Controversy Associated with Dissociative Disorders
Dissociative disorders, as classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), encompass psychiatric conditions marked by a disruption in consciousness, identity, memory, or perception. These disorders, particularly dissociative identity disorder (DID), remain the subject of ongoing controversy in both clinical and academic communities. Even though DID is acknowledged in the DSM-5-TR as the most severe form of dissociation, its legitimacy is disputable alongside the reliability of diagnosis and etiology among some scholars. Some of the controversies that surround DID include whether it is a result of trauma or therapist suggestion; such considerations are important as they have an impact on the clinical practice, clinical and legal dealings, and practice of therapists. In this paper, the main issues are discussed, a professional position based on the analysis of the current literature is specified, suggestions on the preservation of therapeutic relationships are described, and general ethical and legal aspects of the given problem are outlined.
Controversy Surrounding Dissociative Disorders
The most prominent controversy associated with dissociative disorders revolves around the validity and etiology of dissociative identity disorder. The traditional trauma model posits that DID develops as a response to overwhelming, repetitive childhood trauma, particularly sexual or physical abuse (Boyer et al., 2022). In this perspective, dissociation is perceived as a complex coping style in which different identities are created in order to adapt to experiences and feelings that are difficult to deal with.
Conversely, the iatrogenic or sociocognitive model argues that DID may not be a naturally occurring condition but rather the result of therapist suggestion, media influence, or cultural reinforcement (Gauld et al., 2022). From this perspective, people may go through the process of having one or the other identity that is either conscious or unconscious, often under leading questions or therapeutic techniques that encourage dissociation. Critics also assert that there are no clear and distinct biomarkers, a high incidence of misdiagnosis, and similarities between the symptoms of DID, borderline personality disorder, and PTSD (Powers et al., 2022).
Further complicating matters, media portrayals of DID often dramatize the disorder, leading to misconceptions about its presentation. This has fostered skepticism in the public and among professionals, who argue that DID is either rare or misrepresented altogether. Although the DSM-5-TR outlines clear diagnostic criteria, including identity disruption, memory gaps, and clinically significant distress, the clinical utility of these criteria remains debated (Grande, 2018).
Professional Beliefs and Scholarly Support
From a professional standpoint, I acknowledge the reality of dissociation as a clinical phenomenon, especially among trauma survivors. However, I approach DID with cautious skepticism. While the existence of dissociative symptoms is well-documented, the notion of distinct, compartmentalized identities with complete memory segregation appears less empirically grounded.
My belief aligns with a moderate view: DID may exist but likely represents a rare endpoint on a dissociative spectrum. The research by Mclean Hospital (2022) provides compelling evidence that a subset of individuals with severe trauma histories meet diagnostic criteria for DID. Neuroimaging studies show alterations in brain activity during identity switches, lending some biological credence to the disorder (Al-Juhani et al., 2024). However, studies also reveal that many supposed features of DID, such as inter-identity amnesia, can be simulated by actors, and some clinicians may unintentionally reinforce identity fragmentation during therapy (Huntjens et al., 2020). Therefore, I support trauma-informed care that acknowledges dissociative experiences without prematurely pathologizing them as DID. Clinicians should adopt a conservative diagnostic approach, utilizing thorough assessment tools and corroborative histories to differentiate genuine symptoms from suggestibility or malingering.
Strategies for Maintaining the Therapeutic Relationship
Treating individuals with dissociative disorders demands a delicate and informed therapeutic alliance. Establishing trust is paramount, particularly because many patients report early abuse and betrayal by caregivers. Consistency, transparency, and nonjudgmental listening form the bedrock of a stable therapeutic relationship.
One effective strategy is the use of phase-oriented treatment, beginning with stabilization before delving into trauma processing. Therapists should employ grounding techniques, reality orientation, and coping skill development in the early phase. During sessions, attention should be paid to shifts in speech, affect, or awareness, which may indicate dissociative changes. When multiple identity states emerge, the therapist must engage all parts with equal respect and avoid favoring one identity over another.
