment Nursing Diagnosis Nursing Intervention Patient and family Education

Systematized amnesia Assessment Nursing Diagnosis Nursing Intervention Patient and family Education

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

Nursing Process Nursing Diagnosis Planning/Implementation Outcomes Evaluation

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

Nursing Process Nursing Diagnosis Planning/Implementation Outcomes Evaluation

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

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

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

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

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

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