Controversy Associated with Dissociative Disorders

Controversy Associated with Dissociative Disorders

Dissociative Disorder (DD), as defined by Löbbing et al. (2019), refers to a mental disorder that involves patients experiencing a lack of continuity and disconnection between thoughts, surroundings, memories, and actions. The author further adds individuals diagnosed with the condition escape from reality in unhealthy and involuntary ways, thus causing more problems in daily life. It is imperative to note dissociative disorders are often triggered by traumatic experiences that distort memory. Thus, patients diagnosed with the condition experience signs and symptoms such as memory loss, blurred vision, inability to cope with professional stress and mental health problems such as anxiety and suicidal thoughts (Mapanga et al. (2019).

According to Sadock et al. (2015), there are three major DD defined in the DSM-5; dissociative amnesia, dissociative identity disorder, and depersonalization-derealization disorder. However, over the years since the beginning of psychology and psychiatry, there have been controversies associated with diagnosis and treatment. Some psychologists believe DD is not supported by scientific evidence, while proponents of the disorder believe there is a direct relationship between DD and psychological trauma, especially at the early stages of life. On the flip side, the opponents discount the assumption that DD is associated with trauma and argue that DD is caused by socio-cultural and iatrogenesis factors. Therefore, the purpose of this research paper is to present the controversy surrounding DD, explain professional beliefs about DD, and explain various strategies to promote a therapeutic relationship with a client presented with DD.

Controversies That Surround Dissociative Disorders

One of the controversial factors is whether DD is real and are the causatives real. According to a study conducted by Löbbing et al. (2019), the researchers concluded that more than 90% of patients diagnosed with DD have childhood traumas. However, there is no sufficient evidence to show the physiology between traumas and DD. Additionally, other theorists stipulate the treatment of the condition triggers childhood memories, thus leading to the condition. Therefore, if there is no solid association between trauma and the diagnosis of DD, therefore, how can the symptoms be analyzed? The other controversy includes whether the diagnosis of DD is valid. The scales used to assess first-person reports are often crafted. Thus, it may increase false positives. Some patients may fake the symptoms to avoid the adverse consequences of illegal actions. Additionally, DD Is controversial due to the sudden increase experienced in the 1980s, as explained by (Loewenstein, 2018). There were more patients diagnosed in the said year, and this is associated with Sybil’s book, published in 1970; psychologists exaggerated; thus, more patients are diagnosed in line with it.

Professional Believes About Dissociative Disorders

Despite the underlying controversies, DD is a serious and legitimate disorder associated with adverse life events if not attended to properly. Although some individuals may fake the symptoms, there is empirical evidence provided by Ojha & Syed (2020) there is a direct relationship between childhood trauma and DD. Statistically, the author states above 90% of patients diagnosed with the condition have a history of physical or sexual abuse; thus, DD is a mechanism to cope with the trauma. However, not all childhood traumas lead to DD, although most of the traumatic experiences lead to dissociation states, and in worst cases, it leads to multiple disorders. According to Mapanga et al. (2019), dissociative disorders are linked with the highest rate of childhood abuse, besides the neglect of psychiatric disorders. The author further adds catastrophic episodes such as natural disasters, torture, and crimes may catalyze the development of DD. It is also imperative to note that patients diagnosed with DD are not conscious that they are using the condition as a coping strategy. Thus, they experience challenges such as poor social relationships, impaired daily functioning, and a sense of detachment from reality (Loewenstein, 2018).

Strategies for Maintaining Therapeutic Relationships with a Client Diagnosed with DD

According to Löbbing et al. (2019), there are diverse treatment options for patients diagnosed with DD. However, the standard approach includes psychotherapy and the medication process. According to Sadock et al. (2015), the former approach is the primary treatment option, and it involves talk and psychosocial therapy, which involves talking to mental health professionals. Mental health professionals are therefore expected to employ therapeutic techniques such as empathizing and asking open-ended questions to the patient. Another therapeutic approach includes setting time aside with minimal distractions with the patient, letting them share what they want while listening carefully to their explanations. Additionally, talking to them about wellness is imperative, besides avoiding confrontations.

Ethical and Legal Considerations Related to Dissociative Disorders

Psychiatrists often encounter diverse ethical and legal considerations while attending to patients from diverse cultural settings. One of the ethical factors includes whether telling patients the truth about their diagnosis. Earlier on, they were not to disclose, but due to increased patient safety and rights awareness, they were obliged to explain each diagnostic criterion. Another ethical issue is related to discussing the risk of suicide if the condition is not attended to. However, disclosing the risks indicates respect for the patient, leading to increased trust. Conversely, disclosing may lead to adverse effects such as lost hope for recovery, leading to suicidal ideation. It is, therefore, the legal obligation of health practitioners to disclose all details to their clients. Otherwise, it may be regarded as lying by omission.

References

Löbbing, T., Carvalho Fernando, S., Driessen, M., Schulz, M., Behrens, J., & Kobert, K. (2019). Clinical ethics consultations in psychiatric compared to non-psychiatric medical settings: characteristics and outcomes. Heliyon, 5(1), e01192. https://doi.org/10.1016/j.heliyon.2019.e01192

Loewenstein R. J. (2018). Dissociation debates: everything you know is wrong. Dialogues in clinical neuroscience, 20(3), 229–242. https://doi.org/10.31887/DCNS.2018.20.3/rloewenstein

Mapanga, W. W., Casteleijn, D. C., & Odendaal, W. E. (2019). Strategies to strengthen the provision of mental health care at the primary care setting: An evidence map. PLOS. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222162

Ojha, R., & Syed, S. (2020). Challenges faced by mental health providers and patients during the coronavirus 2019 pandemic due to technological barriers. Internet interventions, 21, 100330. https://doi.org/10.1016/j.invent.2020.100330

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer. Chapter 12, “Dissociative Disorders”

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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.

Learning Resources

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

Chapter 12, “Dissociative Disorders”

Osmosis. (2017, November 20). Dissociative disorders – causes, symptoms, diagnosis, treatment, pathology[Video]. YouTube. https://youtu.be

Mad Medicine. (2019, August 18). Dissociative disorders (Psychiatry) – USMLE Step [Video]. YouTube. https://youtu.be/Iz03M9pwhs0

Grande, T. (2018, October 22). The dissociative identity disorder controversy (Trauma vs. Iatrogenic). [Video]. YouTube. https://www.youtube.com/watch?v=zqTP0CP9aDk

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.

Main Assignment:

In 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.