NCM 117 Final: Dissociative Disorders

Dissociative Disorders

• Defined by disruptions in consciousness, memory, identity, and environmental perception
• Interfere with relationships, daily life, and ability to cope with traumatic events
• Dissociation is a subconscious defense mechanism to protect oneself from recognizing the full effects of a traumatic event

Symptoms of Dissociative Disorders

• Memory loss (amnesia) of certain time periods, events, people, and personal information
• Sense of detachment from oneself and emotions
• Perception of people and things around them as distorted and unreal
• Blurred sense of identity
• Significant stress or problems in relationships, work, or other areas of life
• Inability to cope with emotional or professional stress
• Mental health problems, such as depression, anxiety, and suicidal thoughts and behaviors

3 Major Dissociative Disorders

• Dissociative Amnesia: inability to remember important personal information, usually of a traumatic or stressful nature
  • Fugue experience: sudden move to a new geographic location with no memory of past events and often assumption of a new identity
  • Three types of amnesia: localized, selective, and generalized
• Dissociative Identity Disorder (DID): formerly multiple personality disorder
  • Recurrently takes control of behavior, accompanied by inability to recall important personal information
  • "Core" identity is the person's usual personality, and "alters" are alternate personalities
  • Each alter has a particular set of behavior, attitudes, preferences, memories, and ways of thinking
• Depersonalization/Derealization Disorder
  • Persistent or recurrent feeling of being detached from mental processes or body (depersonalization)
  • A sensation of being in a dream-like state in which the environment seems foggy or unreal (derealization)

Causes of Dissociative Disorders

• Not specified

Treatment of Dissociative Disorders

• Psychotherapy: cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), hypnosis, and EMDR therapy
• No specific medications treat dissociative disorders, but medications may be used to treat co-occurring mental health conditions

Related Disorders

• Adjustment Disorder: reaction to a stressful event that causes problems for the individual
• Acute Stress Disorder: occurs after a traumatic event and is characterized by reexperiencing, avoidance, and hyperarousal

Nursing Interventions

• Promote client safety
• Assess for stressors
• Explore client's feelings
• Encourage methods for coping
• Enhance client's self-esteem

Anxiety and Anxiety Disorders

• Anxiety: a normal reaction to stress, but can be beneficial in some situations
• Anxiety Disorders: characterized by excessive fear or anxiety
• Types of anxiety disorders: separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, generalized anxiety disorder, and agoraphobia

HANS SELYE'S GENERAL ADAPTATION SYNDROME

• Alarm Reaction Stage: initial symptoms of stress, including the "fight-or-flight" response
• Resistance Stage: body begins to repair itself, releases a lower amount of cortisol
• Exhaustion Stage: result of prolonged or chronic stress, characterized by fatigue, burnout, depression, anxiety, and decreased stress tolerance

Levels of Anxiety

• Mild Anxiety: close to normal everyday worries and stress, sometimes referred to as situational anxiety
• Moderate Anxiety: more focused than mild anxiety, with symptoms such as stomach pains, racing heartbeat, and sweating
• Severe Anxiety: has much of the same symptoms as mild and moderate anxiety, with added symptoms of vomiting, chest pain, and a sense of dread or impending doom
• Panic Anxiety: the most intense level of anxiety, characterized by an inability to move or function, and a sense of impending doom

Etiology of Anxiety Disorders

• Genetic Theories: heritability of anxiety disorders, including panic disorder, social anxiety disorder, and specific phobias
• Neurochemical Theories: dysfunction of GABA, the body's natural antianxiety agent
• Psychodynamic Theories: overuse of defense mechanisms, and communication of anxiety to infants or children through inadequate nurturing
• Interpersonal Theory: caregivers can communicate anxiety to infants or children through inadequate nurturing
• Behavioral Theory: anxiety is learned through experiences, and people can change or "unlearn" behaviors through new experiences are the study notes for the text:
• Anxiety Disorders*

Techniques to Manage Anxiety

• Thought-stopping and distraction techniques to break the cycle of negative thoughts
• Techniques include:
  • Splashing face with cold water
  • Snapping a rubber band worn on the wrist
  • Shouting

Medications

• For Panic Disorder: BZ's, antihypertensive medications like Clonidine (Catapres) and Propranolol (Inderal)
• For GAD: Buspirone (Buspar) and SSRI or SNRI

Behavioral Therapies

• Systematic desensitization: therapist progressively exposes client to threatening object in a safe setting until anxiety decreases
• Flooding: rapid desensitization, therapist confronts client with phobic object until anxiety decreases
• Nursing Interventions*

For Clients with Anxiety

• Stay calm and non-threatening
• Assure client of safety
• Use simple and clear communication
• Provide a non-stimulating environment
• Administer medications as prescribed
• Recognize precipitating factors
• Encourage client to verbalize feelings

Points to Consider

• Remember that everyone occasionally suffers from stress and anxiety
• Avoid trying to "fix" the client's problem
• Discuss uncomfortable feelings with a more experienced nurse
• Practice techniques to manage stress and anxiety in your own life
• Obsessive-Compulsive and Related Disorders*

Definitions

• Obsessions: recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety or distress
• Compulsions: ritualistic or repetitive behaviors or mental acts to neutralize anxiety

Types of Disorders

• Obsessive-Compulsive Disorder (OCD)
• Trichotillomania
• Dermatillomania
• Hoarding
• Kleptomania
• Pyromania
• Oniomania
• Body Dysmorphic Disorder

Etiology

• Cognitive Theory: thoughts are overly important and need to be controlled
• Genetics: complex network of genes contribute to OCD risk
• Behavioral Factors: people who are extremely organized, neat, and meticulous may be at risk
• Personal Experience: severe trauma can lead to OCD

Diagnostic Criteria (DSM-5)

• Presence of obsessions, compulsions, or both
• Recurrent and persistent thoughts, urges, or images that cause anxiety or distress
• Attempts to ignore or suppress thoughts, urges, or images
• Repetitive behaviors or mental acts to neutralize anxiety
• Related Disorders*
• Excoriation Disorder (Skin-Picking Disorder)
• Trichotillomania (Hair-Pulling Disorder)
• Body Dysmorphic Disorder
• Hoarding Disorder
• Kleptomania
• Oniomania
• Body Identity Integrity Disorder (BIID)
• Treatment*
• Medication: SSRIs
• Behavioral Therapy:
  • Exposure
  • Response Prevention
  • Deep breathing and relaxation techniques
• Nursing Interventions for OCD*
• Offer encouragement, support, and compassion
• Gradually decrease time for client to carry out ritualistic behaviors
• Assist client to use "Exposure" and "Response Prevention" techniques
• Encourage client to manage and tolerate anxiety responses
• Assist client to complete daily routine and activities within agreed-upon time limits duk