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.
 Types
of
Dissociation
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,
such as seeing yourself as
if watching a movie.
3) Derealisation

The world around you

seems unreal. You may
see objects changing in
shape, size or color, 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 behavior in
ways that others could
notice. For instance, you
may be very different at
work from when you are at
home.
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
 FPREDISPOSING ACTORS
1) Genetic
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
Frued (1962) believed that Dissociative Behaviors 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 - repeated physical or sexual
abuse, emotional abuse or neglect.
 Cont…….
 Unpredictable or frightening family environments may also

cause the child to ‘disconnect’ from reality during times of

stress.

 It seems that the severity of the dissociative disorder in

adulthood is directly related to the severity of the childhood
trauma.

 Traumatic events that occur during adulthood may also

cause dissociative disorders. Such events may include war,
torture or going through a natural disaster.
Types Of Dissociative Disorder
 Dissociative Amnesia

 Dissociative Fugue

 Depersonalization Disorder

 Dissociative Identity Disorder

 Trance & possession Disorder

 Ganser’s Syndrome
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.
Amnesia is not ordinary forgetfulness, such as forgetting
someone’s name or where you left your car keys. Memory loss in
amnesia is more profound or wide ranging. Dissociative amnesia
is divided into five distinct types of memory problems.

1. Localised amnesia

2. Selective amnesia

3. Generalised amnesia

4. Continuous amnesia

5. Systematised amnesia
Differential diagnosis
Amnestic disorder due to general medical
condition
Dissociative fugue and dissociative identity
disorder
Post traumatic stress and acute stress disorder
Substance related amnesia
Delirium, dementia and other amnestic disorder
 Dissociative Fugue
(Psychogenic Fugue)
It is characterized by a
sudden, unexpected travel
away from home or
accompanied by an
inability to recall one’s
past and confusion
about personal identity.
Differential diagnosis
Mania
schizophrenia
Depersonalization
Disorder
 persistent or recurrent
feeling of being detached
from one’s own mental
processes or body.
Cont……
 Individuals relate feeling as if they are watching their
lives from outside of their bodies, similar to watching
a movie .

 In severe cases, the person cannot recognize

themselves in a mirror
 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 behavior, 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.
 Unspecified
Dissociative Disorders
Dissociative trance disorder
It is manifested by a temporary marked alterations in the
state of consciousness or by loss of the customary sense of
personal identity without the replacement by an alternate
sense of identity.
Possession trance
It is a variant of dissociative trance and involves single or
episodic alterations in the state of consciousness,
characterised by the exchange of persons identity with new
identiy usually attributed to a spirit or divine power.
Brainwashing
In DSM V this dissociative disorder is described as identity
disturbances due to prolonged and intense coercive
persuasion.
It implies that under conditions of adequate stress and
duress individuals can be made to comply with the
demands of those in power, thereby undergoing major
changes
Recovered memory syndrome
Under hypnosis or during psychotherapy a patient may
recover a memory or a painful experience or conflict-
particularly of sexual or physical abuse- that is etiologically
significant.
If the event recalled never really happened but the person
believes it to be true and reacts accordingly, it is known as
false memory syndrome.
Ganser Syndrome (hysterical pseudo dementia)
Giving approximate answer to question or providing
nonsensical or wrong answers to questions. The answers
given, usually so close to the question as to reveal that
the patient has understood the question. Also called -
nonsense syndrome , balderdash syndrome,
syndrome of approximate .
Clinical features of dissociative
disorder
Affect
 Feeling disconnected from yourself

 Feeling of loss of identity

 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

Perceptual

 May be auditory & visual

hallucination

 Confusion regarding one’s sexuality

 Difficulty distinguish self from others

 Dreamlike view of the world

 Disturbed body image

 Unable to recognize self image in

mirror
Cognitive
Confusion

Distorted thinking

Disturbance of memory

Impaired judgment

Presence of separate
personalities within the same
person

Time disorientation
Complications
 Life difficulties such as broken relationships and job
loss

 Sleep problems such as insomnia

 Sexual problems

 Depression

 Mood swings
• Anxiety

Panic attacks

Suicidal thoughts & feelings

Self-harm

Headache

eating disorder

Phobia & obsessive compulsive

disorder
TREATMENT MODALITIES
Psychopharmacology
Clinicians report some success with SSRI, TCA and MAO
antidepressants, beta blocekers, clonidine and
anticonvulsants and benzodiazepines in reducing intrusive
symptoms, hyperarousal, and anxiety in patients with DID.
Psychotherapy
Hypnosis
Cognitive Therapy
Expressive And Occupational Therapy
Group Therapy
Family Therapy
Pharmacologically facilitated interviews.

Electroconvulsive Therapy
NURSING MANAGEMENT
Nursing diagnosis
1) Disturbed thought process related to memory loss & repressed
trauma as evidenced by inability to recall his /her personal
information.

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.
EVALUATION
1) Which type of disorder is this ??????????????

3
Cont…
2) What is dissociative fugue ?

3) What is Ganser’s syndrome ?

Reference
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.net