NURS EXAM NOTES 4 BEST STUDY GUIDE WITH
COMPLETE SOLUTIONS
COPING
Exemplar: Dissociative Disorders
• Giddens: Concept 32 Coping
• Psych: Dissociative Disorders in Chapter 16
Key terms
• Appraisal: Coping appraisal is how one responds to a situation
• Cognitive restructuring: A core part of cognitive behavioral therapy (CBT). CBT is one of the most effective
psychological treatments for common problems like depression, anxiety disorders. Process of learning to
identify
and dispute irrational or maladaptive thoughts known as cognitive distortions, such as all-or-nothing thinking
(splitting), magical thinking, over-generalization, magnification, and emotional reasoning, which are commonly
associated with many mental health disorders.
DISSOCIATIVE DISORDERS
• Occur after significant adverse experiences/trauma
• Individuals respond to stress with severe interruption of consciousness
• Dissociation is an unconscious defense mechanism
• Protects individual against overwhelming anxiety through emotional separation
• However, this separation results in disturbances in memory, consciousness, self-identity, and perception
Reality testing: Patients with dissociative disorders have intact reality testing
• This means that although the person may have flashbacks or images, these are triggered by current
events, relate to the past trauma, and are not delusions or hallucinations
, NURS EXAM NOTES 4 BEST STUDY GUIDE WITH
COMPLETE SOLUTIONS
Mild fleeting dissociative experiences are relatively common to all of us
• For example, we say we are on “auto pilot” when we drive home from work and cannot recall the last
15 minutes before reaching the house
• These common experiences are distinctly different from the processes of pathological dissociation
Dissociation is involuntary and results in failure of the normal control over a person’s mental processes and
normal integration of conscious awareness
o Dimensions of a memory that should be linked are not and are fragmented
▪ For example, a person may be aware of a sound or smell, but these sensations would not
be linked to the actual event itself, leaving the person fearful and/or confused
▪ The person may reenact, as well as re-experience, trauma without consciously knowing why
Symptoms: May be either positive or negative
• Positive symptoms refer to unwanted additions to mental activity such as flashbacks
• Negative symptoms refer to deficits such as memory problems or the ability to sense or control
different parts of the body
• Dissociation decreases the immediate subjective distress of the trauma and also continues to protect
the individual from full awareness of the disturbing event
Protective for children
• Dissociation can also be somewhat protective for a child to maintain an attachment with abusive or
neglectful caregivers
• This highlights the importance of attachments and relationships in allowing the child to grow
socially, intellectually, and cognitively
, NURS EXAM NOTES 4 BEST STUDY GUIDE WITH
COMPLETE SOLUTIONS
• If abuse or neglect has occurred, these memories become compartmentalized and often do not intrude
into awareness until later in life when the person is in a stressful situation
Types of dissociative disorders include
(1) Depersonalization/derealization disorder
(2) Dissociative amnesia (Includes dissociative Fugue which is a subtype)
(3) Dissociative identity disorder
Depersonalization/derealization disorder: Found in both adolescents and adults often in response to acute stress
• In depersonalization the focus is on oneself
o It is an extremely uncomfortable feeling of being an observer of one’s own body or mental processes
o Feels detached, looking at life through a cloudy window, outside of self
• In derealization the focus is on the outside world
o It is the recurring feeling that one’s surroundings are unreal or distant
o The person may feel mechanical, dreamy, or detached from the body
• Some people suffer episodes of these problems that come and go while others have episodes that begin
with stressors and eventually become constant
• Patients describe these experiences as very distressing and extremely uncomfortable
Dissociative Amnesia: May occur in any age group from children to adults, more common in women
• The amnesia is often related to trauma, and memory usually returns spontaneously after the individual
is removed from the stressful situation
• Marked by the inability to recall important personal information often of a traumatic or stressful nature
o The amnesia may be localized: The patient is unable to remember all events in a certain period
o The amnesia may be selective: The patient is able to recall some but not all events in a certain period
, NURS EXAM NOTES 4 BEST STUDY GUIDE WITH
COMPLETE SOLUTIONS
• Dissociative fugue: A subtype of dissociative amnesia is dissociative fugue
o It is characterized by sudden unexpected travel and an inability to recall one’s identity
and information about some or all of the past
o In rare cases, an individual with dissociative fugue assumes a whole new identity
o In fugue states, individuals often function adequately in their new identities by choosing
simple undemanding occupations and having few intimate social interactions
o After a few weeks to a few months, they may remember their former identities and then
become amnesic for the time spent in the fugue state
o Usually, a traumatic event precedes a dissociative fugue
Dissociative Identity Disorder
• The essential feature of dissociative identity disorder is the presence of two or more distinct
personality states that recurrently take control of behavior
• Each alternate personality (alter) has its own pattern of perceiving, relating to, and thinking about the
self and the environment
• It is believed that severe sexual, physical, or psychological trauma in childhood predisposes an individual
to the development of dissociative identity disorder
• Dissociative identity disorder is associated with at least two dissociative identity states:
o One is a state or personality that functions on a daily basis and blocks access and responses to
traumatic memories
o Another state (also referred to as an alter state) is fixated on traumatic memories
o Each alter is a complex unit with its own memories, behavioral patterns, and social relationships
that dictate how the person acts when that personality is dominant
o Often the original or primary personality is religious and moralistic, and the alters are
COMPLETE SOLUTIONS
COPING
Exemplar: Dissociative Disorders
• Giddens: Concept 32 Coping
• Psych: Dissociative Disorders in Chapter 16
Key terms
• Appraisal: Coping appraisal is how one responds to a situation
• Cognitive restructuring: A core part of cognitive behavioral therapy (CBT). CBT is one of the most effective
psychological treatments for common problems like depression, anxiety disorders. Process of learning to
identify
and dispute irrational or maladaptive thoughts known as cognitive distortions, such as all-or-nothing thinking
(splitting), magical thinking, over-generalization, magnification, and emotional reasoning, which are commonly
associated with many mental health disorders.
