DISSOCIATIVE DISORDERS Prepared by: Eric F.

Pazziuagan, RN, MAN Dissociation Removal from conscious awareness of painful feelings, memories, thoughts, or aspects of identity. Unconscious defense mechanism that protects an individual from the emotional pain of experiences or conflicts that have been repressed. Splitting off helps these individuals endure and survive intense emotion, physical pain, or both. Occurs as a result of extreme stress or trauma, such as war or abuse in childhood and adulthood. Individuals might develop PTSD if trauma is severe and lasting, which can lead to dissociative identity disorder. Abnormal dissociative states can become dissociative disorders when identity, memory, or consciousness is disturbed or altered. Dissociative Amnesia Amnesia: loss of memory or the inability to recall important personal information. Recent amnesia can occur immediately after a traumatic event. Localized amnesia occurs when the individual cannot remember what occurred during a specific period of time. Selective amnesia: ability to recall some events during a specified period.

Patients are sometimes found by the police wandering aimlessly and are confused and disoriented. Dissociative amnesia: one or more episodes of the inability to recall important personal information that is beyond ordinary forgetfulness. Amnesia does not occur only during the course of dissociative identity disorder, nor is the result of a substance (drug or medication) or a medical condition (head trauma). Dissociative Fugue Sudden, unexpected travel away from home or some other location with the assumption of a new identity (partial or complete) or a confusion about ones identity. The travel and behavior appears normal to casual observers; thus, the person does not seem to be wandering in a confused state. May last from a few hours to several days. Usually accompanied by amnesia. Rare; usually follows severe psychosocial stress, such as marital quarrels, personal rejections, military conflict, natural disaster, financial difficulty, and suicidal ideation. Major depression often present prior to dissociative fugue and there might be a history of childhood trauma. Fugue state allows escape or flight from intolerable event or situation. Depersonalization Sense of ones reality is changed, but the person is oriented to time, place, and person.

Individual feel detached from parts of their bodies of from mental processes. Involves an altered sense of self, so that individuals feel unreal or strange or believe that danger is not happening to them but to someone else. As a response to overwhelming stress, individuals are protected form overwhelming anxiety. Can also involve feeling like a robot or feeling as though one is in a dream; often accompanied by symptoms feel that the outside world is changed or unreal.

situations, such as physical, emotional, and sexual abuse.

Splitting off allows the person to survive the trauma but leaves an impaired personality with disconnected parts, or alters. Alter personalities have feelings and behaviors associated with the trauma. Each personality is different from the others and from the original personality. Each personality has its own name, behavior traits, memories, emotional characteristics, and social relations. The primary identity might carry the persons name and be depressed, dependent, and guilty, whereas alternate personalities might be hostile, controlling, and self-destructive. Sometimes, a switch to another personality is sometimes preceded with a headache, or individuals might cover their face and eyes with hands. Patients are admitted when they are suicidal, meaning that the alter personality is trying to harm or kill one of the other personalities for revelations concerning abuse. Severe anxiety or depression related to the coming out of upsetting alters might also be a reason for admission. Safe structure of a hospital: provides emotional security when working with difficult or overwhelming problems. Psychopharmacology Medication does not eliminate the dissociative disorder itself. Medications might help for anxiety and depression.

Buildings appear leaning, everything might be seem grey and dull.

A diagnosis is made only when the prevalence or intensity of the disorder causes marked distress, interferes with daily functioning, and occurs with the absence of other disorders, Imaging study suggested abnormalities on limited cortical areas. Dissociative Identity Disorder (Multiple Personality Disorder) Existence of two or more identities or personalities that take control of the persons behavior. Person or host, is unaware of the other personalities (alters), but the other alters might be aware of each other to varying degrees. May experience memory problems, depersonalization, identity confusion, time loss, voices conversing with each other, and voices that are persecutory. Traditional views: dissociation as a defense against extreme anxiety that is aroused in highly painful and emotionally traumatic

DID: response to medication might be partial, and an alters response to medication might be different and inconsistent. Milieu Management Provisions for a safe environment and a trusting relationship. Assist with group sessions. Provide emotional security, empathy, acceptance, and support. Help patients cope with daily living. DID: ongoing process-oriented groups can be nontherapeutic when patients reveal too much and overwhelm the group or regress. Individual therapy should be in progress. Task-oriented groups are beneficial. Occupational therapy and art therapy: for nonverbal expression to reveal material that cannot be verbally accessed. Milieu meetings: decreases isolation. DID: cognitive therapy, relaxation, stress management, meditation and exercise. Cognitive therapy: decreases blame or guilt surrounding issues of physical or sexual abuse. Before discharge, a safety plan and noharm contract might be necessary, as well as initiating or continuing a support system for the patient. Self-help groups: opportunity to practice social skills and problem solving to develop a sense of empowerment and control. Nurse- Patient Relationship The nurses relationship with clients experiencing amnesia and fugue includes interventions to establish trust and support.

Physiologic and neurologic work-ups to rule out organic causations. Assist with gathering data regarding feelings, conflicts, or situations that patients experienced before the amnesia or fugue state. Patients might have hypnotic sessions to gather data about forgotten material. Slowly help clients deal with anxiety and conflicts in their lives and improve coping skills. Patients with depersonalization disorder are only admitted if they are suicidal, extremely anxious, or depressed. Treatment goad for DID: integrate the personalities or memories, if possible, so that they can survive or coexist in the original personality. Provide caring and empathy and work with patients to establish trust because the relationship of these patients with authority figures might have been inconsistent, rigid, and unpredictable. Contract for patients safety and to reduce self-harm and violence. Remember that even with the presence of a child alter, the patient is an adult, not a child. Be alert for splitting by staff members regarding patients diagnosis. Education about diagnoses, management of feelings, especially anger and rage, and consistency of approach assist the staff in developing a caring, supportive environment for patients so that trust increases and a predictable, positive learning environment is developed.