Dissociative Disorders - MCCC

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 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. 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.