Dissociative and Conversion Disorder and its associated types

Dissociative Disorder
Prof. (Dr.) Rahul Sharma
Professor
HOD of Mental Health Nursing
Ph.D. coordinator
Seedling School of Nursing, Jaipur
National University, Jaipur

Dissociative Disorder
Definitions: Dissociation is one type of
defense mechanism whereby the
person will be protected from
traumatic events by allowing the mind
to forgot or remove itself from painful
situation or memory.

Incidence
* Common in women and among first
degree biological relatives of
individual.
* In adolescence or early adulthood,
but any age it can occur.

Causes
Psychological stress or conflict or frustration.
Childhood trauma or sexual abuse.
Traumatic memories.
Lack of attachment have effect on
neurotransmitters like serotonin.
Depersonalization cause block in
neurotransmitter link.

Causes
Drug abuse like alcohol, barbiturates etc.
Traumatic life events like rape, kidnapping.
Abuse, threats to death, physical violence,
witness to violence.

Types of dissociative disorder
a. Dissociative Amnesia: Impairment of
integration of memories will occur, it is form
of psychogenic amnesia, common form of
dissociative disorder.

causes of dissociative amnesia
 Genetic
 Neurophysiological dysfunction
 Traumatic events
 Repression process- painful events was stored
in unconscious level
 Unexpected bereavements
 Stressful life situations

causes of dissociative amnesia
 Overwhelming stress
 Anxiety provoking internal urges
 Significant distress
 Impairment in social, occupational and other
areas of functioning

C/M of dissociative amnesia
 Clouding of consciousness
 Sudden inability to recall important personal
information
 Loss of memory
 Depressive symptoms
 Memory gap span few minutes, few hours, few
days and years

C/M of dissociative amnesia
 Depersonalization
 Significant distress
 regression

Types of dissociative amnesia
 Generalized amnesia: unable to recall
information about their entire life time.
 Localized amnesia: unable to remember all
events of a circumscribed period (few hours to
few days), loss of memory is localized within a
specific window of time like death of a loved
person.

 Selective amnesia: the ability to remember
some events but not others for a short period
e.g. remembering the stressful events but not
remembering the loss of people during specific
stressful situation.
 Continuous amnesia: inability to recall events
even though they are alert and aware.

 Systematized amnesia: individual can not
remember event that related to specific
information or particular event.

b. Dissociative fugue
It increase in stressful situation. It is psychogenic
state, a sudden unexpected travel away from
home, work place, a feeling of new identity,
unable to recall the past.

Causes of Dissociative fugue
• Substance abuse
• Marital disharmony
• Financial loss
• Occupational distress
• Wars
• Depression

Causes of Dissociative fugue
• Suicidal idea
• Personality disorder
• epilepsy

c. Dissociative identity disorder
Definition: A condition in which 2 or more
distinct identities or personalities states
alternative in controlling the patients
consciousness and behavior.
In multiple personality disorder, the person is
dominated by 2 or more personality of which
only one is manifested at a time.

c. Causes of Dissociative identity
disorder
 Repeated episodes of severe physical or sexual
abuse in childhood
 Lack of supportive person
 Influence of other relatives
 Absence of situational support
 Intense anxiety
 Negative role models

c. Causes of Dissociative identity
disorder
 Unspecified long term societal changes
 Rigid religious beliefs
 Isolation from community
 Lack of cooperation among the employees

c. C/M of Dissociative identity
disorder
 Inadequate defense to handle the intense
anxiety
 Client with dissociative disorder experience
their alters as different names, histories and
personality traits
 Dissociative process are split off from memory
of the primary personality

c. C/M of Dissociative identity
disorder
 Usually primary personality is religious and
moralistic
 Aggressive
 Pleasure seeking
 Voice will have different sounds
 Transition from one personality to another
often during time of stress.

d. Depersonalization disorder
Definition : A persistent or recurrent alteration in
the perception of the self to the extent that
sense of one own reality is temporarily lost,
while reality ability testing remain intact.
In which patients feel that his body is unreal, is
changing or is dissolving.

Cause of Depersonalization disorder
 CNS disease like brain tumours, epilepsy
 Severe sensory deprivation
 Psychological conflicts
 Unpleasant emotions or emotional pain

C/M of Depersonalization disorder
 Person may feel dreamy or detached from the
body
 Ego dystonic e.g. perceiving limbs to be larger
or smaller than normal
 Impairment in social, occupational functioning
make distress

e. Dissociative stupor
 Clients are motionless, mute
 Will not respond to stimulation
 Aware of surrounding
Ganser’s syndrome
 Rarely occurs 4 cardinal symptoms
 Clouding of consciousness
 Hallucination
 Answering approximately
 Physical symptoms

f. Trance and possession disorder
 Total awareness of person’s surroundings
 Narrow attention
 Repeated body movement, postures

f. Trance and possession disorder

D/E of Dissociative disorder
 Complete medical history
 Physical examination
 Psychological examination

T/t of Dissociative disorder
 Tranquilizers or antidepressants
 Hypnosis
 I.V. pentothal sodium may be helpful
 Psychotherapy
 Family therapy
 Diversion therapy
 Yoga, art therapy
 Meditation

Conversion disorder
Definition: Conversion disorder (also known as
functional neurological system disorder) is a
condition in which a person experiences physical
and sensory problems, such as paralysis,
numbness, blindness, deafness or seizures, with
no underlying neurologic pathology.

Conversion disorder
It is a partial or complete loss of normal
integration between immediate sensations and
control of bodily movements or deficits involving
voluntary motor or sensory function due to
underlying psychological conflicts or anxiety.

Causes of Conversion disorder
Traumatic events
Unacceptable emotions
Sexual abuse in childhood
Disturbance in CNS arousal
Lack of situational support

C/M of Conversion disorder
Motor deficit
Lack of coordination or balance
Dysphagia
Akinesia
Urinary retention
Lack of clients social, occupational
functioninng

Paralysis
Sensory deficit
Double vision
Deafness
Sensation of a lump in the throat
Lack of pain sensation
blindness

Hallucination
Environmental misperception

Types of Conversion disorder
a. Dissociative motor disorder:
• Motor disturbances
• Paralysis – monoplegia, paraplegia,
quadriplegia
• Abnormal body movement
• Gait disturbances

b. Dissociative sensory and anesthesia:
• Sensory disturbance are more common
• Hemi anesthesia
• Blindness
• Deafness
• Glove and stocking anesthesia (absence of
sensation at wrist and ankle)

c. Dissociative convulsion:
Hysteria is a Greek word means womb. It is a
clinical epileptic seizures in which body
movement are common. Hysteria is a term often
used to describe emotionally charged behavior
that seems excessive and out of control. When
someone responds in a way that seems
disproportionately emotional for the situation.

D/E of Conversion disorder
• History collection
• Physical examination

T/t of Conversion disorder
• Psychotherapy
• Relaxation techniques
• Behavior modification

Dissociative and Conversion Disorder and its associated types

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Dissociative and Conversion Disorder and its associated types