Week 3 Dissociative Disorders Psychophysiological Disorders Flashcards
Dissociative Disorders
- Group of psychiactric syndromes
- Involuntary and unhealthy
- Disruptions in aspects of Consciousness, identity, memory, motor behavior, or environmental awareness.
Dissociative Disorders
The conscious behaviours we do allow us to destress/decompress. WE have the ability to pull out of that. Someone with dissociative disorders cannot control it.
Dissociative Disorders- DSM-IV-TR
- Dissociative amnesia
- Dissociative fugue
- Depersonalization disorder
- Dissociative disorder not otherwise specified
- Dissociative identity disorder
Dissociate disorder…also known as?
also known as multiple personality disorder. can be HUNDREDS of personalities. Used to manage an overwhelming stressor.
Why do the personalities form?
Unconscious attempt to wall off the overwhelming stressors…memories of trauma. Not one traumatic event…a series.
Dissociation: Unconscious process of “walling-off” of emotions and memory
Personality “fragments” due to trauma
Alters develop to “protect” the individual
Failure to integrate aspects of identity, memory, and feeling states
Disruption in the consciousness processes
sudden disruption in consciousness, identity, or memory.
Blocks of time are lost.
Involuntary process-no decisional process.
Assessment and characteristics
- Presence of two or more personalities
- Inability to recall key personal data
- Personalities reveal themselves at intervals
- Depression/Mood Swings
- Suicidal ideation
- Sleep disorders (sleep is frightening to them)
- Anxiety
- Substance abuse (self medicates)
- Loss of time-amnesia
Will an individual with DD remember their childhood?
Likely not. If their childhood is when the trauma occurred, they will not recall that period of their life.
Call ‘alter’s change the age/gender/overall health of the individual?
Yes! An adult can have a baby alter, a woman can have male alters and vise versa. Some alters may need glasses, or have high blood sugar.
Are personality disorders the same thing as dissociative disorders?
NO! TRUE dissociative disorder is a rare diagnosis.
Mental Status Exam - Appearance
wide variation of facial expression during one meeting
Mental Status Exam - Mood
anxious, depressed, or “feels empty”
Mental Status Exam - Memory
amnesia for certain events or periods
Mental Status Exam - Perception
depersonalization (their self is in a dream world…doesn’t actually exist), derealization (external world is not real…a dream)
Nursing Diagnoses
Anxiety Ineffective coping Personal identity disturbance Sensory perceptual alterations Altered thought processes Powerlessness Risk for self harming behaviors Ineffective role performance
Planning/Intervention
Establishing the therapeutic alliance (might need to do this each time for each personality)
Minimize risk for violence, self or other directed
Contracting with alters for safety
Encourage healthy functioning
Providing safe environment fosters integration
How can you provide a safe environment
Encourage expression of feelings
Help to recognize that alters are a part of host
Psychopharmacology
Anxiolytics may reduce anxiety symptoms…very small dose of trazodone. vistaril. depakote. neurontin…none of these produce dependence/tolerance/addiction
Antidepressants may reduce dysphoria and depressive symptoms
Mood stabilizers may help regulate mood fluctuations
Antipsychotics for symptoms of psychotic proportion.
Can dissociative disorder be voluntary?
NO if it’s voluntary, then it’s not real. Dissociate disorder is an involuntary event.
What one medication treats DD?
None…best you can do is treat the symptoms. Keep a close eye out for self-medicating.
Milieu Therapy…reintegration
Safe, consistent environment Clear boundaries and they're all going to be different boundaries for each alter Group therapies Hypnosis Expressive therapies Ongoing supportive psychotherapy
Risk to self
Prone to self-harm…cutters. Highly suicidal.
Psychophysiological Disorders
Mind body connection
Emotional influences physical
Physical influences emotional
Comorbidity lengthens illness
Psychophysiological Disorders (voluntary or involuntary?)
some can be voluntary, some are involuntary
Physiological Health Problems
Cardiovascular Musculoskeletal Respiratory Gastrointestinal Genitourinary Endocrinologic
Type “C” personality related to..
incidence of cancer
repression of negative emotions, passivity, apologetic, overly cooperative, low self esteem, needs of others placed before self…all this is linked to incidence of cancer
Somatoform Disorders
Somatization disorder Conversion disorder Pain disorder Body dysmorphic disorder Hypochondriasis
Factitious disorders
munchausen’s
munchausen’s by proxy
Somatoform disorders produce
real physical symptoms that cannot be medically explained
Factitious disorders are
abnormal cognitive patterns that are related to how a person thinks and feels in relation to the their physical surroundings. They THINK there is a problem, and there IS a problem…but the individual created it.
