Dissociative Disorders - Chapter 24 Study Guide

Dissociative Disorders Chapter 24 Copyright © 2021 by Elsevier, Inc. All rights reserved. 1  Learning Objectives Lesson 24.1: Dissociative Disorders (Slide 1 of 2) 1. Examine the meaning of the term self‑concept. 2. Describe the continuu...

Dissociative Disorders Chapter 24 Copyright © 2021 by Elsevier, Inc. All rights reserved. 1  Learning Objectives Lesson 24.1: Dissociative Disorders (Slide 1 of 2) 1. Examine the meaning of the term self‑concept. 2. Describe the continuum of self-concept responses. 3. Compare the development of self-concept throughout the life cycle. 4. Classify the main characteristics of dissociative disorders. 5. Describe three types of dissociative disorders. Copyright © 2021 by Elsevier, Inc. All rights reserved. 2  Learning Objectives Lesson 24.1: Dissociative Disorders (Slide 2 of 2) 6. Explain the outstanding feature of a dissociative identity (multiple personality) disorder. 7. State the main goal of treatment for clients with dissociative disorders. 8. Plan three nursing diagnoses (problem statements) for clients with dissociative disorders. 9. Develop a care plan for a client who has been diagnosed with a dissociative disorder. Copyright © 2021 by Elsevier, Inc. All rights reserved. 3  Self-Concept ⬤Self Concept is defined as; The attitudes, notions, beliefs, and convictions that make up a person’s self- knowledge. ⬤Influenced by many factors ⮚ Culture in which you are born. ⮚ Society in which you live. ⮚ Attitudes/beliefs of parents, siblings, and other significant people. ⮚ Experiences in life shape and influence one’s picture of self. Copyright © 2021 by Elsevier, Inc. All rights reserved. 4  Self- Concept Responses ⬤People behave in a manner based on their self-concepts. ⬤Low self concept results in maladaptive behavior responses as the individual defines who they are. ⬤High self esteem and confidence provides the strength to handle anxieties and learn from life’s highs and lows. ⮚ They are satisfied with the roles they play in society Copyright © 2021 by Elsevier, Inc. All rights reserved. 5  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 Try to explore the limits of their abilities. They develop autonomy and a sense of self. When parents reactions are consistent, children develop a stable sense of who they are and a stable self concept. ⮚ School-age children Become aware of different perspectives on life. Children assess their skills and interactions with others and form a mental picture of themselves. If self concept is low adolescence is filled with anxiety and turmoil. Copyright © 2021 by Elsevier, Inc. All rights reserved. 6  Self-Concept Throughout the Life Cycle (Slide 2 of 4) ⬤Self-concept in adolescence ⮚ Early teen years Comfortable self-concept of childhood is challenged ⮞ Influenced by: – Relationships – Confidence – Sexual identity – Body image ⬤ Without love, nurturing and guidance from adults teens do not develop a comfortable self concept. ⬤ Teens will not be prepared to assume adult responsibilities because they are still trying to find themselves. Copyright © 2021 by Elsevier, Inc. All rights reserved. 7  Self-Concept Throughout the Life Cycle (Slide 3 of 4) ⬤Self-concept in adulthood ⮚ Adults with a strong, positive self-concept 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. Individuals are easily threatened and have increased anxiety. Copyright © 2021 by Elsevier, Inc. All rights reserved. 8  Self-Concept Throughout the Life Cycle (Slide 4 of 4) ⬤Self-concept in older adulthood ⮚ Several occurrences and situations can threaten a positive self-concept. ⮚ Ageism - the stereotyping of older adults as feeble, dependent and nonproductive contributes to self concept. ⮚ Health care providers can enhance clients’ feelings of self-worth through active listening and demonstration of concern. Copyright © 2021 by Elsevier, Inc. All rights reserved. 9  Dissociative Disorders ⬤Dissociation ⮚ Is an attempt to cope with deep-seated emotional anxiety or distress. ⮚ Individuals have low self-esteem is a common. ⬤Identity diffusion ⮚ Failure to bring childhood aspects into an effective adult personality. ⮚ Unsure of who they are because they were unable to build a picture of themselves. ⮚ The individual feels empty, anxiety, exploit others, problems with intimacy and lack morals and standards. Copyright © 2021 by Elsevier, Inc. All rights reserved. 