Discussion – Dissociative Disorders

Discussion – Dissociative Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), dissociative disorders are considered disorders in which there is a breakdown in the normal integration of consciousness, memory, sense of self and the environment, emotional responsiveness, perceptions of self and surroundings, motor coordination, and behavior (Drescher, 2022). These disorders are generally considered to occur in response to heightened stress or trauma during early development stages. The DSM-5 categorizes dissociative disorders into three groups: dissociative identity disorder (DID), dissociative amnesia, and depersonalization or derealization disorder. Dissociative disorder patients commonly complain of memory deficits, depersonalization, and or identity crises. These symptoms are often chronic and may be accompanied by other psychiatric disorders, for example, post-traumatic stress disorder and major depressive disorder, which increases the difficulty of diagnosing and treating them.

Controversies in Dissociative Disorders

Diagnosing dissociative disorders remains challenging because of their association with other disorders and several symptoms that may be somehow subjective. DSM-5 insists on assessment based on clinical interviews, a detailed history of symptoms, and the exclusion of any other mental or medical conditions that may be causing the symptoms (Chien & Fung, 2022). DID particularly has caused controversies in terms of its legitimacy; while some practitioners attribute its cause to early childhood trauma, others suggest that suggestive therapeutic practices iatrogenically induce it. Additionally, the patients themselves may not be fully aware of their dissociative symptoms or refuse to disclose them due to fear, shame, or misunderstandings, making diagnosis difficult. Hence, clinicians must participate in comprehensive psychosocial assessments, use standardized tests, and consider the individual’s life experience.

Personal Professional Belief

From a professional perspective, I believe that it is necessary to acknowledge dissociative disorders as actual mental illnesses that require diagnosing and treating correctly. Although there exists some controversy regarding the legitimacy of DID, the suffering that the clients endure is genuine, most of the time stemming from traumatic backgrounds (Bistas & Grewal, 2024). Therefore, it is crucial that in clinical practice, any contact with people exhibiting dissociative symptoms should be approached from a trauma-informed perspective because these symptoms are best seen as adaptive rather than exaggerating or malingering (Yadav & Gunturu, 2024). As highlighted by Boyer et al. (2022), there is evidence that dissociative symptoms persist in trauma survivors across different cultures and, therefore, require more appreciation in the clinical field. Hence, keeping an open-minded but critical approach towards these disorders while being a mental health practitioner and practicing according to evidence-based practice and the client’s needs is crucial.

Strategies to Maintain Therapeutic Relationship

The management of dissociative disorders mainly requires long-term, focused psychotherapy with the goal of synthesizing the different altered identities and addressing potential precursors such as trauma. Out of these, cognitive behavioral therapy, dialectical behavior therapy, and eye movement desensitization and reprocessing have become the most popular therapeutic approaches, most known to address distinct aspects of emotional regulation and trauma (Mitra & Jain, 2023). These therapeutic modalities allow patients to learn effective coping strategies for dealing with stressors, enhance self-insight, and, more importantly, get a chance to face painful memories within a structured and supportive context. Most drugs used for dissociative disorders are used to treat comorbid symptoms like depression, anxiety, or insomnia, which are common in dissociative disorders.

Therapists who manage patients diagnosed with dissociative disorders should have trusting, enduring, and contextually responsive relationships with clients (Opland & Torrico, 2024). Because of their backgrounds of trauma and related issues to do with identity and self-cohesion, clients may have issues with modulation of the emotional state and relationship stability. Measures like setting out a regular structure of sessions, practicing cognitive behavioral techniques, and acknowledging the client’s experiences are essential. Such effective treatments as dialectical behavior therapy and eye movement desensitization and reprocessing that focus on emotion regulation and trauma processing can help promote growth and strengthen the therapeutic relationship. Clinicians also should not impose any bias while practicing. They should be ready to modify the approach to meet the patient’s needs and stage in the process to enhance adherence and sustained recovery.

Legal and Ethical issues

Legal issues related to dissociative disorders include criminal responsibility, consent, and capacity to consent. For instance, people diagnosed with DID may not remember the criminal actions that they are responsible for, making issues of legal responsibility complicated. Such defenses are usually challenging to ascertain because dissociation is a broad concept, and no definitive diagnostic tests exist. Also, their competency assessment may present a challenge if severe dissociative symptoms lead to impaired and fragmented decision-making in the patient. These issues raise whether a person’s legal rights must be safeguarded while the legal system seeks justice.

On the ethical aspect, several issues arise about suggestibility, misdiagnosis, and harm that may be caused by treatment among clinicians handling clients with dissociative disorders. The debate between the trauma-based and the iatrogenic model of DID is particularly ethical when it comes to the role of suggestive therapeutic techniques that can subsequently unintentionally enhance existing or create new dissociative symptoms (Pietkiewicz et al., 2021). Therapists must, therefore, avoid any instances where they impose interpretation or even put questions that give suggestions that steer the patient toward a specific answer. Another aspect of ethical treatment is informed consent, particularly where the patient is being subjected to trauma-focused interventions that can worsen the distress level. Therefore, several measures define ethical practice, such as cautious evaluation, appropriate reporting, and patient protection during therapy.

Conclusion

Dissociative disorders present several diagnostic, therapeutic, legal, and even ethical issues that must be addressed to ensure that patients with dissociative disorders get proper treatment. Given that most of them are caused by past traumatic experiences and present as identity crises, practitioners should use evidence-based diagnostics and interventions while avoiding exploitative approaches. To ensure the rights and justice of a dissociating victim are observed while maintaining justice, legal systems must adapt to the various forms of dissociation. Although controversies exist, especially regarding DID, higher research and awareness can help in better assessment and treatment plans and outcomes. With increasing knowledge, there is a further possibility of client-centered therapy for patients with dissociative disorders.

References

Bistas, K., & Grewal, R. (2024). Unraveling the layers: Dissociative identity disorder as a response to trauma. Cureus, 16(5). https://doi.org/10.7759/cureus.60676

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

Chien, W. T., & Fung, H. W. (2022). The challenges in diagnosis and treatment of dissociative disorders. Alpha Psychiatry, 23(2), 45–46. https://doi.org/10.5152/alphapsychiatry.2022.0001

Drescher, J. (2022, October). What are dissociative disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders

Mitra, P., & Jain, A. (2023, May 16). Dissociative identity disorder. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK568768/

Opland, C., & Torrico, T. J. (2024, October 6). Psychotherapy and therapeutic relationship. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK608012/

Pietkiewicz, I. J., Bańbura-Nowak, A., Tomalski, R., & Boon, S. (2021). Revisiting false-positive and imitated dissociative identity disorder. Frontiers in Psychology, 12(12). https://doi.org/10.3389/fpsyg.2021.637929

Yadav, G., McNamara, S., & Gunturu, S. (2024, August 16). Trauma-informed therapy. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK604200/

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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.

Discussion – 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.

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.

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.