A 7-year-old foster child is brought to the clinic. The child was abused by her parents before going into foster care. As part of a psychosocial assessment to rule out any chronic dissociative pattern of coping, the nurse would ask about which of the following?

24-hour nutritional intake
Ability to play or interact with other children
Odd, contradictory displays of behavior


• Dissociation is a subconscious defense mechanism that helps a person protect his or her emotional self from recognizing the full effects of some horrific or traumatic event by allowing the mind to forget or remove itself from the painful situation or memory. A person may dissociate during an event to prevent full awareness of what is happening, and/or may develop dissociation as an ongoing coping mechanism to manage painful emotions.

• These patients may experience (and the assessment should focus on): a lack of appetite or overeating, estrangement from family members, intrusive thoughts, flashbacks, or dissociative episodes. Dissociative episodes and avoidant behavior may interfere with the patient's ability to socialize and play.

• The patient may not always be able to report emotional trauma because they have dissociated from the event and it is not integrated with their conscious awareness. The nurse should watch for signs of abuse such as startled reactions, unexplained moods, erratic sleep, and fear of objects or other people. Because some patients are not aware they dissociate, the nurse should also observe any patterns that indicate periods of amnesia or unexplained behaviors.

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