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.