Dissociative(Conversion
disorders)
Meaning
It
is a partial or complete loss of the normal interaction between memories of the
past, awareness of identity and immediate sensations and control of bodily
movements.
Classification(icd-10)
•
F44.0 Dissociative
amnesia
•
F44.1 Dissociative fugue
•
F44.2 Dissociative stupor
•
F44.3 Trance and
possession disorders
•
F44.4 Dissociative motor
disorders
•
F44.5 Dissociative
convulsions
•
F44.6 Dissociative
anesthesia and sensory loss
•
F44.7 Mixed dissociative
(conversion) disorders
•
F44.8 Other dissociative
(conversion) disorders
.80
Ganser’s syndrome
.81
Multiple personality disorder
.82
Transient dissociative disorder occurring in childhood and adolescence
.88 other specified dissociative
(conversion) disorder
•
F44.9 Dissociative
(conversion) disorder, unspecified
DISSOCIATIVE
AMNESIA
•
Commonest type
•
Occur in adolescent and
young adults
•
Sudden inability to
recall important personal information usually concerning stressful or traumatic
events
•
Not as everyday
forgetfulness
•
No medical illness
Dissociative amnesia, Types
ü Localized amnesia : inability to recall events
related to a circumscribed period of time.
ü Selective amnesia : ability to remember some
but not all of the events occurring during a circumscribed period of time.
ü Generalized amnesia : failure to recall one’s
entire life
ü Continuous
amnesia : failure to recall successive events as they occur
ü Systematized amnesia: amnesia for certain
category of memory, such as all memories relating to one’s family or to a
particular person
Differential diagnosis of dissociative amnesia
•
Organic mental disorder
•
Alcohol or drug abuse
black outs
•
Head injury
•
Post ictal amnesia
DISSOCIATIVE
FUGUE
•
It is characterized by
episodes of wandering away. During the episode, person adopts a new identity.
•
Onset is sudden and end
abruptly with amnesia about the episode.
•
May last from less than
an hour to a year or more, but generally last in the range of days to weeks
Differential
diagnosis of dissociative fugue
•
Post ictal fugue
•
Alcoholic black-outs
DISSOCIATIVE
STUPOR
•
Patients are motionless
and mute and do not respond to stimulation, but they are aware of their
surroundings.
TRANCE AND POSSESSION DISORDERS
•
Disorders in which there
is a temporary loss of both the sense of personal identity and full awareness
of the surroundings;
•
When associated with
religious rituals the individual acts as if taken over by another personality,
spirit, god or ‘force’
DISSOCIATIVE
MOTOR DISORDER
•
Loss of ability to move
the whole or part of a limb or limbs
•
Paralysis may be partial
or complete
•
Various forms and degrees
of incordination may be evident, particularly in legs, resulting in bizarre
gait or inability to stand
DISSOCIATIVE
CONVULSIONS
•
May mimic epileptic
seizures very closely in terms of movements; but tongue biting, serious
bruising due to falling and incontinence of urine are rare
•
And loss of consciousness is absent or
replaced with a state of stupor or trance
•
Hemianesthesias,
blindness or contracted visual fields and deafness are the common complaints
•
Glove & stocking
anesthesia
MIXED
DISSOCIATIVE (conversion) DISORDERS (F44.0-F44.6)
• These
are combination of any of the types
OTHER
DISSOCIATIVE DISORDERS
•
Ganser’s syndrome
v Characterized
by ‘approximate answers’
v Suggest
a psychogenic etiology
v The
answers are wrong , but show that the person understands the nature of question
asked
•
Multiple personality
disorder/ Dissociative identity disorder
v Rare
v Essential
feature is the apparent existence of two or more distinct personalities within
an individual, with only one of them being evident at a time.
v Each
personality is complete, with its own memories, behavior and preferences
v Change
from one personality to another is usually sudden and closely associated with
traumatic incident
v In
the common form with two personalities one personality is usually dominant, but
neither has the access to the memories of the other and the two are almost
always unaware of each other’s existence
Etiology
•
Psychodynamic theory:
Failure to repress the stressful event resulting in activation of secondary
defense mechanism such as dissociation or conversion.
•
Behavioral theory: dissociative or conversion symptoms are
learned responses to stress. Initially the symptom will be learned from
environment.
•
Biological :Conversion
symptoms are seen in epilepsy, cerebral cortical lesions.
La-belle- indifference
•
Lack of concern
towards the symptoms even if it causes
severe disability.
Treatment
•
Behavioural therapy
v Hypnosis
v Free
association
v IV
amytal/thiopentone/diazepam
• Psychotherapy
with abreaction
•
Supportive psychotherapy
• Psycho
analysis
•
Benzodiazepines
Nursing management
•
Monitor for organic
pathology
•
Identify primary and
secondary gain
•
Don’t focus on disability
•
Don’t allow manipulation
•
Withdraw attention when
focusing on disability
•
Encourage expression of
feelings
•
Positive reinforcement
when using adaptive coping
•
Identify unresolved
conflicts and assist for resolution
COMMENTS