DISSOCIATIVE DISORDERS
• Occur after significant adverse experiences/trauma
• Individuals respond to stress with severe interruption of consciousness
• Dissociation is an unconscious defense mechanism
• Protects individual against overwhelming anxiety through emotional separation
• However, this separation results in disturbances in memory, consciousness, self-identity, and perception
Reality testing: Patients with dissociative disorders have intact reality testing
• This means that although the person may have flashbacks or images, these are triggered by current
events, relate to the past trauma, and are not delusions or hallucinations
, NURS EXAM NOTES 4 BEST STUDY GUIDE WITH
COMPLETE SOLUTIONS
Mild fleeting dissociative experiences are relatively common to all of us
• For example, we say we are on “auto pilot” when we drive home from work and cannot recall the last
15 minutes before reaching the house
• These common experiences are distinctly different from the processes of pathological dissociation
Dissociation is involuntary and results in failure of the normal control over a person’s mental processes and
normal integration of conscious awareness
o Dimensions of a memory that should be linked are not and are fragmented
▪ For example, a person may be aware of a sound or smell, but these sensations would not
be linked to the actual event itself, leaving the person fearful and/or confused
▪ The person may reenact, as well as re-experience, trauma without consciously knowing why
Symptoms: May be either positive or negative
• Positive symptoms refer to unwanted additions to mental activity such as flashbacks
• Negative symptoms refer to deficits such as memory problems or the ability to sense or control
different parts of the body
• Dissociation decreases the immediate subjective distress of the trauma and also continues to protect
the individual from full awareness of the disturbing event
Protective for children
• Dissociation can also be somewhat protective for a child to maintain an attachment with abusive or
neglectful caregivers
• This highlights the importance of attachments and relationships in allowing the child to grow
socially, intellectually, and cognitively
, NURS EXAM NOTES 4 BEST STUDY GUIDE WITH
COMPLETE SOLUTIONS
• If abuse or neglect has occurred, these memories become compartmentalized and often do not intrude
into awareness until later in life when the person is in a stressful situation
Types of dissociative disorders include
(1) Depersonalization/derealization disorder
(2) Dissociative amnesia (Includes dissociative Fugue which is a subtype)
(3) Dissociative identity disorder
Depersonalization/derealization disorder: Found in both adolescents and adults often in response to acute stress
• In depersonalization the focus is on oneself
o It is an extremely uncomfortable feeling of being an observer of one’s own body or mental processes
o Feels detached, looking at life through a cloudy window, outside of self
• In derealization the focus is on the outside world
o It is the recurring feeling that one’s surroundings are unreal or distant
o The person may feel mechanical, dreamy, or detached from the body
• Some people suffer episodes of these problems that come and go while others have episodes that begin
with stressors and eventually become constant
• Patients describe these experiences as very distressing and extremely uncomfortable
Dissociative Amnesia: May occur in any age group from children to adults, more common in women
• The amnesia is often related to trauma, and memory usually returns spontaneously after the individual
is removed from the stressful situation
• Marked by the inability to recall important personal information often of a traumatic or stressful nature
o The amnesia may be localized: The patient is unable to remember all events in a certain period
o The amnesia may be selective: The patient is able to recall some but not all events in a certain period
, NURS EXAM NOTES 4 BEST STUDY GUIDE WITH
COMPLETE SOLUTIONS
• Dissociative fugue: A subtype of dissociative amnesia is dissociative fugue
o It is characterized by sudden unexpected travel and an inability to recall one’s identity
and information about some or all of the past
o In rare cases, an individual with dissociative fugue assumes a whole new identity
o In fugue states, individuals often function adequately in their new identities by choosing
simple undemanding occupations and having few intimate social interactions
o After a few weeks to a few months, they may remember their former identities and then
become amnesic for the time spent in the fugue state
o Usually, a traumatic event precedes a dissociative fugue
Dissociative Identity Disorder
• The essential feature of dissociative identity disorder is the presence of two or more distinct
personality states that recurrently take control of behavior
• Each alternate personality (alter) has its own pattern of perceiving, relating to, and thinking about the
self and the environment
• It is believed that severe sexual, physical, or psychological trauma in childhood predisposes an individual
to the development of dissociative identity disorder
• Dissociative identity disorder is associated with at least two dissociative identity states:
o One is a state or personality that functions on a daily basis and blocks access and responses to
traumatic memories
o Another state (also referred to as an alter state) is fixated on traumatic memories
o Each alter is a complex unit with its own memories, behavioral patterns, and social relationships
that dictate how the person acts when that personality is dominant
o Often the original or primary personality is religious and moralistic, and the alters are
