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Crisis intervention is short-term and focused on immediate safety, not long-term integration. Directed association lacks evidence-based support for treating identity fragmentation in DID.

Psychoanalysis and free association are less effective for DID due to their non-directive nature and limited focus on trauma stabilization. They may exacerbate dissociation without structured containment.

Dextroamphetamines are not indicated for DID and may worsen dissociation or anxiety. Insight psychotherapy alone is insufficient without trauma-focused strategies and stabilization techniques.

Assisting with memory recovery is not appropriate during acute crisis. It may increase distress and worsen dissociation. Trauma processing should only occur after stabilization.

Teaching coping skills is a long-term intervention. In the acute phase, the client may lack the capacity to absorb or apply these strategies due to dissociation and emotional dysregulation.

Referral for integrative therapy is future-oriented. It does not address the immediate risk of harm and cannot substitute for direct safety measures during hospitalization.

 Labeling the client as mentally ill and out of touch with reality reinforces stigma and misrepresents dissociative disorders, which do not inherently involve psychosis or loss of reality testing.

Predicting long-term inpatient care and referencing delusions is inaccurate, as dissociative disorders do not typically involve delusional thinking. This response may increase fear and misunderstanding.

Suggesting the disorder may be fabricated undermines credibility and invalidates the client’s suffering. It reflects bias and contradicts evidence-based understanding of trauma-related dissociation.

Hippocampal dysfunction is a neurobiological explanation, not psychodynamic. It relates to structural brain changes affecting memory, not unconscious defense mechanisms.

Cortical arousal is a physiological response linked to stress and anxiety. It does not reflect the symbolic or unconscious processes emphasized in psychodynamic models.

Overwhelmed coping capacity is a behavioral or trauma-based view. While relevant to dissociation, it lacks the emphasis on unconscious repression central to psychodynamic theory.

Repression is a psychodynamic concept, not neurobiological. It involves unconscious defense mechanisms rather than brain-based dysfunction.

Escaping from reality due to trauma aligns with trauma theory, emphasizing psychological adaptation rather than neurological etiology.

Familial patterns suggest a genetic or psychosocial influence, not a direct neurobiological mechanism. It lacks specificity regarding brain function or structure.

Verbalizing why personalities exist pertains to dissociative identity disorder, not dissociative fugue. This response misattributes diagnostic features and does not reflect discharge criteria for fugue.

Discussing depersonalization is relevant to depersonalization disorder, not fugue. While emotional insight is valuable, it does not confirm readiness for discharge in fugue cases.

Integration of subpersonalities is a therapeutic goal in dissociative identity disorder, not dissociative fugue. This choice confuses diagnostic boundaries and does not apply to the condition being evaluated.

Disturbed sensory perception refers to perceptual distortions like hallucinations, not the emotional detachment seen in depersonalization. It misclassifies the nature of the symptoms.

Self-esteem disturbance involves negative self-evaluation, which is not the primary issue in depersonalization. The client’s challenge is with coping, not self-worth.

Anxiety related to repressed trauma may be present, but the outcome targets behavioral coping, not trauma processing. This diagnosis does not align with the stated goal.

Memory recovery is unpredictable and not a realistic short-term goal. It depends on integration and trauma processing, which typically occur in later phases of treatment.

Verbalizing awareness of alters is a long-term therapeutic milestone. It requires insight and internal cooperation, which are not expected within the first two weeks of hospitalization.

Perceiving stimuli accurately is more relevant to psychotic disorders. DID does not inherently impair sensory perception, making this outcome diagnostically inappropriate.

Stating the function of each personality reflects insight into internal dynamics but does not address the origin or cause of their development. It’s relevant but not aligned with the outcome.

Being redirected during group therapy reflects engagement, not causative understanding. It indicates behavioral participation, not insight into trauma-related etiology.

Understanding that treatment may be lengthy reflects expectation management, not causative awareness. It shows readiness but does not fulfill the outcome’s focus on trauma origins.

While some individuals with DID may experience functional impairment, many maintain occupational and social roles. This statement overgeneralizes and misrepresents the variability in functioning.

DID is no longer classified under Axis II, as the multiaxial system was removed in DSM-5. It is now categorized under dissociative disorders, making this statement outdated.

Not all personalities are mutually aware. Amnesia between alters is common, and events experienced by one identity may not be accessible to others, contradicting this statement.

Identifying stressors is an assessment activity, not a relational intervention. While useful, it does not directly build trust or emotional safety.

Encouraging coping mechanisms is a teaching strategy. It supports long-term management but does not address the immediate need for relational trust during acute anxiety.

Discussing depersonalization episodes may be premature and overwhelming early in care. It risks retraumatization before trust and emotional safety are established.

The term “external environment” refers to derealization, not depersonalization. Depersonalization is centered on the self, not surroundings, making this statement inaccurate.

Transient depersonalization episodes are common, not rare. Up to 50–75% of adults report brief experiences, especially under stress, contradicting the claim of rarity.

Alterations in perception during depersonalization are typically distressing, not relaxing. They often provoke anxiety and fear of losing control or going insane, making this statement misleading.

Transference involves projecting feelings from past relationships onto the caregiver. The client’s statement does not reflect projection of past emotions onto the nurse, making this an inaccurate interpretation.

Displacement refers to redirecting emotions from a threatening source to a safer one. There is no evidence of emotional redirection here; the client is speaking about himself, not shifting blame or emotion.

Identification involves adopting traits or behaviors of another person. The client is not mimicking or internalizing another’s identity or traits, so imitation is not evident in this scenario.

Dissociative amnesia involves memory loss without travel. The presence of wandering and disorientation to identity makes this diagnosis incomplete for the scenario.

Schizophrenia typically presents with psychotic features such as hallucinations, delusions, or disorganized speech. The absence of these symptoms rules out schizophrenia.

Dementia involves progressive cognitive decline, often with poor grooming and impaired social interaction. The client’s intact functioning and age make dementia unlikely.

Depression involves low mood, anhedonia, and hopelessness, but the described estrangement and detachment from self point more toward a dissociative condition than primary mood disorder. Antidepressants may help comorbid depression but are not first-line.

Electroconvulsive therapy is reserved for severe depression or treatment-resistant mood disorders, not depersonalization. This client’s presentation lacks vegetative depressive symptoms or severe suicidal risk, making ECT inappropriate.

Suicide precautions are necessary when there is evidence of suicidal ideation or intent. While dissociative symptoms can be distressing, the stem does not indicate suicidal risk, so constant precautions are not indicated.