NRNP 6655 Discussion Dissociative Disorders
NRNP 6655 Discussion Dissociative Disorders
Have you ever been driving and realized you don’t remember the last few minutes of driving? Or have
you gotten so wrapped up in a book or movie that you lose some awareness of your surroundings?
These are examples of common and very mild dissociation, or a disconnect or lack of continuity between
thoughts, feelings, actions, and sense of self.
There are three major dissociative disorders defined in the DSM-5: dissociative identity disorder,
dissociative amnesia, and depersonalization-derealization disorder. Dissociative disorders may be
associated with traumatic events in order to help manage difficult memories or experiences. Patients
with these types of disorders are likely to also exhibit symptoms of a variety of other dysfunctions, such
as depression, alcoholism, or self-harm and may also be more susceptible to personality, sleeping, and
This week, you will analyze issues related to the diagnosis and treatment of dissociative disorders as well
as associated legal and ethical considerations.
Analyze issues related to the diagnosis and treatment of dissociative disorders
Analyze legal and ethical considerations related to dissociative disorders
Required Readings (click to expand/reduce)
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.).
Chapter 12, “Dissociative Disorders”
Required Media (click to expand/reduce)
Osmosis. (2017, November 20). Dissociative disorders – causes, symptoms, diagnosis, treatment,
pathology [Video]. YouTube. https://youtu.be/XF2zeOdE5GY
Mad Medicine. (2019, August 18). Dissociative disorders (Psychiatry) – USMLE Step 1 [Video]. YouTube.
Grande, T. (2018, October 22). The dissociative identity disorder controversy (Trauma vs. Iatrogenic).
[Video]. YouTube. https://www.youtube.com/watch?v=zqTP0CP9aD
Dissociative disorders are mental disorders that involve experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity. People with dissociative disorders escape reality in ways that are involuntary and unhealthy and cause problems with functioning in everyday life.
Dissociative disorders usually develop as a reaction to trauma and help keep difficult memories at bay.
Symptoms — ranging from amnesia to alternate identities — depend in part on the type of dissociative disorder you have. Times of stress can temporarily worsen symptoms, making them more obvious.
Treatment for dissociative disorders may include talk therapy (psychotherapy) and medication. Although treating dissociative disorders can be difficult, many people learn new ways of coping and lead healthy, productive lives.
Signs and symptoms depend on the type of dissociative disorders you have, but may include:
- Memory loss (amnesia) of certain time periods, events, people and personal information
- A sense of being detached from yourself and your emotions
- A perception of the people and things around you as distorted and unreal
- A blurred sense of identity
- Significant stress or problems in your relationships, work or other important areas of your life
- Inability to cope well with emotional or professional stress
- Mental health problems, such as depression, anxiety, and suicidal thoughts and behaviors
There are three major dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association:
- Dissociative amnesia. The main symptom is memory loss that’s more severe than normal forgetfulness and that can’t be explained by a medical condition. You can’t recall information about yourself or events and people in your life, especially from a traumatic time. Dissociative amnesia can be specific to events in a certain time, such as intense combat, or more rarely, can involve complete loss of memory about yourself. It may sometimes involve travel or confused wandering away from your life (dissociative fugue). An episode of amnesia usually occurs suddenly and may last minutes, hours, or rarely, months or years.
- Dissociative identity disorder. Formerly known as multiple personality disorder, this disorder is characterized by “switching” to alternate identities. You may feel the presence of two or more people talking or living inside your head, and you may feel as though you’re possessed by other identities. Each identity may have a unique name, personal history and characteristics, including obvious differences in voice, gender, mannerisms and even such physical qualities as the need for eyeglasses. There also are differences in how familiar each identity is with the others. People with dissociative identity disorder typically also have dissociative amnesia and often have dissociative fugue.
- Depersonalization-derealization disorder. This involves an ongoing or episodic sense of detachment or being outside yourself — observing your actions, feelings, thoughts and self from a distance as though watching a movie (depersonalization). Other people and things around you may feel detached and foggy or dreamlike, time may be slowed down or sped up, and the world may seem unreal (derealization). You may experience depersonalization, derealization or both. Symptoms, which can be profoundly distressing, may last only a few moments or come and go over many years.