# A nurse is assessing a client who reports experiencing periods of "losing time" and finding themselves in unfamiliar places with no memory of how they got there. The client also mentions that friends have told them they sometimes act like a completely different person. Which assessment finding would be most indicative of a dissociative disorder?

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## 문제

A nurse is assessing a client who reports experiencing periods of "losing time" and finding themselves in unfamiliar places with no memory of how they got there. The client also mentions that friends have told them they sometimes act like a completely different person. Which assessment finding would be most indicative of a dissociative disorder?

## 보기

1. The client reports hearing voices commanding them to harm others
2. The client describes distinct periods of feeling detached from their own body **✔ 정답**
3. The client exhibits rapid mood swings between euphoria and depression
4. The client demonstrates compulsive hand-washing rituals daily

**정답: 2**

## 해설

Depersonalization (feeling detached from oneself) is most indicative of dissociative disorders, aligning with the client's reported memory gaps and identity changes. Other options suggest schizophrenia, mood disorders, or OCD, which do not match the core dissociative symptoms.

## 심화 해설

Understanding the Scenario

The client's report of "losing time," finding themselves in unfamiliar places without memory of the event, and being told they act like a different person are classic clinical clues pointing toward a disruption in the normally integrated functions of consciousness, memory, and identity. In the context of the NCLEX-RN, this presentation should immediately direct your assessment toward a dissociative disorder.

Analysis of the Correct Answer

The correct assessment finding is Option 2: The client describes distinct periods of feeling detached from their own body. This symptom is known as depersonalization, a core feature of dissociative disorders. Depersonalization involves a perceptual change of an "as-if-character" where the self is experienced as unreal, as if one is an outside observer of their own thoughts, feelings, or body [4]. This directly reflects a disruption in the integration of consciousness and self-perception, which is the hallmark of dissociation. The term dissociation itself refers to a sudden, temporary disruption in a person's consciousness, memory, identity, or perception [2]. When a client describes feeling detached from their own body, they are providing a subjective report of this very perceptual disruption, making it a highly indicative finding for a nurse's assessment.

Why the Other Options Are Less Indicative

Option 1: Auditory Hallucinations Commanding Harm

While distressing, hearing voices that command the client to harm others is a psychotic symptom most characteristic of schizophrenia or a psychotic episode, not a primary dissociative disorder. The core pathology in dissociation is a disruption of integrated identity and memory, not a fixed false sensory perception (hallucination) that is externally attributed. Although dissociation can be a response to trauma, and trauma can be a factor in various psychiatric conditions, command hallucinations are a hallmark of a different diagnostic category.

Option 3: Rapid Mood Swings Between Euphoria and Depression

Rapid cycling between extreme emotional poles is a classic feature of bipolar disorder. While individuals with dissociative disorders may experience emotional dysregulation, particularly if there is a history of trauma, the defining feature is not a primary mood disturbance. The mood swings in bipolar disorder are sustained and represent a disturbance in affect regulation, whereas the client in the scenario presents with a disturbance in memory and identity integration.

Option 4: Compulsive Hand-Washing Rituals

Daily, compulsive hand-washing is a behavioral manifestation of an obsession, which is the defining feature of obsessive-compulsive disorder (OCD). This behavior is performed to reduce anxiety caused by an obsessive thought (e.g., a fear of contamination). While a person with a dissociative disorder might engage in repetitive behaviors, the compulsive ritual driven by an obsession is pathognomonic for OCD, not a dissociative process.

Clinical Reasoning and NCLEX Application

To differentiate these conditions on the NCLEX, focus on the primary disruption. For dissociative disorders, the central problem is a failure in the normal integration of identity, memory, and consciousness. The scenario provides two powerful clues: amnestic gaps ("losing time") and identity alteration ("acting like a different person"). The most direct assessment finding that aligns with this is a disturbance in the perception of self, such as feeling detached from one's body. Research on the relationship between trauma and dissociation confirms that dissociative symptoms are a core concept in understanding post-traumatic reactions and involve profound disturbances in self-organization . A tailored psycho-educational program that addresses dissociation targets these very disruptions in self-experience to reduce harmful outcomes, highlighting the clinical significance of recognizing depersonalization . Therefore, when a nurse assesses a client with a suspected dissociative disorder, a report of depersonalization is the most specific and indicative finding among the options provided.References (research sources)

- [2]The Frequency of Dissociative Disorders Among Women Who Experienced Physical Domestic Violence and Were Referred to the Mashhad Department of Forensic Medicine In 2024.Research articleBahrami Z, Naghsh A, Saghebi A. (2025) · DOI: 10.18502/jfrh.v19i4.21076

- [4]Psychedelic-Associated Depersonalization-Derealization Disorder.Research articleMichal M. (2026) · DOI: 10.1007/7854_2025_599

## 임상 시나리오

Clinical Guide: Recognizing Dissociative SymptomsDifferentiating Depersonalization from Psychosis and Mood Disorders
The core feature of dissociative disorders is a disruption of identity, memory, or consciousness. When a client reports "losing time" or acting like a different person, the most indicative assessment finding is depersonalization, described as feeling detached from one's own body or mind.

To differentiate, command hallucinations point toward a psychotic disorder like schizophrenia. Rapid mood swings between euphoria and depression are the hallmark of a mood disorder, such as bipolar disorder. Ritualistic behaviors like hand-washing are compulsions associated with obsessive-compulsive disorder (OCD).

CautionDo not confuse dissociative amnesia or fugue with neurological conditions. A thorough history is crucial; however, in acute settings, always rule out head trauma, substance intoxication, or a medical condition (e.g., epilepsy) before attributing symptoms solely to a psychiatric etiology.

## 핵심 개념

- **Dissociative Disorder (해리성 장애)** — A mental disorder where there is a disruption in the integration of consciousness, memory, identity, emotion, perception, body representation, or motor control. It often develops as a defense mechanism against psychological trauma.
- **Depersonalization (이인증)** — A dissociative symptom where one feels detached from their own mental processes or body, as if observing from outside. ("Feels as if they are outside their own body")
- **Dissociative Amnesia (해리성 기억상실)** — A dissociative disorder characterized by an inability to recall important personal information about a stressful event. It goes beyond ordinary forgetfulness.
- **Dissociative Identity Disorder (해리성 정체성 장애, DID)** — Two or more distinct identity states exist, and these identity states repeatedly take control of the individual's behavior, accompanied by amnesia for important personal information.
- **Trauma (외상)** — A severe stress event that is psychologically overwhelming and exceeds the individual's ability to adapt. It is considered a major causative factor in dissociative disorders.

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