Controversy Associated With Dissociative Disorders

**Controversy Associated With Dissociative Disorders**

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### Introduction

Dissociative disorders, particularly Dissociative Identity Disorder (DID), have sparked considerable debate within the psychiatric community. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) classifies and outlines the criteria for these disorders, yet not all practitioners agree on their validity and diagnostic criteria. This paper explores the controversy surrounding dissociative disorders, examines clinical, ethical, and legal considerations in treating these patients, and provides strategies for maintaining a therapeutic relationship with them.

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### The Controversy Surrounding Dissociative Disorders

Dissociative disorders, including DID, Dissociative Amnesia, and Depersonalization/Derealization Disorder, are characterized by a disconnection between thoughts, identity, consciousness, and memory. DID, previously known as Multiple Personality Disorder, is particularly controversial due to doubts about its legitimacy and diagnostic criteria. Critics argue that DID may be a byproduct of suggestive therapeutic practices or media influence rather than a genuine psychiatric condition. Furthermore, the difficulty in distinguishing dissociative disorders from other mental health issues, such as borderline personality disorder or schizophrenia, adds to the diagnostic complexity and skepticism (Brand, Loewenstein, & Spiegel, 2019).

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### Professional Beliefs About Dissociative Disorders

Despite the controversy, I believe that dissociative disorders are legitimate and require careful diagnostic and therapeutic approaches. Research indicates that dissociative disorders often result from severe trauma or abuse, leading to fragmented identities as a coping mechanism (Dorahy et al., 2014). Recognizing the impact of trauma is essential in understanding these disorders.

1. **Trauma-Related Origins**: Studies support the notion that dissociative disorders often stem from early childhood trauma, validating their inclusion in the DSM-5-TR (Dorahy et al., 2014).

2. **Clinical Evidence**: Neuroimaging and clinical studies have shown distinct neural patterns in individuals with DID, suggesting biological underpinnings of the disorder (Reinders et al., 2019).

3. **Patient Experiences**: Accounts from individuals diagnosed with dissociative disorders highlight consistent symptoms and challenges, further supporting the disorder’s legitimacy (Brand et al., 2019).

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### Strategies for Maintaining the Therapeutic Relationship

Maintaining a strong therapeutic relationship with clients presenting with dissociative disorders is crucial for effective treatment. Here are some strategies:

1. **Building Trust**: Establishing trust is essential. Be patient, empathetic, and consistent in your interactions. Clients with dissociative disorders often have a history of trauma and mistrust.

2. **Validating Experiences**: Validate the client’s experiences and symptoms without judgment. Acknowledge their struggles and the reality of their dissociative symptoms.

3. **Safety and Stability**: Focus on creating a safe and stable environment. Implement grounding techniques and coping strategies to help clients manage dissociative episodes (Chu, 2011).

4. **Collaboration and Empowerment**: Collaborate with clients in setting therapeutic goals and empower them to take an active role in their treatment.

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### Ethical and Legal Considerations

Ethical and legal considerations are paramount when working with clients with dissociative disorders.

1. **Confidentiality**: Ensure strict adherence to confidentiality. Due to the sensitive nature of dissociative disorders, protecting client information is crucial (APA, 2017).

2. **Informed Consent**: Provide clear and thorough information about the diagnosis, treatment options, and potential risks to obtain informed consent (APA, 2017).

3. **Non-Maleficence and Beneficence**: Prioritize the client’s well-being by avoiding harm and promoting beneficial outcomes. This includes avoiding suggestive techniques that could exacerbate dissociative symptoms (Chu, 2011).

4. **Legal Documentation**: Maintain accurate and detailed records of the client’s diagnosis, treatment plan, and progress to safeguard against legal disputes and ensure continuity of care (Brand et al., 2019).

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### Conclusion and Reflections

In conclusion, dissociative disorders, particularly DID, remain controversial in the psychiatric community. However, evidence supports their legitimacy, emphasizing the need for careful diagnostic and therapeutic approaches. By implementing strategies to build trust and validate experiences, clinicians can maintain effective therapeutic relationships with clients. Ethical and legal considerations are critical in ensuring the protection and well-being of clients with dissociative disorders. Understanding these complexities will inform my future practice, enhancing my ability to provide empathetic and competent care to individuals with dissociative disorders.

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### References

– American Psychiatric Association. (2017). *Ethical principles of psychologists and code of conduct*. Washington, DC: American Psychiatric Association.
– Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2019). Dispelling myths about dissociative identity disorder treatment: An empirically based approach. *Psychiatry Research*, 274, 350-358.
– Chu, J. A. (2011). *Rebuilding shattered lives: Treating complex PTSD and dissociative disorders*. John Wiley & Sons.
– Dorahy, M. J., Brand, B. L., Sar, V., Kruger, C., Stavropoulos, P., Martinez-Taboas, A., … & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. *Australian & New Zealand Journal of Psychiatry*, 48(5), 402-417.
– Reinders, A. A., Willemsen, A. T., Vos, H. P., den Boer, J. A., & Nijenhuis, E. R. (2019). Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. *PLoS ONE*, 14(3), e0212335.