10  Characteristics of Dissociative Disorders ⬤Is an involuntary escape from reality by disconnecting between thoughts, consciousness and memory, such as day dreaming. ⬤The Disorders arises from two sources. ⮚ Amnesia or fugue (problem lies with memory or consciousness) ⮚ Dissociative identity disorder (problem lies with one’s identify) multiple personalities Copyright © 2021 by Elsevier, Inc. All rights reserved. 11 Depersonalization/Derealization Disorder ⬤Depersonalization: ⮚ During an episode one feels detached or unconnected to self (detached from body). ⮚ Response to severe anxiety. ⮚ Serves as a defense mechanism and can become a maladaptive behavior. ⬤Derealization: ⮚ Involves a detachment and feelings of unreality in relation to one’s surroundings ⮚ Serve as defense mechanisms, which become maladaptive behaviors. Copyright © 2021 by Elsevier, Inc. All rights reserved. 12  Dissociative Amnesia ⬤Amnesia ⮚ Loss of memory ⬤Dissociative amnesia ⮚ Characterized by an inability to remember personal information that cannot be explained by ordinary forgetfulness. ⮚ Its an attempt to avoid extreme stress by blocking memories from consciousness. Example a rape, the victim feels emotionally numb and depressed. Copyright © 2021 by Elsevier, Inc. All rights reserved. 13  Dissociative Fugue ⬤Is 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, to protect the individual. Copyright © 2021 by Elsevier, Inc. All rights reserved. 14 Dissociative Fugue 15  Dissociative Trance Disorder ⬤In many cultures, trances are expressions of spiritual or religious beliefs. ⬤Cultural trances are entered 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” Copyright © 2021 by Elsevier, Inc. All rights reserved. 16  Dissociative Identity Disorder (DID) ⬤Presence of two or more personalities that repeatedly take control of an individual’s behavior. ⬤Formerly called multiple personality disorder. ⬤Essential feature is presence of other personalities. Copyright © 2021 by Elsevier, Inc. All rights reserved. 17  Dissociative Identity Disorder (DID) ⬤The individual has a personal history of time lossed. ⬤Unexplained possessions. ⬤Changes in relationships. ⬤Out of body experiences. ⬤Patterns of speech and actions, which one does not have control over. ⬤Each personality is unique and represents the individual at a different developmental stage and serves a protective purpose. 18 Dissociative Identity Disorder (DID) ⬤The primary personality (host) may or may not be aware of the other personalities (called alters). ⬤The transition from one personality to the other is sudden and related to stress. ⬤Identities may cooperate but often attempt to take control and refuse to share knowledge. ⬤Main goal of treatment is helping the client combine the personalities into one functional individual. 19  Therapeutic Interventions (Slide 1 of 4) ⬤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. ⮚ Most effective results are seen when clients are able to work with stable, established and experienced multidisciplinary treatment teams. Copyright © 2021 by Elsevier, Inc. All rights reserved. 20  Therapeutic Interventions (Slide 2 of 4) ⬤Treatments and therapies begin with assessment and stabilization. ⬤Assessment: ⮚ History, symptoms, support systems, relationships, medical status, substance abuse, sleeping and eating disorders. ⬤Stabilization: ⮚ The client reveals his/her complexities, plan for stabilization is jointly developed. ⬤After stabilization the next phase is to Revisit and rework past traumas. ⬤Pharmacologic therapy: ⮚ No specific medication, prescribed for short periods. Treatment is based on symptoms. Copyright © 2021 by Elsevier, Inc. All rights reserved. 21  Therapeutic Interventions (Slide 3 of 4) ⬤Nursing (therapeutic) process: ⮚ Assessments describes the client’s behaviors, communication, anxiety, depression, and social functioning, and presence of amnesia. ⮚ Expected outcome is to be able to obtain maximum level of effective functioning and self actualization. ⮚ Interventions are directed at helping them examine their situation and related feelings within an environment of safety and support. This process assists the growth of personal insight, which is the first step to making behavioral changes Copyright © 2021 by Elsevier, Inc. All rights reserved. 22  Therapeutic Interventions (Slide 4 of 4) ⬤Nursing (therapeutic) process ⮚ Care and treatment of individuals with dissociative problems are complex, time-consuming, and challenging. ⮚ Health care providers are challenged with accepting and understanding the messages sent by dissociated individuals. ⮚ Treatment of clients with backgrounds of trauma is often frustrating, but can be rewarding. Copyright © 2021 by Elsevier, Inc. All rights reserved. 23 Copyright © 2021 by Elsevier, Inc. All rights reserved. 24