Elsevier items and derived items © 2005 by Mosby, Inc. 0 CHAPTER 24 Dissociative Disorders

1Elsevier items and derived items © 2005 by Mosby, Inc.

CHAPTER 24 Dissociative Disorders

CHAPTER 24 Dissociative Disorders


• All attitudes, notions, beliefs, and convictions that make up a person’s sense of self

• Includes perceptions of personal characteristics and abilities, interactions with other people and the environment, values, associated experiences, and object, goals, and ideals

(Cont’d…)

Self-ConceptSelf-Concept


(…Cont’d)

• Influenced by many factors in one’s environment• The continuum of responses ranges from a low

(which results in maladaptive behavior) to strong and healthy (which leads one toward self-actualization).

Self-ConceptSelf-Concept


• Self Esteem- individuals judgment of his or her own worth

• Self-Ideal- personal standards of how one should behave

• Personal Identity-awareness of one self as an individual

• Role performance- socially expected behavioral patterns


Healthy Personality

• Effectively perceive and function within their worlds

• Achieve a sense of peace and harmony allowing them to cope with lifes anxieties, traumas, and crises

• High self esteem & confidence levels- provide strength to handle anxieties and learn from life’s highs and lows


• Infancy Infants do not view themselves as separate from the rest of the world. After time, begin to distinguish themselves as different from their mother Following a series of social experiences, develop stable relationships and learn to feel

good about themselves

• Toddler stage Become independent by exploring their environments and testing their

capabilities Develop autonomy and a sense of self through experiencing a variety of

behaviors

(Cont’d…)

Development of Self-Concept throughout the Life Cycle



(…Cont’d)

• School age Become aware of different perspectives on life Learn about social norms, peer pressures, and moral issues

• Adolescence In teens, self-concept of childhood is challenged. As teens mature they develop more complex pictures of themselves. Self-concept is influenced by relationships with family and peer play. Thinking becomes more abstract.

(Cont’d…)




(…Cont’d)

• Adulthood Adults with strong, positive self-concept explore their environment,

because they have a background of success and effectiveness. Adult with low self-concept views self as inadequate or incapable.

• Older adulthood In later life, many events and situations can threaten positive self-concept. Threats to the stability of one’s lifestyle often lead to changes in self-

concept.




• Dissociation: An attempt to cope with deep-seated emotional anxiety or distress • Many patients have low self-esteem.

Feelings of weakness, inadequacy, and helplessness Expressed as some degree of anxiety Feelings of self-rejection and dislike are expressed through various behaviors

• Identity diffusion: Failure to integrate various childhood identifications into an effective adult personality

• Not sure who they really are because they have been unable to build a “picture” of themselves

• Drift through life

(Cont’d…)

Dissociative Disorders Dissociative Disorders


contd

• Problems with intimacy and caring

• Empathy is lacking

• Moral codes or standards of behavior are often missing


(…Cont’d)

• A disturbance in the normal interactions of consciousness, identity, memory, and perception The most anxiety-producing aspects of self are walled off or split from the remainder of

the personality in an attempt to cope with severe anxiety or emotional trauma. New evidence reveals that, although once rare, these disorders are becoming more

common in the U.S., especially among victims of child abuse. More frequent in women Be alert to customs and practices of different cultures Refer to table 23-1 p. 249

(Cont’d…)



• When the disturbance of a dissociative disorder occurs primariy with memory or consciousness; amnesia or fugue results

• Dissociative identity- MPD- when the disturbance is with ones identity , part of self assume separate personalities

• Traumatic experiences are the baseis of all dissociative disorders


(…Cont’d)

• Depersonalization disorder A response to severe anxiety associated with blocking of

awareness and fading of reality Client feels detached or unconnected to self during episodes Serves as a defense mechanism, but does nothing to relieve the

cause of the distress; so, it soon becomes maladaptive behavior Commonly associated with other mental disorders

(Cont’d…)



(…Cont’d)

• Amnesia: Loss of memory• Dissociative amnesia is characterized by an inability to remember

(personal information) that cannot be explained by ordinary forgetfulness. Clients have gaps in their recall of certain events during childhood, usually

ones related to extremely stressful events. Clients require a great deal of emotional support. Client safety is a primary therapeutic goal because suicide attempts are

common.

(Cont’d…)



(…Cont’d)

• Amnesiac fugue Fugue: Escape from reality

• Main characteristics Sudden, unexpected travel that client cannot later

recall

• Response to an overwhelmingly stressful or traumatic event

• Extreme expression of the fight-or-flight response, engaged as a defense

• May travel miles from home, to another continent• Behave normally but are confused about their

personal identity

(Cont’d…)

DissociativeFugueDissociativeFugue


contd

• Some assume new identities complete with new jobs, and new significant others

• Personality changes are noticeable• After the fugue- may experience aggressive

impulses, conflict, depression, guilt and suicidal wishes

• Loss of memory of the events during fugue• Recovery is rapid some amnesia may remain


(…Cont’d)

• Dissociative trance Trance: A state resembling sleep in which consciousness remains but

voluntary movement is lost Cultural trances are entered into voluntarily and cause no distress or harm.

• Possession trance: Appearance of one or more distinctive identities that direct the client to perform sometimes complex behaviors and activities

(Cont’d…)



(…Cont’d)

• Dissociative identity disorder (DID): The presence of two or more identities or personalities that repeatedly take control of the client’s behavior

• A defense against intense, prolonged, and inescapable trauma • Client’s history

Many episodes of “time loss” Unexplained possessions Changes in relationships Out-of-body experiences Awareness of other personalities

(Cont’d…)



(…Cont’d)

• In DID, clients do not always report a history of abuse or trauma because emotions buried so deep.

• Different personalities emerge Each has its own way of thinking about and relating to the world. Each personality is unique and often represents the individual at a certain

developmental stage. Identities may be helpful, controlling, seductive, or destructive. Each serves a specific protective purpose. They may differ in age, gender, knowledge, state of health, speech, and behaviors.

(Cont’d…)



(…Cont’d)

• Treatments and therapies Begin with assessment and stabilization Client must perceive environment as one in which they can safely examine their

conflicts. Assessment includes clients’ history, symptoms, support systems, medical

status, relationships, problems with substance abuse and sleeping and eating disorders.

May include psychotherapy, group therapy, family therapy, psychoeducation, or expressive therapies, like art, poetry, or dance

• No specific medications available



Nursing Process• Good assessments• Self concept nursing diagnoses• Expected outcome is to obtain maximum level of

functioning and self actualization• Establish trust• Assist growth of personal insight• Emotionally support• Assess for self destructive thoughts• Contractual agreements help• Daily journal

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Elsevier items and derived items © 2005 by Mosby, Inc. 0 CHAPTER 24 Dissociative Disorders