PSYCH FINALS

• Dissociative Identity Disorder (DID)

  A dissociative disorder characterized by having two or more distinct personalities with the ability to take control of the person, and amnesia
• DID is five times more common in women than in men, possibly because women are more often abused sexually
• In the psychiatric population, 15% have a dissociative disorder
• Multiple Personality Disorder (MPD)


  The former name for Dissociative Identity Disorder
• The American Psychiatric Association accepted Multiple Personality Disorder as a diagnostic category

  1980
• DID


  • Average number of alters is 13 and the mode is six, however, there have been cases of patients with over one hundred alters
  • Alters can have different handwriting, genders, sexual orientations, ages, clothing tastes, and even allergies
  • The host personality is the dominant personality, or the one in control the majority of the time is the "original" personality
  • The host, although often unaware of his alters, may sense that something is wrong
  • An "alter" is any other personality existing in a DID patient
  • Each personality will have different sets of thoughts, memories, feelings, and behaviors
• Amnesia


  • The second constant symptom of DID
  • Both the original (host) personality and the alters are aware of lost periods of time
  • They are often hesitant to talk about their symptoms of amnesia or their multiple selves
• Other variable symptoms of DID

  • Substance abuse
  • Suicidal tendencies
  • Dissociative disorders apart from DID
• Relationships between the alters


  • They are mutually aware of each other
  • They are mutually unaware of each other
  • One is aware of the other, but the awareness is not reciprocated
  • Another pattern involves two or more dominant personalities and one or more subordinates
• Psychotherapy


  • The primary method of treatment for DID
  • The creation of an empathetic atmosphere of safety
  • Appropriate warnings to the DID patient
  • Strengthen the patient across all alters in order to stabilize the personality system
• There are no drugs to treat DID itself, but they can be used to treat symptoms like PTSD, depression, and anxiety
• Sexual identity


  The pattern of a person's biologic sexual characteristics
• Sexual orientation


  One's attractions, desires, and arousals towards others based on their sex and gender
• Sexual behavior


  How one responds to sexual impulses and desires
• Gender identity


  A person's sense of maleness or femaleness
• Sexuality Orientations


  • Bisexuality (both sexes)
  • Transexual/transgender (individuals whose sexual identities are entirely with the opposite sex)
  • Heterosexuality (opposite sex)
  • Homosexuality (same sex)
  • Transvestism ("cross-dresser")
• Stages of the Sexual Response Cycle

  • Desire - ability, interest, and willingness to receive sexual stimulation
  • Excitement - psychological stimulation, vaginal lubrication, clitoral swelling, pelvic congestion and nipple erection in females, stiffening and increase in length and width of the glans of the penis in males, increased vital signs and "sex flush"
  • Orgasm - strong, rhythmic contractions of the vagina and uterus in women, emission and ejaculation of seminal fluid in men, peak in vital signs and sex flush
  • Resolution - organs and body systems return to unaroused state, satisfaction is felt
• When is a Sexual Behavior Abnormal?


  When it causes harm to other people, persistent or recurrent distress, or impairment in important areas of functioning
• Types of Sexual Disorders


  • Alteration in gender identity
  • Alteration in sexual orientation
  • Alteration in sexual behavior
  • Alteration in sexual functioning
  • Painful sexual disorders
• Gender Identity Disorder


  A condition in which there is a discrepancy between an individual's gender identity and assigned (biological) sex, characterized by refusal to engage in culturally "gender-appropriate" behaviors and recurrent fantasies of being the opposite gender and cross-dressing
• Specific Diagnostic Criteria for Gender Identity Disorder in Children

  • Stated desire to be other sex
  • Cross-dressing
  • Cross-sex role play
  • Cross-sex toy and activity preference
  • Cross-sex peer affiliation
• Theories of Gender Identity Disorder

  • Biological - include pre- and post-natal hormone levels and genetic makeup
  • Psychological - describes how sex-linked characteristics are maintained and transmitted to other members of a culture
  • Social - include ideas regarding gender roles conveyed by family, authority figures, mass media, and other influential people in a child's life
• Treatment for Gender Identity Disorder

  • For very young children, parents should set limits to the child's cross-gender behaviors
  • For older children/early adolescents, puberty blocker and hormones
  • For adults, individual and, if appropriate, couples therapy is recommended
• Alterations in Gender Identity

  • Transsexualism - persistent discomfort about one's sex assignment, with intense feeling or preoccupation about transsexual surgery, feeling of being trapped in the wrong body
  • Gender Identity Disorder of Childhood - persistent and intense distress at one's sexual identity
• Alterations in Sexual Orientation


  • Ego-Dystonic Homosexuality - client experiences inappropriate homosexual arousal pattern
• Alterations in Sexual Behavior


  • Sexual Acting Out - extramarital affairs and promiscuous individuals
  • Paraphilia - sexual urges or fantasies that are directed toward nonhuman objects, pain to self, partner, or children, or other non-consenting individuals
• Sexual Dysfunction


  Individual is unsatisfied in his sexual function, including Hypoactive sexual desire (absence of sexual fantasies and desires), Sexual aversion (avoidance of genital sexual contact with a partner), and Sexual arousal disorder (persistent or recurrent lack of subjective sense of sexual excitement and pleasure)
• Painful Sexual Disorders


  • Vaginismus - involuntary vaginal spasm at penetration
  • Dyspareunia - painful sexual intercourse
• Nursing Diagnoses for Sexual Disorders

  • Altered sexuality patterns
  • Ineffective individual coping
  • Altered family process
  • Anxiety
  • Potential for violence: self-induced or to others
• Nursing Interventions for Sexual Disorders

  • Sexuality belief and values discussion
  • Encourage to discuss feelings of guilt, remorse, anger, and loneliness
  • Explain to the client the institution of suicidal precaution
• Substance Abuse


  Overindulgence in or dependence on an addictive substance, especially alcohol or drugs
• Types of Substances Abused

  • Downers (depressants of the SNS) - Alcohol, Opiates, Narcotics
  • Uppers (stimulants of the SNS) - Cocaine, Ecstasy, Cannabis
• Intoxication


  A condition when physical or mental control markedly diminished by the effects of alcohol or drugs
• Detoxification


  The process of removing toxic substances in the body
• Withdrawal


  When the person stops using drugs or alcohol and the brain rebounds by producing a surge of adrenaline that causes withdrawal symptoms
• Overindulgence in or dependence on an addictive substance

  Especially alcohol or drugs
• Downers

  Depression of SNS
• Uppers


  Stimulation of SNS
• Most Commonly Abused Substances

  • Alcohol
  • Opiates
  • Narcotics
  • Hallucinogens
  • Stimulants
  • Inhalants
  • Cigarettes
• Withdrawal

  When the person stop using drugs or alcohol and the brain rebounds by producing a surge of adrenaline that causes withdrawal symptoms