LESSON PLAN

ON
Dissociative Disorder

Submitted to :
Submittted by :
Mr.Muthuvenkatachalam.S Ms. Ekata
Asst. Professor M.Sc
Nursing, Ist yr
HCN,SRHU
HCN,SRHU

LESSON PLAN

Name of student teacher Ms. Ekata

Subject Mental Health Nursing

Topic Dissociative Disorder

Group B.Sc Nursing 3rd year

Date/Time 25.5.2014

Venue LT-3

A.V Aids Power point, Chalk and board

Method of teaching Lecture-cum-discussion

Duration of teaching 1 hour

Previous knowledge: Students have some knowledge related to the topic.

General objective:
At the end of teaching students will be equipped with the knowledge regarding dissociative disorder, its types,clinical features, Diagnostic
evaluation, and nursing management of dissociative disorder .

Specific objectives:
At the end of teaching students will be able to:

 Introduce dissociative disorder

 define dissociation & dissociative disorder
 to describe the classification of dissociative disorder
 list down the clinical features of dissociative disorder.
 To explain the psychopharmacology & nursing management
TIM SPECIFIC CONTENT EVALUATIO
E OBJECTIVES TEACHING/LE N
ARNING
ACTIVITY
AV AIDS
Students will be INTRODUCTON
able to introduce
Dissociation . Dissociation is a mental process involving changes in normal
memory and attention that lead to changes in the availability and
accessibility of memory. Under normal conditions people are able
to recall most everything they experience. By contrast, Explained with
dissociative people may be unable to recall memories for events PowerPoint
that they experienced while dissociated.
What do you
Dissociation
mean by
Dissociation is a mental process where a person disconnects from dissociation?
their thoughts, feelings, memories or sense of identity.

Types of Dissociation:

1- amnesia
2- Derealisation
3- Depersonalization
 4- Identity confusion
5- Identity alteration
1) Amnesia: Amnesia refers to the inability to recall
important personal information that is so extensive that it is
not due to ordinary forgetfulness, or when you can’t
remember incidents or experiences that happened at a
particular time. (Maldonado et al., 2002)

2) Depersonalization: A feeling that your body is unreal,

changing or dissolving. It also includes out-of-body experiences,
Explained with the
such as seeing yourself as watching a movie. help of PowerPoint.

3) Derealisation:
The world around you seems unreal. You may see objects
changing in shape, size or colour, or you may feel that other
people are robots.

4) Identity confusion : Feeling uncertain about who you are.

You may feel as if there is a struggle within to define yourself.

5) Identity alteration: This is when there is a shift in your role

or identity that changes your behaviour in ways that others could
Students will be notice. For instance, you may be very different at work from
able to define the when you are at home.
dissociative Define Dissociative
disorder. Disorder.
DISSOCIATIVE DISORDER- Dissociative disorders are
condition that involve disruption or breakdown of memory ,
 awareness, identity or perception.

EPIDEMIOLOGICAL STATISTICS:

 Some studies indicate that dissociation occurs

approximately 5% - 30% in general population.
 More frequently in women > men
 More frequently in adolescent & young adults > older age
group
 A higher prevalence occurs in lower socio-economic
group, in rural population & among with less educative.
 Dissociative Identity Disorder occurs 3 – 9 times more
frequently in women > men
Students will be
able to describe PREDISPOSING FACTORS : What are the
the predisposing predisposing
factors of 1)Genetic factors of
dissociative
dissociative Discussed with PPT.
disorder?
disorder. DID is more common in 1st degree relatives with this disorder
than general population.

2)Neurobiological

Some studies have suggested a possible link between Dissociative

Identity Disorder & certain neurological conditions like-Epilepsy
and severe migraine Headache etc.
 3) Psychodynamic Theory

Freud (1962) believed that Dissociative Behaviour occurs when

individuals repressed distressing mental contents from conscious
awareness.

4 ) Psychological Trauma

Most mental health professionals believe that the underlying

cause of dissociative disorders is chronic trauma in childhood like Discussed with
- repeated physical or sexual abuse, emotional abuse or neglect. PPT.

 Unpredictable or frightening family environments may

also cause the child to ‘disconnect’ from reality during What are the
times of stress. types of
 It seems that the severity of the dissociative disorder in dissociative
adulthood is directly related to the severity of the . disorder?
childhood trauma.
Students will be
 Traumatic events that occur during adulthood may also
able to list down Power point
cause dissociative disorders. Such events may include war, presentation
the types of
Dissociative
torture or going through a natural disaster.
Disorder.
Types Of Dissociative Disorder:

1) Dissociative Amnesia
2) Dissociative Fugue
3) Depersonalization Disorder
4) Dissociative Identity Disorder
 5) Trance & possession Disorder
6) Ganser’s Syndrome

1) Dissociative Amnesia (Psychogenic Amnesia):

It is characterized by an inability to recall important personal

information, usually of a traumatic or stressful nature, that is too
extensive to be explained by ordinary forgetfulness.

 This type of amnesia can last from a few days to one or

more years.
Discussed with PPT.
2) Dissociative Fugue (Psychogenic Fugue):

It is characterized by sudden, unexpected travel away from home

or accompanied by an inability to recall one’s past and confusion
about personal identity.

For example, you may abruptly leave home or work and travel
away, forgetting who you are and possibly adopting a new
identity in a new location.

3) Depersonalization Disorder: persistent or recurrent feeling of

being detached from one’s own mental processes or body.

 Individuals relate feeling as if they are watching their lives

from outside oftheir bodies, similar to watching a movie .
 In severe cases, the person cannot recognize themselves in
 List down the
a mirror equipments
required for ECT?
4) Dissociative identity disorder:(multiple personality disorder)

It is characterized by "switching" to alternate identities when you

. are under stress that is the coexistence of two or more personality
states within the same person.