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This assignment provides a comprehensive overview of the controversy surrounding dissociative disorders, offering insights into maintaining therapeutic relationships and addressing ethical and legal considerations in clinical practice.

 

 

Controversy Associated With Dissociative Disorders

The  DSM-5-TR is a diagnostic tool. It has evolved over the decades, as have the classifications and criteria within its pages. It is used not just for diagnosis, however, but also for billing, access to services, and legal cases. Not all practitioners are in agreement with the content and structure of the  DSM-5-TR, and dissociative disorders are one such area. These disorders can be difficult to distinguish and diagnose. There is also controversy in the field over the legitimacy of certain dissociative disorders, such as dissociative identity disorder, which was formerly called multiple personality disorder.

In this Assignment, you will examine the controversy surrounding dissociative disorders. You will also explore clinical, ethical, and legal considerations pertinent to working with patients with these disorders.

Resources

 

Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.

 

WEEKLY RESOURCES

earning Resources

Required Readings

· Boland, R. Verdiun, M. L. & Ruiz, P. (2022).  Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

· Chapter 11, “Dissociative Disorders”

 

To Prepare

· Review this week’s Learning Resources on dissociative disorders.

· Use the Walden Library to investigate the controversy regarding dissociative disorders. Locate at least three scholarly articles that you can use to support your Assignment.

The Assignment (2–3 pages)

· Explain the controversy that surrounds dissociative disorders.

· Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.

· Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.

· Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.

· NRNP_6665_Week9_Assignment_Rubric

NRNP_6665_Week9_Assignment_Rubric
Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeIn 2–3 pages, address the following:• Explain the controversy that surrounds dissociative disorders.	15 to >13.0 pts Excellent The response includes an accurate and concise explanation of the controversy within the field related to dissociative disorders. 13 to >11.0 pts Good The response includes an accurate explanation of the controversy within the field related to dissociative disorders. 11 to >10.0 pts Fair The response includes a somewhat vague or inaccurate explanation of the controversy within the field related to dissociative disorders. 10 to >0 pts Poor The response includes a vague or inaccurate explanation of the controversy within the field related to dissociative disorders. Or the response is missing.	15 pts
This criterion is linked to a Learning Outcome• Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.	25 to >22.0 pts Excellent The response includes a thorough and well-organized explanation of the student’s professional beliefs about dissociative disorders. Rationale demonstrates critical thinking and is strongly supported with three scholarly references. 22 to >19.0 pts Good The response includes a well-organized explanation of the student’s professional beliefs about dissociative disorders. Rationale is clear and appropriately supported with three scholarly references. 19 to >17.0 pts Fair The response includes a somewhat vague explanation of the student’s professional beliefs about dissociative disorders. Rationale is somewhat unclear and references either provide weak support for the rationale or are not scholarly/current. 17 to >0 pts Poor The response includes a vague explanation of the student’s professional beliefs about dissociative disorders. Rationale is unclear and references are inappropriate. Or the response is missing.	25 pts
This criterion is linked to a Learning Outcome• Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.	30 to >26.0 pts Excellent The response includes an accurate and concise explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder. 26 to >23.0 pts Good The response includes an accurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder. 23 to >20.0 pts Fair The response includes a somewhat vague or incomplete explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder. 20 to >0 pts Poor The response includes a vague or inaccurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder. Or the response is missing.	30 pts
This criterion is linked to a Learning Outcome• Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.	15 to >13.0 pts Excellent The response includes an accurate and concise explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important. 13 to >11.0 pts Good The response includes an accurate explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important. 11 to >10.0 pts Fair The response includes a somewhat vague or incomplete explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important. 10 to >0 pts Poor The response includes a vague and inaccurate explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important. Or, response is missing.	15 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.	5 to >4.0 pts Excellent Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 to >3.5 pts Good Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 3.5 to >3.0 pts Fair Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. 3 to >0 pts Poor Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 to >4.0 pts Excellent Uses correct grammar, spelling, and punctuation with no errors 4 to >3.5 pts Good Contains one or two grammar, spelling, and punctuation errors 3.5 to >3.0 pts Fair Contains three or four grammar, spelling, and punctuation errors 3 to >0 pts Poor Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.	5 to >4.0 pts Excellent Uses correct APA format with no errors 4 to >3.5 pts Good Contains one or two APA format errors 3.5 to >3.0 pts Fair Contains three or four APA format errors 3 to >0 pts Poor Contains many (five or more) APA format errors	5 pts
Total Points: 100

 

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