It can be evaluated medically.
Primary Gain
Exempt from usual activities (if you're sick, you don't go to work/school) Not responsible for illness Expected to desire health Expected to seek assistance Expected to cooperate with plan of care
Primary gain is the direct
benefit from having that illness
Secondary Gain
Indirect benefit of illness (you get lay down and watch tv all day) Increased attention Treats and special privileges Not responsible for illness Recipient of care and nurturing
When you desire the secondary gain
dependency needs that haven’t been met at some point in a particular way
Etiology
Genetic
Biochemical
Psychodynamic
Learning Theory
Somatoform disorders
Physical symptoms not fully explained by a medical condition
Symptoms do cause impairment or distress
Symptoms are not intentionally produced
Somatoform disorder example
Exam the next day, you FEEL sick. (but no fever, etc)
Somatization disorder
Physical complaints Cannot be explained medically Usual onset before age 30 Extends to a period over years Pain, GI, Sexual, Neuro symptoms Symptoms are not intentionally produced 0.2-2% women, 0.2% men, prevalence
Conversion Disorder
Voluntary motor/sensory functions
Symptom is initiated or exacerbated by stressor
Symptoms not intentionally produced
Symptoms cannot be explained medically
Impaired social, occupational, or role functioning
“La belle indifference”
“La belle indifference”
very matter-a-fact about the situation. i woke up and I can’t walk. Meh.
Pain disorder
Pain requiring clinical focus
Causes distress in social, occupational or role function
Psychological factors contribute to onset
Not intentionally produced
Not accounted for by a Mood, Anxiety or Psychotic disorder
Body dysmorphic disorder
Unrealistic focus regarding a deformed or defective feature
Excessive grooming to disguise
Clinically significant impairment of social, occupational or role function
Not better accounted for by another disorder
Somatoform Disorder : Nursing Diagnosis
Ineffective/maladaptive coping
Disturbance in self perception
Fears of chronic disease
Disturbance in sensory perception
Nursing intervention
Identify gains provided by symptoms Clear review of objective findings Regular supportive brief contacts Hear concerns regarding emotional pain Incentive to resolve symptoms Support healthy function- no focus on disability ID maladaptive coping- teach adaptive strategy ID episodes of increased symptoms
Nursing interventions, cont
Establish therapeutic alliance Non judgmental approach Careful documentation Behavioral therapy Individual and/or group psychotherapy Psychopharmacology Team management of boundaries
Evaluation
Recognition of symptoms
Replace maladaptive coping with adaptive strategies
Verbalize relationship of increased anxiety to increased symptoms
Increased role function
Acceptance of self
Factitious Disorders
Conscious fabrication of physical or psychological disorder symptoms
Need to be seen as ill, impaired
Often co-morbid with personality disorders
Does not preclude true disorder
Diagnosis always implies psychopathology
Munchausen’s syndrome
Predominant physical symptoms
Signs and symptoms of an apparent medical condition
Life revolves around obtaining care
Disorder limited only by patient’s ability to maintain the symptoms
Chronic disorder- lifelong pattern
Munchausen’s by proxy
Intentional production of symptoms in another (usually a child or a dependent individual)
Goal is indirect assumption of sick role
Usual co-morbidity personality disorder
Can munchausen’s and/or munchausen’s by proxy be treated?
No…treatment is unsuccessful
Munchausen’s by proxy…what happens to the dependent?
Prognosis is poor if child remains with offending adult
Prognosis is good if child is separated from offending adult
Nursing Approach - assessment
Thorough, written team approach
Documentation of communications, behaviors
Nursing approach plan/intervention
Communicate among the team
Care provided by team members
Teaching
nursing approach evaluation
Team communication with family
