02.05 Dissociative Disorders

Okay, so let’s talk about Dissociative Disorders, this is where we get into mental health disorders that are pretty rare, but it’s still important to know what to expect and how to care for these clients.

So, the textbook definition of Dissociative Disorders is a group of disorders in which conscious awareness is separated from previous thoughts, memories, or feelings. So, the best way to explain this is - have you ever been driving home from school or work and suddenly you’re home and you can’t even really remember how you got there or any specific turns you took? Those moments became disconnected from your conscious awareness. You were present, you were still doing the driving, but you weren’t conscious of it.

So here’s our client. And here’s all of their conscious existence - memories, thoughts, feelings - everything that kind of guides who they are and what they do on a daily basis. When they have a dissociative episode, it’s like it completely cuts off their conscious connection to this - like a big brick wall. They can’t consciously access it at all. So they’re completely disconnected from everything that made them who they were. So you may see a loss of memory or a complete change in identity.

So it’s thought to be an extreme coping mechanism for an extremely traumatic event. Think about how traumatic something would have to be for your brain to unconsciously dissociate with reality - like you HAVE to get away from it and completely disconnect from the situation. Keep that in mind because these clients may have some serious trauma in their lives.

So, there are four main types, so we want you to understand the basic differences between them. Again, this is very rare, but it’s important that you understand what your clients are going through and how to help them. The first is Dissociative Identity Disorder. In this case the client has two or more distinct personalities. So they’ll break from the reality of who they are and have another personality they jump into that has different thoughts, feelings, memories. Dissociative Amnesia is when they are unable to recall important information like their name or who they are or their family because of extreme anxiety. It’s just like the amnesia you’d see with a head injury, except it’s due to emotional trauma, not physical trauma. The next is Dissociative Fugue. This is when they develop an entirely new identity - new name, new story, new passions, everything. They have no memory of who they used to be, and the new identity becomes a coping mechanism. But more than that, some clients will literally leave their home and their family and start a completely new life because they truly believe they are now this new person, and have NO connection to the old one. Finally depersonalization disorder, also called derealization. This is when a client feels like they’re outside of their own body - they don’t recognize themselves in the mirror or feel like they’re in a foggy dream-like world. Their consciousness has disconnected from their physical body. If you check out the patient story attached to this lesson, the gentleman talks about what that’s like for him.

So when we start to talk about interventions for mental health disorders, you’ll start to see patterns develop, some of these apply to all disorders. Normally, we try not to give you a list of a dozen interventions - but in the case of mental health, many of them are safety related because the client’s conscious and rational thought may not be intact. So we always, always, always put safety first. Make sure they don’t have plans to harm themself or anyone else. We want to establish trust and rapport, and we want to orient them to reality as best we can. Remember that this disconnect and possibly new personality or identity is very real to them, so we don’t challenge too much, but we try to keep them in reality. We encourage them to explore their feelings and thoughts about the situation and we focus on their strengths, not their difficulties or struggles or what they aren’t getting right. We always want to start with simple tasks or simple requests and move to the more complex ones as they’re able. We want to promote healthy coping mechanisms and compliance with their therapy and meds if they’re on them. Being consistent will be the most helpful thing for their recovery. And of course we always want to involve the support system and make sure they have what they need.

As with other mental health disorders, priority nursing concepts are safety, coping, and mood / affect.

Let’s just recap - Dissociative Disorders are when a client’s conscious awareness is disconnected from their past thoughts, memories, and feelings. They are disconnected from the reality of who they were. This is usually an extreme coping mechanism for some sort of extreme anxiety or traumatic experience. There are four types - Dissociative Identity Disorder, or DID, Dissociative Amnesia, Dissociative Fugue, and Depersonalization Disorder. We want to make sure we establish trust, reorient them to reality, encourage their strengths and for them to explore their feelings, and support them with small tasks and healthy coping mechanisms - plus educating their support system. And, as always, safety first - always do a self-harm assessment and ask if they have a plan.

Okay, that’s it for Dissociative Disorders. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. And, as always, happy nursing!