Dissociative Disorders Controversy

Dissociative Disorders Controversy

Since the beginning of modern psychology and psychiatry, there has been controversy over dissociative disorders. Dissociative identity disorder is an erratic disorder that is evidenced by severe behavioral health symptoms. It is typically associated with childhood traumatic experiences (Mitra & Jain, 2021). However, there exist debates surrounding dissociative disorders revolving around key aspects of diagnosis and classification, etiology, and treatment approaches.

Diagnosis and classification of dissociative disorder have been very controversial. Formally referred to as multiple personality disorder, dissociative identity disorder has been argued by critics that it was not well-defined, leading to misdiagnosis or overdiagnosis. Some critics also question if dissociative disorder is a unique set of behaviors and symptoms that some clinicians do not see in front of their eyes or willful symptoms created by other clinicians who are not sure something is there or not (Gillig, 2019).

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The etiological aspect of dissociative identity disorder has been argued on the basis of fantasy. This model of fantasy associates dissociative disorder with cognitive distortions, fantasy, and suggestibility. Moreover, the fantasy theory sees that people with dissociative disorder have high vulnerability levels, predisposed psychological symptoms, are influenced by media, and are isolated socially (Mitra & Jain, 2021). Lastly, treatment approaches have been put on the debate about their appropriateness. Some professionals are of the opinion that a long-term treatment approach uses cognitive behavioral therapy and other intensive forms of psychotherapy. Others believe that treatment should be done based on the symptoms (Gillig, 2019).

Professional Beliefs About Dissociative Disorders

My professional beliefs about dissociation are shaped and supported by available clinical evidence and research. First, according to Blihar et al. (2020), neuroanatomical brain changes exist in patients with dissociated identities. Compared to normal brain structure, patients with dissociative disorder have a smaller subcortical and cortical volume in the amygdala, parietal, and hippocampus structures, which are helpful in personal and perceptional awareness (Blihar et al., 2020). Moreover, the frontal structures associated with fear learning and movement execution are relatively smaller than in normal people. Also, these patients present with larger white matter tracts whose function is communication between somatosensory association areas and precuneus (Blihar et al., 2020).

Secondly, as supported by evidence, I believe childhood trauma causes dissociative disorder. According to Reinders & Veltman (2020), there is a correlation between a smaller volume of hippocampus and childhood maltreatment. The hippocampal volume and childhood maltreatment have been reported to have a negative correlation in unmedicated persons for the community and people with transdiagnosis of psychiatric disorders like dissociative disorder (Reinders & Veltman, 2020). Neuroanatomical data is an undisputable parameter, for it is unlikely to be cognitively manipulated (Reinders & Veltman, 2020).

Lastly, according to the Fantasy Model (FM), patients with severe symptoms of dissociation score high on measures of fantasy proneness and report extra cognitive impairments. Even though neurobiological research has not been able to show that high fantasy is prone, some studies have shown possible deficits in the working memory of dissociative identity disorder individuals. Moreover, dissociative symptoms have been linked with sleep-wake cycles, which leads to memory failures (Dimitrova et al., 2020).

Establishing Therapeutic Relationships with Clients with Dissociative Disorders

Establishing and maintaining therapeutic relationships with dissociative disorder patients requires the use of several strategies psychoeducation, grounding skills, and cognitive and sensory awareness. Psychoeducation is a technique that is used in acknowledging and normalizing the symptoms of the patients and relating them with their daily life dysfunction. It enables an understanding of the patients and their relatives about the important role of coping skills in therapy and intellectual strengths (Subramanyam et al., 2020).

Grounding skills are key in helping the patient in detachment from emotional pain and regain focus. This technique helps shift the patient’s attention from negative emotions to focus on the present time. They are taught coping responses such as hand washing that detach them from strong emotions. Cognitive awareness is the strategy of asking cognitive-oriented questions like, “Where am I? When is today?” Lastly, sensory awareness is a technique that involves the use of the five senses to anchor to the present moment; for instance, feeling the back of the chair and describing the texture of the chair (Subramanyam et al., 2020).

Ethical and Legal Considerations

Ethical and legal considerations to be on the lookout for when dealing with dissociative disorders include confidentiality. The patient may share sensitive information about their past, which should be handled with strict confidentiality (Rocchio, 2020). Obtaining consent from the patient on all aspects of assessment and treatment is important, with the client understanding the potential benefits and risks. Also, it is important to ensure that one does not implant false memories in the patient through the use of evidence-based techniques. A mental health professional should look into the legal recommendations of the area of jurisdiction. For instance, as noted by Rocchio (2020), mental health professionals are required to report to relevant authorities in suspected cases of child abuse.

References

Blihar, D., Delgado, E., Buryak, M., Gonzalez, M., & Waechter, R. (2020). A systematic review of the neuroanatomy of dissociative identity disorder. European Journal of Trauma & Dissociation, 4(3), 100148. https://doi.org/10.1016/j.ejtd.2020.100148

Dimitrova, L., Fernando, V., Vissia, E. M., Nijenhuis, E. R. S., Draijer, N., & Reinders, A. A. T. S. (2020). Sleep, trauma, fantasy and cognition in dissociative identity disorder, post-traumatic stress disorder and healthy controls: a replication and extension study. European Journal of Psychotraumatology, 11(1), 1705599. https://doi.org/10.1080/20008198.2019.1705599

Gillig, P. M. (2019). Dissociative identity disorder: a controversial diagnosis. Psychiatry (Edgmont (Pa.: Township)), 6(3), 24–29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719457/

Mitra, P., & Jain, A. (2021, November 21). Dissociative Identity Disorder. PubMed. https://www.ncbi.nlm.nih.gov/books/NBK568768/

Reinders, A. A. T. S., & Veltman, D. J. (2020). Dissociative identity disorder: out of the shadows at last? The British Journal of Psychiatry, 219(2), 1–2. https://doi.org/10.1192/bjp.2020.168

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. https://doi.org/10.1007/s12207-020-09384-9

Subramanyam, A., Somaiya, M., Shankar, S., Nasirabadi, M., Shah, H., Paul, I., & Ghildiyal, R. (2020). Psychological Interventions for Dissociative Disorders. Indian Journal of Psychiatry, 62(8), 280. https://doi.org/10.4103/psychiatry.indianjpsychiatry_777_19

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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.

Dissociative Disorders Controversy

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.

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.

Required Media
• Osmosis. (2017, November 20). Dissociative disorders – causes, symptoms, diagnosis, treatment, pathology. Links to an external site. [Video]. YouTube. https://youtu.be/XF2zeOdE5GYLinks to an external site.
• Mad Medicine. (2019, August 18). Dissociative disorders (Psychiatry) – USMLE Step 1Links to an external site. [Video]. YouTube. https://youtu.be/Iz03M9pwhs0Links to an external site.
• Grande, T. (2018, October 22). The dissociative identity disorder controversy (Trauma vs. Iatrogenic)Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=zqTP0CP9aDk

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 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.