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Dissociative Disorders - Coggle Diagram
Dissociative Disorders
1. Introduction & Core Concept
· Definition: A disruption in the normal
integration
of consciousness, memory, identity, emotion, perception, or body representation.
· Core Cause: A protective survival mechanism against overwhelming trauma (especially in childhood).
· Spectrum:
· Normal: Daydreaming, highway hypnosis.
· Pathological: Chronic, involuntary, causes distress/impairment.
2. Key Features of Dissociation
· Amnesia: Inability to recall important personal information.
Depersonalization: Feeling detached from one's own mind or body (like an outside observer).
· Derealization: Feeling detached from the external world (surroundings seem unreal).
· Identity Alteration: The presence of two or more distinct personality states (alters).
3. Main Types of Dissociative Disorders
· Dissociative Amnesia:
· Core Symptom: Inability to recall traumatic or stressful information.
· Types: Localized (most common), Selective, or with Dissociative Fugue.
·Depersonalization/Derealization Disorder (DPDR):
· Core Symptom: Persistent/recurrent feelings of detachment from self (depersonalization) and/or surroundings (derealization).
· Reality Testing: Patient knows the feeling is not real.
· Dissociative Identity Disorder (DID):
· Core Symptom: Presence of two or more distinct identity states (alters) that take control of behavior.
· Required: Dissociative Amnesia (gaps in memory, "lost time").
· Switching: Transition between identity states, often triggered by stress.
4. Treatment & Management Principles
· Primary Goal: Stabilization, safety, and integration.
· Psychotherapy: Trauma-focused therapy (e.g., EMDR, parts work for DID) is essential.
· Core Skill: Grounding Techniques (to manage acute dissociation):
· Sensory (5-4-3-2-1): Name 5 things you see, 4 you can touch, 3 you hear, 2 you smell, 1 you taste.
· Cognitive: Mental tasks (counting backwards, naming capitals).
· Physical: Holding ice, splashing water, stomping feet.
5. Critical Nursing Role & Interventions
· Priority #1: Safety & Risk Management:
· High risk of self-harm and suicide. Conduct frequent assessments.
· Ensure a safe environment (remove sharp objects).
· Therapeutic Communication:
· Maintain Neutrality: Do not show favoritism to any alter; treat all as one person.
· Validate: Acknowledge the protective function of dissociation.
· Use Preferred Name: Use the patient's primary name unless a specific protocol is in place.
·
Documentation
:
· Be objective. Describe behaviors, triggers, and level of dissociation.
· Example: "Patient's voice and demeanor changed, now identifying as 'X'. Oriented to place but not time."
·Psychoeducation:
· Teach the patient that dissociation is a trauma-based coping mechanism to reduce shame.