Dissociative and Conversion Disorder and its associated types

conversion and dissociation disorder were synonymously used. in these disorder, ability to exercise conscious and selective control is impaired to a degree that can vary from day to day or even from hour to hour.

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

2. 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.

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

4. 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.

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

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

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

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

9. 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

10. C/M of dissociative amnesia Depersonalization Significant distress regression

11. 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.

12. Types of dissociative amnesia 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.

13. Types of dissociative amnesia Systematized amnesia: individual can not remember event that related to specific information or particular event.

14. 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.

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

16. Causes of Dissociative fugue Suicidal idea Personality disorder epilepsy

17. 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.

18. 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

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

20. 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

21. 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.

22. 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.

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

24. 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

25. 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

26. e. Dissociative stupor

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

28. f. Trance and possession disorder

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

30. 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

31. 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.

32. 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.

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

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

35. C/M of Conversion disorder Paralysis Sensory deficit Double vision Deafness Sensation of a lump in the throat Lack of pain sensation blindness

36. C/M of Conversion disorder Hallucination Environmental misperception

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

38. Types of Conversion disorder 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)

39. Types of Conversion disorder 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.

40. D/E of Conversion disorder History collection Physical examination

41. T/t of Conversion disorder Psychotherapy Relaxation techniques Behavior modification