Download Dissociative Disorders

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
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Assessment
Nursing Diagnosis
Nursing Intervention
Patient and family Education
Selective amnesia
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Assessment
Nursing Diagnosis
Nursing Intervention
Patient and family Education
Continuous amnesia
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Assessment
Nursing Diagnosis
Nursing Intervention
Patient and family Education
Generalized amnesia
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Assessment
Nursing Diagnosis
Nursing Intervention
Patient and family Education
Systematized amnesia
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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
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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
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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:
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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
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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.