Psychiatric-Mental Health Nurse Educators' Perceptions of Teaching Dissociative Disorders: A Reflexive Thematic Analysis.

BACKGROUND AND PURPOSE: Although the prevalence of dissociative disorders (DDs) is up to 10 percent of the general population, psychiatric-mental health (PMH) registered nurses lack education on how to care for individuals diagnosed with these disorders. METHOD: Sixty-two PMH nurse educators completed an anonymous online survey about their perceptions of teaching DDs to nursing students. Braun and Clarke's six-phase framework was used to conduct an inductive, reflexive thematic analysis of the data. RESULTS: Three primary themes were identified: lack of resources, differing opinions on the value of teaching DDs, and stigma. CONCLUSION: Though roughly 75 percent of participants reported that they teach DDs to their nursing students, they endorsed concerning misperceptions about the diagnoses. By failing to properly educate future PMH RNs about DDs, individuals with DDs are at risk of receiving inadequate and inappropriate nursing care and experiencing poor outcomes.

[Hold or traumatic dissociation at work]. / L'emprise ou la dissociation traumatique à l'œuvre.

For professionals confronted with intrafamily violence, being aware of the phenomena of the hold of the perpetrator and understanding its devastating psychotraumatic mechanisms are key to being able to provide better protection, information and care to the victims. Their behaviour, which seems paradoxical, arouses doubts and sometimes even brings into question the victims, when they are actually suffering from traumatic dissociation and memory of the violence.

Quand le trauma s'intrique avec l'anorexie mentale.

A person having suffered traumatic life events may find relief in the formation of symptoms. Anorexia can therefore be envisaged as a way of facing up to the trauma, both as a means of positioning oneself, as well as a solution for relieving the traumatic suffering. However, giving up these symptoms is sometimes difficult, as the case of Léa demonstrates.

Sexual health and dissociative experiences among abused women.

Sexually transmitted infections are a significant public health issue impacting women. Intimate partner violence (IPV) is one risk factor for STIs/HIV. Women who are the victims of IPV often experience psychological difficulties, including dissociation. Dissociative symptoms may play a role in women's ability to practice safe sex and negotiate condom use, although this has been underexplored. This mixed methods study examined the dissociative symptoms of 22 women experiencing IPV and examined the ways in which these women described their own sexual health and behaviors as well as how they protected themselves from sexually transmitted infections and HIV.

[Nursing care of acute and transient psychotic disorder]. / Prise en charge infirmière d'une bouffée délirante aiguë.

Around the clinical situation of a patient presenting an acute and transient psychotic disorder, the importance of team work becomes evident. Nursing care is present in all phases of the patient's care, from admission to discharge, including in the isolation room and the electroconvulsive therapy sessions. Presence, support, reassurance as well as the bond with the family are cornerstones of the nursing care.

[Psychological consequences and treatment of female victims of violence]. / Conséquences psychologiques et prise en charge des femmes victimes de violences.

Domestic violence often just reproduces the repeated violence suffered as a child. The treatment of a female victim depends a lot on her traumatic past, and the care is designed in coordination with various partners. By improving the identification and care of children who are so-called witnesses to family violence, but who are really co-victims, in other words abused, it is possible to avoid violence in all its forms being reproduced across the generations.

In search of an adult attachment stress provocation to measure effect on the oxytocin system: a pilot validation study.

BACKGROUND: Oxytocin is a promising biomarker for psychiatric conditions arising from early relational trauma, childhood maltreatment, and attachment dysregulation, including posttraumatic stress and dissociative disorders. OBJECTIVE: This exploratory pilot study examined plasma oxytocin as a biomarker for alterations in the attachment system. DESIGN: We used a single group, repeated-measures design with 15 women. The protocol used a film clip previously validated as a provocation to the hypothalamic-pituitary-adrenal axis. RESULTS: The repeated-measures ANOVA showed differences in oxytocin across the three time points. Correlations with oxytocin indicated that measures of dissociation and somatization correlated most strongly with higher levels of oxytocin measured during exposure to the film's bonding scene and posttraumatic stress disorder correlated most strongly with lower levels at the film's abandonment scene. Post hoc analyses revealed differences in oxytocin response related to psychopathology. CONCLUSION: Replication studies should characterize participants on a range of psychiatric conditions associated with attachment dysregulation.

Becoming one person: living with dissociative identity disorder.

Dissociative identity disorder is a rare diagnosis, although people currently with a diagnosis of psychosis may in fact be experiencing what is associated with the disorder. This article is co-authored by a nurse and a person who has lived with alters (multiple personalities) for nearly all of her life. Because of the rarity of the diagnosis, there is much misunderstanding and ignorance among lay people and mental health professionals. This article therefore clarifies historical and contemporary issues surrounding this particular mental health problem both through examining the literature and through narrative of the person's experience. Special attention is given to the reality of coping with the difficulties that dissociative identity disorder create.

Acute confusion and unreal experiences in intensive care patients in relation to the ICU syndrome. Part II.

