Controversy Associated with Dissociative Disorders

Controversy Associated with Dissociative Disorders

Dissociative disorders are characterized by disturbances in otherwise integrated functionalities such as memory, control or body movements, consciousness, and sensation. Per DSM-V, dissociative amnesia without fugue, dissociative amnesia with fugue, and dissociative identity disorder, among others, are some of the strata detailed in the text. Notwithstanding, controversies about these disorders have long existed.

To begin with, controversies about dissociative disorders date back to the dawn of modern psychiatry. With the expansion of scientific knowledge and subsequent understanding of scientific principles underlining mental health illnesses, many scholars implicate psychological traumas in the development of dissociative disorders. This belief led to the confabulation of trauma theories to explain the nexus between trauma and dissociative states. Per the trauma model, dissociative disorders are psycho-biological states that serve protective purposes against overwhelming and traumatic experiences (Loewenstein, 2018). In this respect, dissociation works to mitigate the impact of trauma by altering the state of consciousness. The endorsement of these postulations by various scholars and studies saw the stratification of dissociative disorder into two continua. These are pathological dissociation and normal dissociation.

Contrary opinions on dissociative disorders reject the notion that trauma is linked to dissociative disorders. Through the iatrogenic, fantasy, and sociocognitive models, skeptics place fantasies, hypnosis, and false beliefs attributed to repressed memories and diverse personalities as causal factors for dissociative disorders (Loewenstein, 2018). These models opine that psychological processes do not adequately explain amnesia in trauma and that people who experienced traumatic events do remember their experiences.

I concur with the scientific explanations of dissociative states. Scientific findings continue to demonstrate the nexus between acute and chronic traumatic experiences with dissociative disorders. Uyan et al. (2022) note that higher dissociation scores are linked with traumatic experiences. Several studies have also revealed a high correlation between elevated dissociation scores and early or cumulative trauma. Boyer et al. (2022) report that persons with multiple traumatic experiences are likely to develop dissociative disorders. The accuracy of self-report diagnostic tools such as the DES Taxon Scales (DES-T) also points to the validity of the scientific reasoning behind dissociative disorders. Ross (2021) notes that dissociative scales maintain high accuracy and can thus be used to assess these disorders. While these findings epitomize the greater need to understand dissociative disorders, they give insight into the possibility of the scientific reasoning being accurate. Despite many unanswered questions on the development of these disorders, the body of knowledge presented skews my beliefs towards scientific reasoning.

Clients presenting with dissociative disorders preserve their identity as humans. Regardless of their opinions and narrations of whatever happened to them, maintaining objectivity when clients with dissociative disorders is paramount. Strategies that can be used to maintain a healthy therapeutic relationship with these clients include active listening, sharing knowledge of their disease processes, maintaining open-mindedness, and learning the needs of the clients. This will allow them to open up and share more.

Several ethical and legal considerations should be made when handling patients with dissociative disorders. To begin with, an altered personality is covered under various legal statutes under the insanity defense. In this respect, one may not be liable to litigation if he/she commits a criminal act when his/her personality is altered. Understanding these legal provisions is paramount as it may inform how caregivers handle a client with dissociative disorder. It may prevent them from being judgmental and attaching negative labels to the client. An ethical consideration, in this respect, is beneficence. Caregivers have an ethical obligation to do good. It is thus imperative that they treat their patients objectively to better their clinical outcomes.

 References

Boyer, S. M., Caplan, J. E., & Edwards, L. K. (2022). Trauma-related dissociation and the dissociative disorders: Delaware Journal of Public Health, 8(2), 78–84. https://doi.org/10.32481/djph.2022.05.010 

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 

Ross, C. A. (2021). The dissociative taxon and Dissociative Identity disorder. Journal of Trauma & Dissociation, 22(5), 555–562. https://doi.org/10.1080/15299732.2020.1869645 

Uyan, T. T., Baltacioglu, M., & Hocaoglu, C. (2022). Relationships between childhood trauma and dissociative, psychotic symptoms in patients with schizophrenia: A case-control study. General Psychiatry, 35(1). https://doi.org/10.1136/gpsych-2021-100659 

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Controversy Associated with Dissociative Disorders

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 who 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.