Dissociative Disorder

Dissociative disorder is a group of mental disorders characterized by disturbances in the functions of identity, memory, consciousness, or perception of the environment. It is associated with exposure to an extremely traumatic event.

Dissociative disorder includes dissociative amnesia, dissociative fugue, dissociative identity (multiple personality) disorder, and depersonalization disorder.

Dissociative Amnesia
Dissociative amnesia is the inability to recall important personal information because it is anxiety provoking. Memory impairment may be partial or almost complete.
There are three types of dissociative disorder:

1. Localized: block out all memories about specific period.
2. Selective: recalls some but not all memories about a specific period.
3. Generalized: loss of all memory about past life.

Dissociative Fugue

Dissociative fugue is a disorder in which client assumes a new identity in a new environment. It may be suddenly. The client may drift from place to place and develops few social relationships.

Dissociative Identity (Multiple Personality)
Two or more fully developed distinct and unique personalities exist within the person and may take full control of the client one at a time. This disorder is used as a method of distancing and defending self from anxiety and traumatic experiences. The transition from one personality to the other is related to stress and is sudden.

Depersonalization Disorder
Depersonalization disorder is an altered self perception in which client’s reality is temporally lost or changed. The client will have feelings of detachment and intact reality testing.

Specific Intervention for Dissociative Disorder Client:

• Develop a trust with the client.
• Encourage verbal expression of anxiety and concerns.
• Encourage client to explore methods of coping.
• Orient the client and identity sources of conflicts.
• Focus on the client’s strengths and skills.
• Use stress reduction techniques.
• Allow the client to progress at his or her own pace.
• Plan for individual, group, and family psychotherapy.

Bipolar Disorder

Bipolar disorder is an affective disorder characterized by the occurrence of alternating periods of euphoria (mania) and depression.

Signs and Symptoms Of Mania:

• Becomes angry quickly.
• Distracted by environmental stimuli.
• Extroverted personality
• Flights of idea
• Delusional self-confidence.
• Grandiose and persecutory delusions
• Inability to eat or sleep.
• High and unstable affect.
• Inappropriate dress.
• Inappropriate affect.
• Initiation of activity
• Restlessness
• Pressured speech
• Sexually promiscuous
• Unlimited energy
• Urgent motor activity
• Significant decrease in appetite

Signs and Symptoms Of Depression:

• Decreased emotion and physical activity
• Decrease in activities of daily living
• Easily fatigue
• Inability to make decisions
• Introverted personality
• Internalizing hostility
• Lack of initiative
• Lack of energy
• Lack of self-confidence
• Lack of sexual interest
• Withdrawn from groups

Interventions for maniac patients:

• Remove hazardous objects from the environment
• Assess the client closely for fatigue
• Promote sleep
• Provide rest periods
• Provide private room
• Hypnotic or sedative medication as prescribed
• Encourage the patient to ventilate feeling
• Calm and slow interaction
• Encourage patient to focus on one topic during conversation
• Ignore and distract patient from grandiose thinking
• Present reality to patient
• Do not argue with patient
• Provide high-calorie finger foods and fluids
• Reduce environmental stimuli
• Set limits on inappropriate behaviors
• Provide physical activities and outlets for tension
• Avoid competitive games
• Provide gross motor activities such as walking and writing
• Provide structured activities with nurse
• Provide simple and direct explanations for routine procedures
• Supervise the administration of medication

Deal With Aggressive Behavior Patients:

• Assist patient to identify feeling of frustration and aggression
• Encourage patient to talk out instead of acting out
• Assist patient in identifying precipitating events or situations lead to aggressive behavior
• Describe the consequences of the behavior on self and others
• Assist in identifying previous coping mechanism
• Assist in problem solving techniques.

Deal With De-escalation Techniques:

• Maintain safety for the patient, others and self
• Maintain a large personal space and use non-aggressive posture
• Calm in approaching and communicating
• Clear tone of voice, be assertive not aggressive
• Avoid verbal struggles
• Assist the patient with problem-solving and decision making
• Provide the patient with clear option

Deal With Manipulative Behaviors:

• Set clear, consistent, realistic and enforceable limits
• Communicate the expected behaviors
• Be clear with the consequences associated with exceeding limits
• Discuss the patient’s behavior in non-judgmental and non-threatening manner
• Avoid power struggles with the patients

Mental Health & Illness

DSM-IV-TR: Mental Illness/Disorder is defined as a clinically significant behavioral or psychological syndrome or pattern associated with distress or disability......with increased risk of death, pain, disability and is not a reasonable (expectable) response to a particular situation (APA 2000).

On the other hand Mental Health is defined as a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and cope with adversity. (US Surgeon General Report, Dec 1999).



There are six major categories of positive mental health (Marie Jahoda in 1958) :

1. Attitudes of individual toward self
2. Presence of growth and development, or actualization
3. Personality integration
4. Autonomy and independence
5. Perception of reality
6. Environmental mastery

The health person will accepts the self, self-reliant, and self-confident.