This document discusses dissociative disorders including amnesia, dissociative fugue, dissociative identity disorder, and depersonalization disorder. It describes the assessment, nursing diagnoses, interventions, and education for patients with each disorder. Predisposing factors like trauma, genetics, and neurological conditions are also examined. Treatment approaches include removing stressors, psychotherapy, and in severe cases of dissociative identity disorder, long-term intensive psychotherapy.

1. Dissociative Disorders
Chapter 9

2. Introduction
• Dissociative disorders are defined by a disruption
in the usually integrated functions of
consciousness, memory, identity, or perception.
• Dissociative disorders are thought to be quite rare,
but when they do occur they may present a very
dramatic clinical picture of severe disturbance in
normal personality functioning.
• There is an increase in reported cases of amnesia.

3. Amnesia: Assessment
• Localized amnesia
– Inability to recall all incidents associated with the traumatic event for a
specific time period following the event.
• Selective amnesia
– Inability to recall only certain incidents associated with a traumatic
event for a specific period after the event.
• Continuous amnesia
– Inability to recall events occurring after a specific time up to and
including the present.
• Generalized amnesia
– Rare phenomenon of not being able to recall anything that has
happened during the person’s entire lifetime, including his or her
personal identity
• Systematized amnesia
– Person cannot remember events that relate to a specific category of
information, such as one’s family or on particular person or event.

4. Localized amnesia
• Assessment
• Nursing Diagnosis
• Nursing Intervention
• Patient and family Education

5. Selective amnesia
• Assessment
• Nursing Diagnosis
• Nursing Intervention
• Patient and family Education

6. Continuous amnesia
• Assessment
• Nursing Diagnosis
• Nursing Intervention
• Patient and family Education

7. Generalized amnesia
• Assessment
• Nursing Diagnosis
• Nursing Intervention
• Patient and family Education

8. Systematized amnesia
• Assessment
• Nursing Diagnosis
• Nursing Intervention
• Patient and family Education

9. Dissociative Fugue: Assessment
• Characteristic feature of dissociative
fugue is a sudden, unexpected travel
away from home or customary workplace
• A person in a fugue state unable to recall
personal identity, and assumption of a new
identity is common

10. Nursing Process
• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation

11. Dissociative Identity Disorder:
Assessment
• Characterized by the existence of two or more
personalities within a single individual
• Transition from one personality to another is
usually sudden, often dramatic, and
usually precipitated by stress

12. Nursing Process
• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation

13. Predisposing Factors
• Biological Theories
– Genetics
• Possible hereditary factor
– Organic
• Certain neurological conditions may predispose
individuals to DID
• Psychological Influences:History of Traumatic
Experience
• Sexual abuse, Psychological abuse andPhysical
abuse

14. Depersonalization Disorder
• Assessment: Characterized by a temporary
change in the quality of self-awareness that
often takes the form of:
– Feelings of unreality
– Changes in body image
– Feelings of detachment from the environment
– Sense of observing oneself from outside the body

15. • Symptoms of depersonalization disorder are
often accompanied by:
– Anxiety
– Fear of going insane
– Depression
– Obsessive thoughts
– Somatic complaints
– Disturbance in the
subjective sense of time
• Physiological theory
– Neurophysiological basis
• Psychodynamic theory
– Emphasizes the psychological conflict and
disturbances of ego structure in the predisposition to
depersonalization disorder

16. Nursing Process
• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation
• Client/Family Education

17. Treatment Modalities
• Dissociative amnesia
– Remove from stress
– Intravenous amobarbital
– Supportive psychotherapy
• Dissociative fugue
– Cognitive therapy
– Group therapy
– Family therapy

18. Treatment Modalities
• Dissociative identity disorder
– Intense long-term psychotherapy
• Depersonalization disorder
– Various regimens have been tried, although none
has proved widely successful.