Therapists should also avoid suggestive language or hypnosis, which may inadvertently reinforce identity division. Instead, focusing on integration—the unification of fragmented experiences into a coherent sense of self—should remain the long-term therapeutic goal (American Psychiatric Association, 2022).
Ethical and Legal Considerations
The treatment of dissociative disorders presents several ethical and legal challenges. Clinically, there is a risk of iatrogenesis, where the clinician inadvertently causes or exacerbates dissociative symptoms through suggestive techniques. Ethical practice requires that therapists use empirically validated assessment tools, seek supervision when in doubt, and avoid interpreting every symptom as evidence of DID.
Another ethical concern involves confidentiality and informed consent. Given the complexity of DID, clinicians must ensure that all identity states are understood and that consent to treatment is obtained. This can be challenging when identity states are unaware of each other or disagree on therapeutic goals. Practitioners must document carefully, engage in clear communication, and involve legal counsel when needed (American Psychiatric Association, 2022).
From a legal perspective, dissociative disorders often arise in forensic settings, where defendants claim memory loss or involuntary behavior due to an alternate identity. The DSM-5-TR cautions against using psychiatric diagnoses as definitive evidence in legal contexts (Zepinic, 2021). Courts may view DID skeptically, and clinicians testifying in such cases must present objective, well-substantiated evaluations while maintaining professional neutrality.
Conclusion
Dissociative disorders, particularly DID, remain among the most debated diagnoses in psychiatry. While dissociation as a response to trauma is a clinically supported phenomenon, DID’s etiology, diagnosis, and presentation continue to spark scholarly and professional disagreement. Clinicians must strike a balance between validating client experiences and avoiding over-pathologization or iatrogenic harm. Through trauma-informed care, evidence-based practice, and ethical integrity, mental health professionals can support clients experiencing dissociation while contributing to a more nuanced understanding of these complex disorders.
References
Al-Juhani, A., Alzahrani, M. J., A, Z. A., Alnefaie, A. N., Alnowaisser, L. N., Alhadi, W., Alghamdi, J. K., & Bauthman, M. S. (2024). Neuroimaging and brain-based markers identifying neurobiological markers associated with criminal behaviour, personality disorders, and mental health: A narrative review. Cureus. https://doi.org/10.7759/cureus.58814
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787
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
Gauld, C., Espi, P., Revol, O., & Fourneret, P. (2022). Explanatory hypotheses of the ecology of new clinical presentations of dissociative identity disorders in youth. Frontiers in Psychiatry, 13(67). https://doi.org/10.3389/fpsyt.2022.965593
Grande, T. (2018, October 22). The dissociative identity disorder controversy (Trauma vs. Iatrogenic) [Video]. YouTube. https://www.youtube.com/watch?v=zqTP0CP9aDk
Huntjens, R. J. C., Rijkeboer, M. M., & Arntz, A. (2020). Schematherapy in DID: Treatment length and related studies on dissociative amnesia. European Journal of Psychotraumatology, 11(1), 1711638. https://doi.org/10.1080/20008198.2020.1711638
Mclean Hospital. (2022, August 29). Understanding dissociative identity disorder. McLean Hospital. https://www.mcleanhospital.org/essential/did
Powers, A., Petri, J. M., Sleep, C., Mekawi, Y., Lathan, E. C., Shebuski, K., Bradley, B., & Fani, N. (2022). Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample. Journal of Anxiety Disorders, 88(67), 102558. https://doi.org/10.1016/j.janxdis.2022.102558
Zepinic, V. (2021). Forensic notion of the trauma-related dissociation. Beijing Law Review, 12(03), 948–972. https://doi.org/10.4236/blr.2021.123049
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Question 
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.
Controversy Associated with Dissociative Disorders
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
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.