Dissociative Disorders

Self-Concept

  • Definition: All attitudes, notions, beliefs, and convictions that make up a person’s self-knowledge.
  • Impact of Low Self-Concept: Leads to maladaptive behavioral responses.
  • Influencing Factors:
    • Culture and society.
    • Attitudes and beliefs of parents, siblings, and significant others.
    • Experiences.

Continuum of Self-Concept Responses

  • Behaviors are largely based on self-concepts.
  • Behavioral responses related to self-concept exist on a continuum.
  • Healthy Personality:
    • Individuals can effectively perceive and function within their world.
    • Individuals can struggle with life’s problems while feeling good about living.

Self-Concept Throughout the Life Cycle

  • 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.
  • Adolescence:
    • Early teen years: Comfortable self-concept of childhood is challenged.
    • Influenced by relationships, confidence, sexual identity, and body image.
  • Adulthood:
    • Strong, positive self-concept: Allows for free exploration of the environment due to a background of success and effectiveness.
    • Low self-concept: Leads to viewing oneself as inadequate or incapable.
  • Older Adulthood:
    • Many occurrences and situations can threaten a positive self-concept.
    • Health care providers can enhance older clients’ feelings of self-worth through active listening and demonstration of concern.

Dissociative Disorders

  • Dissociation: An attempt to cope with deep-seated emotional anxiety or distress.
  • Low Self-Esteem: A common component of many mental health problems.
  • Identity Diffusion: Failure to bring various childhood identifications into an effective adult personality.

Characteristics of Dissociative Disorders

  • Becoming more common in the United States.
  • Arise from two sources:
    • Amnesia or fugue (problem lies with memory or consciousness).
    • Dissociative identity disorder (problem lies with one’s identity).

Depersonalization/Derealization Disorder

  • Response to severe anxiety associated with blocking of awareness and fading of reality.
  • Serves as a defense mechanism and can become a maladaptive behavior.
  • Derealization: Involves detachment and feelings of unreality in relation to one’s surroundings.
  • Commonly associated with other mental disorders.

Dissociative Amnesia

  • Amnesia: Loss of memory.
  • Dissociative Amnesia: Characterized by an inability to remember personal information that cannot be explained by ordinary forgetfulness.
  • Most memory lapses are related to extremely stressful events.

Dissociative Fugue

  • Sudden, unexpected travel with an inability to recall the past.
  • Occurs in response to an overwhelmingly stressful or traumatic event.
  • Extreme expression of the fight-or-flight mechanism, engaged to protect the individual.

Dissociative Trance Disorder

  • Cultural trances are entered into voluntarily and cause no distress or harm to the individual; individuals do not lose their identity during trances.
  • Dissociative Trance Disorder: Occurs when trances cause “clinically significant distress or functional impairment.”

Dissociative Identity Disorder (DID)

  • Presence of two or more identities or personalities that repeatedly take control of an individual’s behavior.
  • Formerly called multiple personality disorder.
  • Presence of other personalities within one individual.
  • Each personality is unique and represents the individual at a different developmental stage.

Therapeutic Interventions

  • Treatment for dissociative disorders involves long-term therapy provided in an outpatient setting.
  • Hospitalization is required only if:
    • Anger, aggression, or violence is directed toward self or others and presents a danger.
    • Individuals are unable to function because of memory loss, rapid switching between identities, flashbacks, or overwhelming emotions.
    • Medications must be evaluated or adjusted.
  • Treatments and therapies:
    • Assessment
    • Stabilization
    • Revisit and rework past traumas
    • Pharmacologic therapy
    • Treatment often is based on symptoms
    • All medications are prescribed only for short periods
  • Nursing (therapeutic) process:
    • Assessments should describe the client’s behaviors, communications, anxiety, depression, and social functioning, along with the presence of amnesia.
    • Nursing diagnoses for clients are related to self- concept responses and depend on clients’ identified problems.
    • Interventions are directed at helping them examine their situation and related feelings within an environment of safety and support.
    • Care and treatment of individuals with dissociative problems are complex, time-consuming, and challenging.
    • Health care providers are challenged with the twin tasks of accepting and understanding the messages sent by dissociated individuals.
    • Treatment of clients with backgrounds of trauma is often frustrating, but can be extremely rewarding.