Dissociative Disorders

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Dissociative Disorders

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A. These disorders involve alteration in the function of consciousness, personality, memory, or identity.

B. Dissociative disorders may be sudden and temporary or gradual and chronic.

C. Clients diagnosed with these types of disorders handle stressful situations by "splitting" from the situation and going into a fantasy state.

D. The disorders are an unconscious defense mechanism that protects one against overwhelming anxiety.

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Types of Dissociative Disorders

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A. Dissociative Amnesia

1. Is the sudden temporary inability to recall extensive personal events.

2. The memory loss includes gaps in memory for extended periods of time or memories of the precipitating event.

3. Usually occurs after a traumatic event, such as a threat of death, or injury, an intolerable life situation, or a natural disaster.

4. It is the most common dissociative disorder.

5. Dissociative amnesia with fugue

A. it is characterized by a person suddenly leaving home or work with the inability to recall his or her identity so this involves flight as well as loss of memory.

B. The person may even assume a new identity.

C. This disorder rarely occurs.

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Types of Dissociative Disorders continued

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B. Dissociative identity disorder (formerly called multiple personality disorder)

1. The person assumes two or more identities simultaneously.

2. The dissociative aspect emerges during stress.

3. It is a sever form of dissociation thought to be a coping mechanism.

4. It is characterized by the client's dissociation from events that occur in everyday life or a traumatic experiences such as severe child abuse or sexual, physical, or psychological abuse.

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Types of Dissociative Disorders continued

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C. Depersonalization disorder

1. It is characterized by a temporary loss of one's reality and the ability to feel and express emotions.

2. Expresses detachment with regard to surroundings (objects or individuals). The client experiences others as unreal or visually distorted.

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Nursing Assessment

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A. Depression, mood swings, insomnia, potential for suicide

B. Varying degrees of orientation

C Varying levels of anxiety

D. Impairment of social and occupational functioning.

E. Alcohol or drug abuse (Drug screening is necessary to determine presence and level of abuse)

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Nursing plans and Interventions

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A. Reduce environmental stimulation to decrease anxiety.

B. Stay with client during period of depersonalization (The client is often fearful, and the nurse's presence assists in providing support and comfort during fearful episode)

C. Demonstrate acceptance of client's behavior during various experiences and personalities

D. Document emergence of different personalities, if present.

E. Implement suicide precautions if assessment indicates risk.

F. Encourage client to identify stressful situations that cause a transition from one personality to another.

G. Help client to identify effective coping patterns used in other stressful situations.

H. Assist client in using new alternative coping methods.

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Hesi hint:

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The nurse should be aware that all behavior has meaning.

Avoid giving clients diagnosed with dissociative disorders too much information about past events at one time. The various types of amnesia that accompany dissociative disorders provide protection from pain. Too much, too soon may cause decompensation.