Dissociative Disorders Flashcards
Removal from conscious awareness of painful feelings, memories, thoughts, or aspects of identity
Dissociation
Mainly characterized by disturbance in identity, memories, thoughts, or aspects of identity
Dissociative Disorders
Precipitated by extreme stress or trauma
Dissociative Disorders
Types of Dissociative Disorders
-Dissociative Amnesia
-Dissociative Fugue
- Dissociative Identity Disorder
loss of memory or inability to recall important personal information
Amnesia
Inability to form new memories after onset of amnesia
Anterograde
Inability to recall memories before amnesia
Retrograde
Characteristics of Dissociative Amnesia
-One or more episodes of the inability to recall important personal information that is beyond ordinary forgetfulness
-Lost information is usually stressful or traumatic in nature
-(+) wandering, disorientation, confusion
-Psychosocial stressors: threat of physical injury or death
(+) wandering, disorientation, confusion
Dissociative Amnesia
What’s the Psychosocial Stressors of Dissociative Amnesia?
Threat of physical injury or death
Nursing Diagnosis of Dissociative Amnesia
-Impaired Memory
- Ineffective Coping
Goals for Dissociative Amnesia
-Help the person to remember forgotten or traumatic events in a controlled way & to accept & integrate them
-Resolve distressing situations
-Strengthen coping skills
Interventions for Dissociative Amnesia
-Involvement of family member/significant other to remember what happened
-Trauma work (CISM)
-Hypnosis
Characteristics of Dissociative Fugue
-Sudden, unexpected travel away from home or some other location with the assumption of a new identity or a confusion about one’s identity
-(+) amnesia
-Unable to recall events during fugue state
(+) Amnesia
Dissociative Fugue
Psychosocial stressors of Dissociative Fugue
-Marital quarrels
-Personal rejections
- Military conflict
- Natural disasters
- Financial difficulty
- suicidal ideation
Nursing Diagnosis of Dissociative Fugue
-Risk for Injury
- Impaired Memory
- Ineffective Coping
Interventions for Dissociative Fugue
Fugue states usually end rather abruptly on their own
Supportive psychotherapy- to help person identify & resolve stressors leading to fugue state and to learn better coping skills, so that fugue does not happen again.
Existence of two or more personalities that take control of the person’s behavior
Dissociative Identity Disorder (D.I.D)
Has a Host & Alters
Dissociative Identity Disorder (D.I.D)
Original Personality
Host
Dissociative Personality/-ies
Alters
Precipitated by abuse (Sexual)
Dissociative Identity Disorder (D.I.D)
Initially, unaware of the existence of alters
Host
Experiences amnesia while alters takes over
Host
Has an awareness of the existence of alters
Alters
Each has its own name, behavior traits, memories, emotional characteristics, and social relations
Alters
Represents fragments of the host’s sense of identity with different identity states remembering distinct information
Alters
Management-Milieu
Psychotherapy
-Long- term, intensive, out- patient
-Directed toward uncovering the underlying psychological conflicts, helping him or her gain insight into these conflicts, and striving to synthesize the various identities into one integrated personality.
Part of psychotherapy that involves mental re-experience of trauma/abuse that caused the illness
Abreaction
Part of Psychotherapy that blending of all personalities into one
Integration
Used to look into each personalities
Hypnosis
Part of Psychotherapy that recommends when an aggressive or suicidal alter is in a dominant role
Hospital admission
Psychopharmacology Management of Dissociative Identity Disorder (D.I.D)
-Anxiolytics, as ordered
- Anti-depressants, as ordered
This drug is used if client becomes hostile
Anxiolytics
This drug is used to control anxiety
Anti-depressants
Nursing Management of Dissociative Identity Disorder (D.I.D)
-Establish trust and rapport
- Facilitate physiologic and neurology work ups to rule out organic causes
- Assist in slowly helping patients deal with anxiety and conflicts in their lives and improve coping skills
-Treat an adult patients as an adult even if an alter is a child
- Be consistent with approach to develop a caring and supportive environment
-If patient has suicidal tendencies, facilitate initiation of no-harm contract
- If patient becomes aggressive, deal with aggression while observing the principle of least restrictive treatment.
Dealing with Aggressive Patients
-Ensure scene safety, when in doubt do not act alone
- Attempt verbal de-escalation (use a calm, firm voice)
- Direct the patient to take a voluntary time-out in a quiet area
- Inform the patient aggressive behavior is not acceptable
-Offer PRN medications to help the patient return to a calm state (e.g., Lorazepam)
- Provide a “show of force/strength” (gather 4-6 team members to remain in sights with patient interactions
Involves debriefing
Dealing with aggressive patients
