1. Dissociative Disorders
Chapter 24
Dissociative Disorders
Copyright © 2013 by Elsevier Inc. All rights reserved.

2. Copyright © 2013 by Elsevier Inc. All rights reserved.
Learning Objectives
Examine the meaning of the term self‑concept.
Describe the continuum of self-concept responses.
Compare the development of self-concept throughout the life cycle.
Classify the main characteristics of dissociative disorders.
Describe four types of dissociative disorders.
Copyright © 2013 by Elsevier Inc. All rights reserved.

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Learning Objectives
Explain the outstanding feature of a dissociative identity (multiple personality) disorder.
State the main goal of treatment for clients with dissociative disorders.
Plan three nursing diagnoses for clients with dissociative disorders.
Develop a care plan for a client who has been diagnosed with a dissociative disorder.
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4. Continuum of Self-Concept Responses (p. 274)
Range of behavioral responses related to self-concept can be seen as occurring on a continuum.
Self-concept
All of the attitudes, notions, beliefs, and convictions that make up a person’s self-knowledge
Low self-concept results in maladaptive behavioral responses.
Self-concept develops over time. Small fluctuations are normal, based on life experiences.
How does self-concept form the frame of reference from which people view the world? (It is the sum of several personality components, such as body image, self-esteem, self-ideal, personal identity, and role performances.)
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5. Continuum of Self-Concept Responses cont’d. (p. 274)
Healthy personality
Individuals with a healthy personality are able to effectively perceive and function within their world.
Individuals with a healthy personality are able to struggle with life’s problems while feeling good about living.
People who have developed healthy personalities have learned effective coping and social skills, which help them deal with life’s challenges. They are said to be resilient.
Mental health problems arise when these skills are not learned, and negative, self-defeating behaviors become coping mechanisms.
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6. Self-Concept Throughout the Life Cycle (p. 275)
Self-concept in childhood
Infants
Learn to trust others when their needs are consistently met
Toddlers
Try to explore the limits of their abilities
School-age children
Become aware of different perspectives on life
Toddlers need consistent behavior from their parents as they test their parents’ limits. While they are learning what is acceptable and what is not, positive reinforcement encourages the development of a healthy self-concept.
School-age children learn the limits of acceptable behavior with the addition of new rules and limitations outside of their home environment.
Consistency from teachers becomes important. Children who are bullied at school can begin to develop a negative self-concept.
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7. Self-Concept Throughout the Life Cycle cont’d. (p. 275)
Self-concept in adolescence
Early teen years
Comfortable self-concept of childhood is challenged.
Influenced by
Relationships
Confidence
Sexual identity
Body image
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8. Self-Concept Throughout the Life Cycle cont’d. (p. 275)
Self-concept in adulthood
Adults with a strong, positive self-concept can freely explore their environment because they have a background of success and effectiveness.
Adults with a low self-concept view the self as inadequate or incapable.
Choices in careers and relationships are related in terms of where an adult falls on the continuum of self-concept responses.
Decreased productivity and independence, failing health, and death of loved ones can challenge how a person has defined himself or herself throughout life.
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9. Self-Concept Throughout the Life Cycle cont’d. (p. 276)
Self-concept in older adulthood
In later life, 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.
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10. Dissociative Disorders (p. 276)
Dissociation
An attempt to cope with deep-seated emotional anxiety or distress
Low self-esteem is a common component of many mental health problems.
Identity diffusion
Failure to bring various childhood identifications into an effective adult personality
Dissociation is a coping mechanism. It ranges from normal behaviors (such as a “mini escape” of daydreaming) to extreme behaviors that interfere with daily activities and progress to a mental disorder.
How can the care provider identify a patient suffering from a dissociative disorder? What are several signs and symptoms?
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11. Depersonalization Disorder (p. 277)
Response to severe anxiety associated with blocking of awareness and fading of reality
Serves as a defense mechanism and can become a maladaptive behavior
Clients often describe their experiences as watching themselves in a movie or floating above their bodies.
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12. Dissociative Amnesia (p. 278)
Loss of memory
Dissociative amnesia
Characterized by an inability to remember personal information that cannot be explained by ordinary forgetfulness
Most of these memory lapses are related to extremely stressful events.
The inability to put all of the pieces together can be very frustrating and even frightening for clients suffering from dissociative amnesia.
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13. Dissociative Fugue (p. 278)
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
Clients often appear as normal to new individuals they meet. How should a care provider assess whether a patient is experiencing a dissociative disorder?
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14. Dissociative Trance Disorder (p. 279)
Cultural trances are entered into voluntarily and cause no distress or harm to the individual.
During trances, individuals do not lose their identity.
Dissociative trance disorder
Occurs when trances cause “clinically significant distress or functional impairment”
A client often has no memory of the trance, especially when they experience a possession trance.
What therapeutic interventions would benefit a client with a dissociative trance disorder?
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15. Dissociative Identity Disorder (p. 279)
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.
What outstanding feature stands out in a dissociative identity (multiple personality) disorder?
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16. Therapeutic Interventions (p. 280)
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
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17. Therapeutic Interventions cont’d. (p. 280)
Treatments and therapies
Assessment
Stabilization
Revisit and rework past traumas
Pharmacological therapy
Treatment often is based on symptoms.
All medications are prescribed only for short periods.
Define the main goal of treatment for clients with a dissociative disorder.
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18. Therapeutic Interventions cont’d. (p. 281)
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.
List three nursing diagnoses for clients with a dissociative disorder.
Develop a care plan for a client in whom a dissociative disorder has been diagnosed.
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Question 1
According to Erikson, during the infant stage of development, what must infants learn?
Trust
Autonomy
To form mental pictures of themselves
To form strong, positive self-concepts
Correct Answer: 1
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Question 2
The nurse is caring for a school-age child. According to Erikson, what developmental task is this child trying to accomplish?
Autonomy
To form a mental picture of himself
To form a strong, positive self-concept
To define himself
Correct Answer: 2
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Question 3
The nurse is taking care of a client who has an inability to remember personal information that cannot be explained by ordinary forgetfulness. The client’s condition is known as what?
Dissociation
Dissociative amnesia
Trance
Dissociative identity disorder
Correct Answer: 2
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Question 4
The nurse is working in a mental health facility. Her client is in a state that resembles sleep. The client is conscious, but voluntary movement is lost. The client’s condition is known as what?
Dissociative identity disorder
Identity diffusion
Trance
Dissociative amnesia
Correct Answer: 3
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