1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

2. Chapter 14Dissociative Disorders

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Dissociation The mechanism that allows the mind to separate certain memories, most often of unpleasant situations or traumatic events, from conscious awareness Separated parts are kept in the unconscious, or are repressed, and may emerge at any time Repression – keeping painful thoughts and memories buried until the encounter of a similar situation as the original event

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Dissociative Disorder Most often seen in those who have experienced severe trauma or abuse Disturbance in the ordinarily organized functions of the –Conscious awareness –Memory –Identity –View of oneself in relation to the environment

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Dissociative Disorders Dissociative amnesia Dissociative fugue Dissociative identity disorder Depersonalization disorder

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Dissociative Amnesia Inability to remember important personal information beyond ordinary forgetfulness –Localized  occurs within a few hours –Selective  retains portions of the event –Generalized  unable to recall any aspect of life –Continuous  present and past are lost Common s/s of Dissociative Amnesia Box 14.2 Page 207 http://www.youtube.com/watch?v=Q9_dqu7qz2w

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Dissociative Fugue The inability to recall some or all of a person’s past or identity, accompanied by the sudden and unexpected travel of the person away from his or her home or place of employment –Confusion about personal identity or assumption of new identity –Usually of short duration with treatment

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Dissociative Fugue (cont.) Often remember things unrelated to identity, such as how to drive a car After return to former self, unable to remember time of the altered identity Malingered fugue  occurs in people trying to avoid legal, financial, or unwanted personal situation Common s/s of Dissociative Fugue Box 14.3 Page 207 http://www.youtube.com/watch?v=QajubDsCcrw

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Dissociative Identity Disorder Formerly known as multiple personality disorder Two or more distinct subpersonalities present in the same person Often associated with severe childhood abuse Lengthy and chronic disorder Average onset during early school years

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Dissociative Identity Disorder (cont.) One subpersonality manifested at a time “Host” or primary personality dominantassumes given name, is passive and self-blaming, usually seeks treatment Host unaware of other states during their dominance Switching process  changing of personalities Unable to connect aspects of identity with past/present Common s/s of Dissociative Identity Disorder Box 14.5 Page 209 Sybil –Part One (http://www.youtube.com/watch?v=m1_Z6-v4uT0&feature=related)http://www.youtube.com/watch?v=m1_Z6-v4uT0&feature=related –Part Two (http://www.youtube.com/watch?v=1vANyDFgjZU)

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Depersonalization Disorder Persistent and recurrent experience of feeling detached from mental processes or body without disorientation –Unsure of personal identity or information –Derealization  perceive external environment as unreal or changing (mechanical) –Unable to recognize illogical nature of feelings –Anxiety, depression, somatic complaints –Report feeling like a robot or outside observer –Often do not seek treatment until adolescence, symptoms may present during childhood Common s/s of Depersonalization Disorder Box 14.6 Page 210

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Dissociative Disorders Many people with these disorders recover completely without treatment The goal is to help the person integrate fragmented personalities into one identity –Psychotherapy –Cognitive techniques –Hypnosis –Medications (antianxiety and antidepressants) may be useful for symptoms of anxiety or depression associated with the disorder

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied AssessmentPg. 210 –Rule out physical condition –Rule out psychotic disorders, such as schizophrenia –Clinical interview to discover significant childhood or adult trauma –Baseline psychosocial assessment –Document the client’s behavior and verbal statements

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) Nursing diagnoses may includePg. 211 –Altered thought processes –Sensory perception alteration –Personality identity disturbance –Self-care deficit –Ineffective individual coping –Anxiety

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) Expected outcomes may includePg. 211 –Associated memory deficit with past stressful events –Verbalizes reality-based perception of the environment –Demonstrates more adaptive coping methods in response to stressful situations

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) InterventionsPg. 212 –Active listening –Encouragement and support to achieve control over anxiety –Assist the client to develop an awareness of the behaviors that are damaging

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) Evaluation is based onPg. 213 –The client’s acknowledgment of the existence of more than one personality –Progress toward goal of integrating all personalities into single personality

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A situation in which a person forgets all aspects of his or her life is called A. Localized amnesia B. Selective amnesia C. Generalized amnesia D. Continuous amnesia

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Generalized amnesia Rationale: Someone with generalized amnesia is unable to remember anything about his or her life.

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Amnesia accompanied by sudden travel away from home or work and the establishment of a new identity is called A. Dissociative fugue B. Dissociative identity disorder C. Depersonalization disorder D. Derealization

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Dissociative fugue Rationale: A dissociative fugue occurs when a person unexpectedly travels away from his or her home or place of work and establishes a new identity. After the person returns home, he or she might not recall events before or during the fugue. Often law enforcement personnel find the person confused when questioned.

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. The “host” personality in someone with dissociative identity disorder is often passive and self-blaming.

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: The “host,” or primary personality, is the dominant personality in dissociative identity disorder. The host personality assumes the person’s given name and is usually the personality to seek treatment.

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The experience of feeling outside one’s own body as an observer is associated with A. Dissociative identity disorder B. Dissociative fugue C. Depersonalization D. Dissociative amnesia

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Depersonalization Rationale: The persistent and repetitious feeling of being detached from one’s thoughts or body (without disorientation) is called depersonalization. A person dealing with depersonalization might say that he or she feels like a robot.