Dissociative Disorders (Hysterical Neuroses, Dissociative Type)

1. Assessment:
   1. Dissociative amnesia: partial or total inability to recall the past; occurs during highly stressful events; client may have conscious desire to escape but be unable to accept escape as a solution; uses repression.
   2. Dissociative fugue: client not only forgets but also flees from stress.
   3. Dissociative identity disorder: client exhibits two or more complete personality systems, each very different from the other; alternates from one personality to the other without awareness of change (one personality may be aware of others); each personality has well-developed emotions and thought processes that are in conflict; uses repression.
   4. Depersonalization disorder: loss of sense of self; feeling of self-estrangement (as if in a dream); fear of going insane.
   
   
2. Analysis/nursing diagnosis:
   1. Sudden alteration in:
      1. Memory (short- and long-term memory loss: cannot recall important personal events) related to repression.
      2. Personal and social identity (amnesia: forgets own identity; becomes another identity) related to intense anxiety, childhood trauma/ abuse, threat to physical integrity, underdeveloped ego.
   2. Sensory/perceptual alteration of external environment related to repression and escapism.
   3. Confusion related to use of repression.
   4. Spiritual despair related to conversion of conflict into physical or mental flights.
   5. Altered meaningfulness (hopelessness, helplessness, powerlessness) related to lack of control over situation.
   
   
3. Nursing care plan/implementation:
   1. Remove client from immediate environment to reduce pressure.
   2. Alleviate symptoms using behavior-modification strategies.
   3. Divert attention to topics other than symptoms (not remembering names, addresses, and events).
   4. Encourage socialization rather than isolation.
   5. Avoid sympathy, pity, and oversolicitous approach.
   6. Health teaching: teach families to avoid reinforcing dissociative behavior; teach client problem solving, with goal of minimizing stressful aspects of environment.
   
   
4. Evaluation/outcome criteria: recall returns to conscious awareness; anxiety kept within manageable limits.