Controversy Associated With Dissociative Disorders
In a normal state, mental dissociation can occur, but a connection with the surroundings can easily be established if needed. However, for some individuals, mental dissociation is pervasive. It becomes hard for such individuals to recall experiences or break down their memories. Dissociative disorders create issues with how an individual recalls events, their identity, and experiences. Most of the controversies surrounding dissociative disorders are related to the causes of such disorders, the diagnosis process, identification, and treatment of dissociative disorder patients.
There exists a lot of conflict on the etiology of dissociative disorders. Most of the disorders are associated with traumatic and stressful events and experiences. Others might be a result of medical usage and treatment regimens, while others might be a result of substance use and abuse. Dissociative disorders might also result from other mental disorders, such as anxiety and bipolar disorders. Other arguments related dissociative disorders to socio-cultural causes. Therefore, dissociative disorders cannot be directly attributed to any behaviors, health conditions, or substance usage.
Another controversy is related to the categorization, diagnosis, and differentiation of dissociative disorders. Dissociative disorders, according to the DSM-5, are categorized as mental disorders associated with memory, identity, behavior, and emotional problems. The diagnoses for dissociative disorders may overlap between the three types of dissociative disorders. Dissociative disorders are associated with a multitude of comorbidities, including mental disorders identified by the DSM-5, such as conversion disorder, obsessive-compulsive disorder, and anxiety disorder, among others. Therefore, it is hard to develop distinct causes of dissociative disorder and establish the validity of diagnoses.
Professional Beliefs about Dissociative Disorders
A lot of debates exist today among health professionals on dissociative disorders. The conflict among professionals is on the causes and diagnostics criteria for the disorders. Health professionals, especially in psychiatry and psychology, hold varied beliefs on dissociative disorders, with some relating it to traumatic experiences and others relating the disorders to multiple causes, including genetic, neurobiological development, and clinical causes. These debates and controversies have led to the development of various notions about dissociative disorders.
There exist beliefs that dissociative disorders are a fad. The take of dissociative disorders as a fad has been fueled by false memory researchers who identified dissociative disorders as manifestations of false memories, meaning they are not valid mental disorders (Ross, 2022). Drawing from the work by McHugh (2013), another belief long held is that dissociative disorders are a North American issue and overly diagnosed. Other beliefs, as illustrated by Barlow et al. (2016), present dissociative disorders as rare and vary across cultures, making them hard to diagnose. This has resulted in the view that dissociative disorders are not as serious as other mental disorders categorized by the DSM-5.
Another of the most prevalent beliefs is that dissociative disorders are mostly a result of treatments and medicines rather than past traumatic experiences. McHugh (2013) also points out that some literature has argued that the treatment of dissociative disorders risked causing more mental harm to the patient. Although most of these beliefs have been refuted by research on dissociative disorders, a large number of practicing professionals still argue on the basis of such beliefs.
Strategies for Maintaining a Therapeutic Relationship with a Client with a Dissociative Disorder.
The diagnosis and treatment process of dissociative disorder patients remains one of the most underserved fields with a substantial impact on public health (Loewenstein, 2022). The issue remains to be the confusing nature of dealing with the disorders’ patients and the varying undistinctive nature of its symptoms. However, a therapeutic relationship with patients is important to achieve better mental outcomes. A therapeutic relationship with clients with a dissociative disorder can be maintained by taking time to understand their emotions from a neutral perspective, understanding what triggers them, and educating them on such emotions and how to manage them. According to Kornhaber et al. (2016), therapeutic relationships with a patient could be improved by taking time to therapeutically listen to the patient, respond professionally to the patient’s expressed emotions, identify their unmet needs and wants, and placing the patient at the center of the therapy sessions.
Having sufficient knowledge of dissociative disorders is another way in which to develop and maintain a therapeutic relationship with a client who has dissociative disorders. Knowledge can help therapists look beyond beliefs and myths about dissociative disorders and differentiate between related manifestations from other mental disorders. Bolsinger et al. (2019) point out that improving research efforts in acute psychiatric settings and promoting awareness can create necessary competencies for both clinicians and patients, which can facilitate a good therapeutic relationship in such care settings.
Clinical, Ethical, and Legal Considerations in Nursing Practice Related To Dissociative Disorders
The beliefs held by professionals on dissociative disorders in the health care sectors, especially those tasked with diagnosing and treating dissociative disorders, have an impact on clinical, ethical, and legal considerations when dealing with related patients. One of the major legal and ethical considerations is the accountability of people with dissociative disorders for their actions. For instance, in a case trial, an individual cannot be held accountable if they claim to have dissociative disorders. However, the advice of a qualified mental health specialist is required to ascertain the psychological fitness of the convicted to stand or not stand for trial (Rocchio, 2020). In clinical settings, mental health nurses handling patients with dissociative disorders need to understand the vulnerabilities associated with such patients and provide person-centered therapy and care that best meets their emotional condition. This consideration reduces the chances of causing unintended mental harm to the patient during therapy.
Brand, B. L., Sar, V., Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A., & Middleton, W. (2016). Separating fact from fiction: An empirical examination of six myths about dissociative identity disorder. Harvard review of psychiatry.
Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2016). Abnormal psychology: An integrative approach. Cengage learning.
Bolsinger, J., Jaeger, M., Hoff, P., & Theodoridou, A. (2020). Challenges and opportunities in building and maintaining a good therapeutic relationship in acute psychiatric settings: A narrative review. Frontiers in psychiatry, 10, 965.
Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review. Journal of multidisciplinary healthcare, 9, 537.
Loewenstein, R. J. (2022). Dissociation debates: Everything you know is wrong. Dialogues in clinical neuroscience.
McHugh, P. (2013). Do fads ever die?. The Journal of nervous and mental disease, 201(4), 357-358.
Rocchio, L. M. (2020). Ethical and professional considerations in the forensic assessment of complex trauma and dissociation. Psychological injury and law, 13(2), 124-134.
Ross, C. (2022). False Memory Researchers Misunderstand Repression, Dissociation and Freud. Journal of Child Sexual Abuse, 1-15.
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The DSM-5 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, 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.
Examine the controversy surrounding dissociative disorders. You will also explore clinical, ethical, and legal considerations pertinent to working with patients with these disorders.
Review this week’s Learning Resources on dissociative disorders.
Use the 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.
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