While the different personality states influence the person’s

behaviour, the person is usually not aware of these personality
states and experiences them as memory lapses.

The time required to switch from one identity to another is

usually a matter of seconds but less frequently.

5) Trance & Possession Disorder :

This disorder is very common in India. Possession trance is

characterized by a transient alteration in identity whereby one's
normal identity is temporarily replaced (possessed) by a spirit,
ghost, or other person.

The experience of being "possessed" by another entity, such as

a person, god, demon, animal, or inanimate object, holds different
meanings in different cultures .

Clinical Features:
  Loss of control over one's actions.
Behaviour change or acting differently.
Loss of awareness of surroundings.
Loss of personal identity.
Change in tone of voice.
Wandering attention.
Trouble concentrating.
Students will be Loss of sense of time.
able to list down Loss of memory.
the clinical Belief that one's body changed in appearance
features of
dissociative 6) Ganser;s Syndrome : (hysterical pseudo dementia)
disorder.
Giving approximate answer to question or providing nonsensical
or wrong answers to questions. The answers given, usually so Discussed with PPT.
close to the question as to reveal that the patient has understood
the question. Also called - nonsense syndrome , balderdash
yndrome, syndrome of approximately .

Clinical features of dissociative disorder

 Feeling disconnected from yourself

 Feeling of loss of identity Discussed with PPT.
 Feeling of insecurity , inferiority , fear & shame
 Feeling of unreality of the world
 Inability to drive pleasure
 Heightened sense of isolation
 Lack of spontaneity of inner continuity
 BEHAVIORAL

 Blunted affect
 Lack of spontaneity
 Loss of impulse control
 Emotional passivity
 Idiosyncratic communication
 Loss of decision – making ability
 Social withdrawal

PERCEPTUAL

 May be auditory & visual hallucination Discussed with chalk

 Confusion regarding one’s sexuality and board.
 Difficulty distinguish self from others
Students will be  Dreamlike view of the world
able to list down  Disturbed body image
the complications  Unable to recognize self image in mirror
of dissociative
disorder. COGNITIVE

 Confusion
 Distorted thinking
 Disturbance of memory
 Impaired judgment
 Presence of separate personalities within the same
person
 Time disorientation
 COMPLICATION:

 Life difficulties such as broken relationships and job loss

 Sleep problems such as insomnia
 Sexual problems
Students will be  Depression
able to describe  Mood swing & Anxiety
the treatment  Panic attacks
plan.  Suicidal thoughts & feelings
 Self-harm
 Headache
 eating disorder
 Phobia & obsessive compulsive disorder

Diagnostic Criteria for dissociative disorder:

 Firstly rule out physical disorders & substance abuse

 Standard tests including-
- dissociation experiences scale
- dissociative disorder interview scale What do you
 ICD10 criteria understand by this
depiction
TREATMENT MODALITIES: regarding ECT?

1) Psychopharmacology Treatment

 Although there are no medications that specifically treat What do you

understand by this
 depiction
dissociative disorders. But the doctor may prescribed – regarding ECT?

- antidepressants
-anti-anxiety medications or
-tranquilizers

 help to control the symptoms associated with dissociative

disorders.

2) Psychotherapy

Psychotherapy is the primary treatment of dissociative disorder.

This is very effective treatment.
 A safe environment
 Hypnosis Discuss about the
 Art therapy nursing
 Cognitive therapy management.
 Supportive psychotherapy
 Behaviour therapy
 Abreaction therapy
 Counselling
 Free Association

NURSING MANAGEMENT:

Assessment

-Physical assessment
 -psychological test
-Collect information related to childhood trauma
-Physical assessment with psychosocial assessment to
determine behavioural alterations

Nursing diagnosis

1) Disturbed thought process related to memory loss & repressed

trauma as evidenced by inability to recall his /her personal
Students will be information.
able to summarize
the topic. 2) Ineffective individual coping related to loss of identity or travel
away from home as evidenced by inability to use available
Sources.

3)Personality identity disturbance related to childhood trauma or

more than one personality state as evidenced by inability to
Maintain complete perception of self or runaway from home.

WHEN TO SEE A DOCTOR:

If you or someone you love has significant, unexplained

memory loss or experiences a dramatic change in
behaviour when under stress, talk to a doctor.
A chronic sense that your identity or the world around
you is blurry or unreal also may be caused by a
Dissociative disorder. Effective treatment is available for
These conditions. Seek medical help.
If someone or child experiences abuse or another
 traumatic situation, talk to a doctor as soon as
possible. Early intervention and counselling may help
prevent the formation of dissociative disorders.

Conclusion: Dissociation is a mental process involving

changes in normal memory and attention that lead to changes
in the availability and accessibility of memory. Under normal
conditions people are able to recall most everything they
experience. By contrast, dissociative people may be unable to
recall memories for events that they experienced while
dissociated.

EVALUATION

1) Which type of disorder is this ?

2) What is dissociative fugue ?
3) What is Ganser’s syndrome ?

ASSIGNMENT ON:

Care of multiple personality disorder patient

Bibliography:

 Sreevani. R, a guide to mental health and psychiatric

nursing, 3rd edition , jaypee brothers Medical Publishers ,
page no. 184-188
 Townsand Merry C, psychiatric mental health nursing 5th
edition , pg no : 669-698
 Gail Stuart W, principles of psychiatric nursing 8th
edition , pg no – 262 – 287
 www. Medline.com.
 www.mentalhelp.netCare of multiple personality disorder