Saint Mary’s University

Bayombong, Nueva Vizcaya

School of Health & Natural Sciences

NURSING DEPARTMENT
Course No. NCM 117 Lecture
Subject: Care of Client with Maladaptive Patterns of Behavior, Acute and Chronic
Yr. Level: BSN 3
Contact Hours/Credit Units: 4 fours/week(4units)_____________________________________

CHAPTER 16

DISSOCIATIVE IDENTITY DISORDER

l. Introduction

This disorder is the most extreme manifestation of a dissociative disorder and it involves
multiple parts of the personality existing within one person. These have evolved as separate
personality states as the only feasible way for a child to cope with ongoing trauma and abuse.

ll. Learning Objectives

1. Apply the moral and ethical-legal principles in dealing with the care of client with dissociative
identity disorder.
2. Obtain a comprehensive psychiatric history and conduct a thorough assessment of mental
status of a client with dissociative identity disorder.
3. Formulate a holistic nursing care plan for client with dissociative identity disorder.
4. Execute a safe, appropriate mental health activity for client with dissociative identity disorder.
5. Utilize effectively the therapeutic use of self in caring client with dissociative identity disorder.

lll. Core Content of the Chapter

DISSOCIATIVE DISORDER:
- It is the “splitting off” an idea or emotions from one’s consciousness.
- Defense Mechanism (DM) is repression because the conscious personality cannot handle
the anxiety.

Types of Dissociative disorder:

1. Dissociative amnesia - Is a sudden inability to recall personal information.
Causes: - Severe stress - Physical injury - Death
Behavior: - Confused - Disoriented - Wandering around
TYPES OF AMNESIA:
1. Selective – The person recalls only a part of the event.
2. Generalized – The person cannot recall anything in his entire life.
3. Localized – The person cannot recall, short period of time. After a traumatic event
(hours)
4. Continuous – The person cannot recall successive events as they are.
2. Dissociative fugue - A sudden unexpected travel to other places accompanied by an inability
to recall past identity.
Causes: - Traumatic event - War - Conflict - Rejection - Marital quarrels
Behavior: - Confused memory loss - Recovery is fast but client can’t recall.

3. Depersonalization - It is an alteration in one’s self. Like “living in a dream”

Causes: - Over whelming stress & anxiety
Behavior: - Feels “detached from self” but reality testing is intact. Robot feeling.

4. Dissociative Identity - having two or more distinct personality or identities (alters).

Causes: - Childhood physical & sexual abuse (flashbacks, nightmares)
Behavior: - “switching” (blinking & rolling of eyes, headache, covering/hiding of face, twitching)
occurs from one alter to another.

Management:
1. Interact with the patient. (trust)
2. Keep them safe. ( anxiety)
3. Provide non-demanding, simple routines. ( anxiety)
4. Encourage to do things for them self. (thrill seeker)
5. Assist in decision making. ( stress)
6. Stress management.

IV. Activity:
Students are advised to watch the movie “Hide and Seek” Robert De Niro and Dakota Fanning
(Dissociative Identity Disorder) There will be a SHORT QUIZ about the Film.
Long Quiz

V. Bibliography:
Videbeck, S. (2020). Psychiatric-Mental Health Nursing. Wolters
Keltner, N., Bostrom C., & McGuiness T. (2012). Psychiatric Nursing. Elsevier Inc.

Prepared by:

Mrs. Rosalie C. Carreon, RN, MSN

Nursing Department