Dissociative Disorders Chapter 9 Introduction Dissociative disorders are

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Dissociative Disorders Chapter 9

Dissociative Disorders Chapter 9

Introduction • Dissociative disorders are defined by a disruption in the usually integrated functions

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 incidents associated with the traumatic

Amnesia: Assessment • Localized amnesia – Inability to recall 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

Localized amnesia • • Assessment Nursing Diagnosis Nursing Intervention Patient and family Education

Selective 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

Continuous amnesia • • Assessment Nursing Diagnosis Nursing Intervention Patient and family Education

Generalized 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

Systematized amnesia • • Assessment Nursing Diagnosis Nursing Intervention Patient and family Education

Dissociative Fugue: Assessment • Characteristic feature of dissociative fugue is a sudden, unexpected travel

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

Nursing Process • • Nursing Diagnosis Planning/Implementation Outcomes Evaluation

Dissociative Identity Disorder: Assessment • Characterized by the existence of two or more personalities

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

Nursing Process • • Nursing Diagnosis Planning/Implementation Outcomes Evaluation

Predisposing Factors • Biological Theories – Genetics • Possible hereditary factor – Organic •

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 and. Physical abuse

Depersonalization Disorder • Assessment: Characterized by a temporary change in the quality of self-awareness

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

• 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

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

Treatment Modalities • Dissociative amnesia – Remove from stress – Intravenous amobarbital – Supportive

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 –

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