Types of Dissociative Disorder

1. Dissociative Amnesia

This is a sudden inability to recall important personal information, particularly concerning a traumatic or stressful life event. The memory loss is too great to be explained by ordinary forgetfulness.

• Localized Amnesia: No memory of specific events that took place within a specific window of time (e.g., no memory of a car wreck itself).

• Selective Amnesia: Recall of only small parts of events that took place in a defined period of time (e.g., recalling only some parts of an abusive series of events).

• Generalized Amnesia: Patients cannot remember anything in their entire lifetime, including their own identity.

• Continuous Amnesia: Patients have no memory of events up to and including the present time.

• Systematized Amnesia: Loss of memory for a specific category of information (e.g., missing all memories about one specific family member).

2. Dissociative Fugue (Psychogenic Fugue)

This involves a sudden, unexpected travel away from home or the workplace, often with the assumption of a new identity and an inability to recall the past. The onset is sudden, often in the presence of severe stress. Following recovery, the patient has no recollection of the events that took place during the fugue. The course is typically brief (hours to days), but can last for months.

3. Dissociative Stupor

A rare condition in which patients are motionless and mute and do not respond to stimulation, yet they remain fully aware of their surroundings.

4. Ganser’s Syndrome

A rare condition characterized by four main features:

1. Giving ‘approximate answers’ to simple questions (e.g., answering $3 + 3 = 7$).

2. Psychogenic physical symptoms.

3. Hallucinations (usually visual and elaborate).

4. Apparent clouding of consciousness.

5. Dissociative Identity Disorder (DID) (Multiple Personality Disorder)

The person is dominated by two or more distinct personalities (called “alters”), of which only one is manifest at a time. Typically, one personality is not aware of the existence of the others. The transition from one personality to another is sudden, and the new behavior usually contrasts strikingly with the patient’s normal state.

6. Trance and Possession Disorders

This is common in various cultures and is characterized by a temporary loss of both the sense of personal identity and full awareness of the surroundings. When induced by religious rituals, the person may feel taken over by a deity or spirit.

Management and Interventions

Treatment Modalities

Treatment typically involves various forms of psychotherapy, as the role of drugs is limited unless managing comorbid anxiety or mood symptoms.

• Psychotherapy:

  • Free Association

  • Hypnosis (to access repressed memories)

  • Abreaction Therapy (to relive and express intense emotions tied to a trauma)

  • Supportive Psychotherapy

  • Behavior Therapy (e.g., aversion therapy, operant conditioning)

• Drug Therapy: Drugs have a limited role but may be used short-term (e.g., benzodiazepines) for anxiety.

Nursing Interventions

• Rule Out Organic Pathology: Monitor physician’s assessments and lab reports to ensure there is no underlying medical condition.

• Manage Disability Focus: Do not focus on the physical disability. Encourage the patient to perform self-care activities as independently as possible and only intervene when assistance is necessary.

• Discourage Manipulation: Do not allow the patient to use the disability as a manipulative tool to avoid participating in therapeutic activities. Withdraw attention if the patient continues to overly focus on physical limitations.

• Encourage Verbalization: Encourage the patient to verbalize fears and anxieties related to their conflicts.

• Positive Reinforcement: Provide positive reinforcement for the patient when they identify or demonstrate alternative, adaptive coping strategies.

• Goal Setting: Identify unresolved specific conflicts and assist the patient in setting realistic goals and identifying possible solutions for the future.