Dissociative Disorders week 6

Dissociative Disorders

Chapter Overview

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Self-Concept

  • Definition: All of the attitudes, notions, beliefs, and convictions that constitute a person’s self-knowledge.

  • Influences on Self-Concept:
      - Culture
      - Society
      - Attitudes/beliefs of parents, siblings, and other significant individuals
      - Personal experiences

  • Implications: Low self-concept often results in maladaptive behavioral responses.

Self-Concept Throughout the Life Cycle

Slide 1 of 4: Self-Concept in Childhood

  • Infants:
      - Learn to trust others when their needs are consistently met.

  • Toddlers:
      - Explore the limits of their abilities.

  • School-age Children:
      - Become aware of different perspectives on life.

Slide 2 of 4: Self-Concept in Adolescence

  • Early Teen Years:
      - The comfortable self-concept established in childhood is challenged.
      - Influenced by:
        - Relationships
        - Confidence
        - Sexual identity
        - Body image

Slide 3 of 4: Self-Concept in Adulthood

  • Individuals with a strong, positive self-concept:
      - Able to explore their environment freely due to a background of success and effectiveness.

  • Individuals with a low self-concept:
      - View themselves as inadequate or incapable.

Slide 4 of 4: Self-Concept in Older Adulthood

  • In later life, various occurrences and situations can pose threats to a positive self-concept.

  • Health care providers can enhance older clients’ feelings of self-worth through:
      - Active listening
      - Demonstration of concern

Dissociative Disorders

  • Definition of Dissociation: An attempt to cope with deep-seated emotional anxiety or distress.

  • Common Components: Low self-esteem is frequently associated with various mental health problems.

  • Identity Diffusion: The failure to integrate various childhood identifications into an effective adult personality.

Characteristics of Dissociative Disorders

  • Increasing prevalence of dissociative disorders in the United States.

  • Arise from two main sources:
      - Amnesia or Fugue:
        - Problem lies within memory or consciousness.
      - Dissociative Identity Disorder (DID):
        - Problem lies within the individual's identity.

Types of Dissociative Disorders

Depersonalization/Derealization Disorder

  • Definition: A response to severe anxiety characterized by the blocking of awareness and fading of reality.

  • Function: Acts as a defense mechanism, which can evolve into maladaptive behavior.

  • Derealization: Involves feelings of detachment and unreality concerning one’s surroundings.

  • Commonality: Often associated with other mental disorders.

Dissociative Amnesia

  • Definition: Characterized by an inability to remember personal information not explained by typical forgetfulness.

  • Typical Causes: Most memory lapses are connected to highly stressful events.

Dissociative Fugue

  • Definition: Sudden and unexpected travel accompanied by an inability to recall one’s past.

  • Trigger: Often occurs in response to overwhelming stress or trauma.

  • Mechanism: Represents an extreme expression of the fight-or-flight response to protect the individual.

Dissociative Trance Disorder

  • Cultural Trances: These trances may be voluntarily entered without causing distress or harm to the individual.

  • Differentiation: During these trances, individuals maintain their identity.

  • Dissociative Trance Disorder: Occurs when trances cause “clinically significant distress or functional impairment.”

Dissociative Identity Disorder (DID)

  • Definition: Presence of two or more identities or personalities that recurrently take control of an individual's behavior.

  • Formerly Known As: Multiple personality disorder.

  • Characteristics: Each personality is unique and reflects the individual at different developmental stages.

Therapeutic Interventions

Slide 1 of 4: Overview of Treatment

  • Long-Term Therapy: Treatment for dissociative disorders generally takes place in an outpatient setting.

  • Hospitalization Criteria: Required only if:
      - Anger, aggression, or violence is directed toward self or others, presenting a danger.
      - Individuals cannot function due to memory loss, rapid identity switching, flashbacks, or overwhelming emotions.

  • Medication Evaluation: Medications must be assessed or adjusted appropriately.

Slide 2 of 4: Treatments and Therapies

  • Assessment: Understanding individual conditions thoroughly.

  • Stabilization: Helping clients reach a state of stability.

  • Past Trauma Work: Revisiting and reworking past traumatic experiences.

  • Pharmacologic Therapy:
      - Use of antidepressants and antipsychotics for associated symptoms (e.g., auditory-visual hallucinations).
      - Medications are usually prescribed for short durations only.

Slide 3 of 4: Nursing (Therapeutic) Process

  • Assessments: Should describe behaviors, communications, anxiety, depression, social functioning, and the presence of amnesia.

  • Nursing Diagnoses: Relate to self-concept responses depending on identified issues.

  • Interventions: Aim to help clients examine their situations and associated feelings within a safe and supportive environment.

Slide 4 of 4: Challenges in Treatment

  • Complex Care Requirements: Treatment for individuals with dissociative disorders is multifaceted, demanding, and time-intensive.

  • Provider Challenges: Healthcare providers must navigate understanding the messages conveyed by dissociated individuals.

  • Trauma Backgrounds: Treating clients with histories of trauma can be particularly challenging, but ultimately rewarding.