The intensive care unit syndrome (ICU syndrome) is defined as an altered emotional state occurring in a highly stressful environment, which may manifest itself in various forms such as delirium, confusion, crazy dreams or unreal experiences. The purpose of this part of a study of patients' experiences is to describe and illuminate patients' experiences of acute confusion, disorientation, wakefulness, dreams and nightmares during and after their stay in the ICU. The data were obtained from 19 ventilated patients, who were interviewed twice and had stayed at least 36 hours in the ICU, the first interview being about one week after discharge from the ICU, and the second 4-8 weeks later. The hermeneutic approach used when interpreting and analysing the text from the interviews revealed that patients' experiences of unreal experiences were often associated with intense fear. Intense or continuous unbearable fear seems to result in frightening unreal experiences, which further increase the level of fear. Care actions or caring relationships with relatives or nurses can reduce this fear, which can help to prevent the occurrence and/or duration and intensity of the unreal experiences. Trust and confidence in nurses or significant others and feelings of self-control or trust in self-control seemed to reduce the risk of unreal experiences so that adverse stimuli might only trigger a mild confusion.

Coming out. My experience as a mental patient.

1. There is still a strong stigma attached to mental illness, and surprisingly many psychiatric nurses reinforce that stigma. Although some professionals may go into therapy to improve self-esteem and become better professionals, they may run the risk of destroying their career. 2. The experience as a patient in a mental health facility can result in nightmares and flashbacks, and damage due to restraints. Because "coming out" can destroy one's career, the safest place for a nurse with a history of hospitalization or substance abuse may be "in the closet." 3. If the stigma of mental illness is going to be changed, then it must start with the changing of the attitudes and perceptions of mental health professionals.

Dissociation & multiple personality disorder. A challenge for psychosocial nurses.

1. Multiple personality disorder (MPD) is a dissociative disorder in which two or more distinct personality states exist within an individual. At least two of these personalities recurrently take full control of the person's behavior. 2. Most MPD clients report histories of severe childhood trauma, particularly physical, sexual, and ritual cult abuse. MPD most likely originates in childhood, but is not usually diagnosed until adulthood. In most reported cases, the first dissociative episode is thought to have occurred at a very young age. 3. Signs and symptoms that may suggest MPD include a history of medical and psychiatric diagnoses; inconsistencies in accounts of elapsed time and physical behaviors; psychophysiological complaints; experiencing voices inside the head; and an individual referring to herself as "we" instead of "I."

Coping strategies: a psychoeducational approach to post-traumatic symptomatology.

Survivors of extensive childhood abuse frequently present complicated clinical dilemmas in the inpatient setting; they experience complex post-traumatic and dissociative symptomatology, such as flashbacks and other reexperiencing phenomena, as well as intense affects and self-destructive impulses. Such patients seek recommendations of how to manage their post-traumatic symptomatology, as well as how to tolerate intense affects and maintain safety. The nursing staff at McLean Hospital's Dissociative Disorders Program have developed a psychoeducational approach that patients have found useful. Coping strategies, which the patients learn to formulate, help clients stall impulsivity and dissociative episodes through the use of healthy diversions, grounding techniques, and support networks.

Vicarious traumatization in the work with survivors of childhood trauma.

1. Persons working with victims of childhood trauma may experience traumatic countertransference and vicarious traumatization. After hearing a patient's trauma story, which is a necessary part of childhood trauma therapy, staff may experience post-traumatic stress disorder, imagery associated with the patient's story and the same disruptions in relationships as the patient. 2. During the first 6 months of working with survivors of childhood trauma, common behaviors of staff members were identified, including a lack of attention, poor work performance, medication errors, sick calls, treatment errors, irreverence, hypervigilance, and somatic complaints. 3. Staff working with victims of childhood trauma can obtain the necessary staff support through team support, in traumatic events, and in a leadership role.

From fragmentation to wholeness: an integrative approach with clients who dissociate.

TOPIC: Three domains of treatment with the client who dissociates. SOURCE: Author's clinical work, review of literature. GOAL: To describe the use of building ego strength, modulating affect, and supporting abreaction to decrease fragmentation. CONCLUSION: The nurse psychotherapist can use these interventions to decrease fragmentation with clients who dissociate.

Trauma and dissociation: treatment perspectives.

TOPIC: How advanced practice nurses can work with trauma survivors to decrease dissociation as a needed coping mechanism. PURPOSE: To review the literature on trauma and dissociation as well as current treatment perspectives. SOURCES: Review of the literature and authors' clinical experience. CONCLUSIONS: Advanced practice nurses can use knowledge of selected psychopharmacological medications and Erikson's stages of psychosocial development to plan treatment for posttrauma clients.

Dissociation in adults with a diagnosis of substance abuse.

Dissociation is a defence mechanism whereby individuals under stress separate affect and/or behaviour from the normal flow of consciousness. It is common in people who have experienced trauma. A Dissociative Experience Scale was used to study 51 subjects who were members of inpatient or outpatient substance abuse programmes. Thirty per cent of the group scored 15 or higher, suggesting that dissociative events are common in this population. Nurses need to understand the phenomenon of dissociation and the relationship between trauma, dissociation and substance abuse. This will enhance their assessment of patients and increase their knowledge base regarding appropriate treatment.