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Controversy Associated With Dissociative Disorders

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.

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Controversy Associated With Dissociative Disorders 

Dissociative disorders are controversial life-limiting conditions characterized by an involuntary escape from reality. It is a disconnection between thoughts, identity, memory, and consciousness. Although the condition is not limited to a specific age or ethnic affiliation, it is common among women. The symptoms usually develop after a traumatizing event like abuse or war as a coping mechanism to protect self from negative memories. Simply said, it is dissociating from a situation or experience that is too violent, painful, or traumatic enough to assimilate to the conscious self. Nonetheless, symptoms are often different from one person to another. Finding treatment may be a difficult task for mental health professionals but it involves psychotherapy and medications towards better outcomes. Although the condition elicits numerous controversies from the past, modern research provides credible evidence about its content, criterion, and construct validity.

The controversy that Surrounds Dissociative Disorders

A diagnosis of dissociative disorder sparks controversial discussions even in modern psychiatry with reported cases receiving criticism for misdiagnosis and social contagion. The re-classification of multiple personality disorder as DID is maybe a part of the complexity of understanding the disorder in the psychiatric field. Notwithstanding, Freudian concepts are hard-held on complete repression of traumatic experiences revealed through hypnosis. In contrast, the Iatrogenic Model, the Socio-cognitive Model, and the Fantasy Model label the disorder as an obsession of the past.

The Iatrogenic Model is one of the major opponents of DID. The argument in the model is that from a conscious or unconscious level, the dissociation level (e.g. multiple personalities) is created, encouraged, or exaggerated by the therapist’s expectations (Loewenstein, 2018). Health professionals who believe in ‘repressed memories’ utilize risky approaches like hypnosis to obtain forgotten traumatic experiences but, instead, ‘implant’ false memories (Loewenstein, 2018). Simply said, the therapist suggests the existence of multiple personalities, and consciously in a bid to please, or unconsciously, the patient develops the expected symptoms.

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The socio-cognitive model suggests that DID is a falsified psychiatric disorder without any validity but a consequence of psychotherapy and the media. The model associates the disorder with the North American Culture emphasis on child abuse, the existence of multiple personalities, and repressed memories (Loewenstein, 2018). Consequently, the ‘fad’ is enough to influence people about believing in the possibility of DID. Similarly, the Fantasy Model classifies DID as a rare cognitive trait that fuels a false perception about the existence of traumatic experiences (Loewenstein, 2018). The three theories are an effort to discredit the existence of DID as a diagnosis in mental health. Instead, it is portrayed as a fabricated fad by the patient and the mental health professional.

Professional View about Dissociative Disorders

My professional view is that dissociation is a ‘real’ psychiatric condition evident in modern research discrediting the false conclusions of the traditional models. The socio-cognitive model describes DID as a 'fad'- something intended to be fashionable for some time. However, recent literature by Doray et al. (2014) states that DID is a valid psychiatric disorder with an accurate differentiation from other disorders. The research proves that DID is not a ‘fad’ by providing credible evidence about its content, criterion, and construct validity.

Another false perception is that DID is overdiagnosed in North America. In contrast, a study by Brand et al. (2009) through thorough assessments and validated interviews proves that DID is prevalent all over the world. The study goes further to determine the treatment efficacy of 232 DID patients from every continent apart from Antarctica. It is proof that DID is not a North American issue but a mental health condition affecting millions of people around the world. It contrasts the previous false Fantasy model conclusion that DID is a rare psychiatric condition. Foote et al. (2006) observe a prevalence of 6% among highly traumatized individuals from the USA inner-city samples. It contradicts the previous conclusion of DID rarity in the community and its existence as an iatrogenic disorder rather than trauma-focused.

Maintaining Therapeutic Relationships

Maintaining a therapeutic relationship with a patient diagnosed with dissociative disorder requires a skilled mental health provider for better outcomes. Therapists have to detect any possibility of a psychotic breakdown and intervene appropriately based on the knowledge that DID patients present with multiple comorbidities (e.g. substance abuse and anxiety). Effective therapeutic relationships require that the therapist identifies such conditions and acts effectively to avoid hindering the therapy's progress (Subramanyam et al., 2020). Countertransference is also a problem as the therapist explores the causes of maladaptive thinking. It is the therapist's role to identify counter-transference and manage it sensitively to avoid damaging the therapeutic alliance with the patient (Subramanyam et al., 2020). Doing so achieves and maintains effective therapeutic interactions for better patient outcomes.

 

 

Ethical Considerations

Ethical considerations are an important tenet in treating trauma patients. Some ethical considerations in treating DID include informed consent for difficult interventions, boundary issues, counter-transference, vicarious traumatization, the risk for re-traumatization, and suicide (Zelechoski, 2019). A formal model towards ethical decision-making in such ethical dilemmas is adhering to the principles of beneficence, non-maleficence, autonomy, justice, and fidelity. Consequently, the therapist must have formal training on psychotherapy before treating DID, be conversant with the clinical manifestations, and the psychodynamic nature of DID to ensure an accurate diagnosis and management (Zelechoski, 2019). Doing so is consistent with the ethical framework of proper psychiatric care.

Conclusion

Dissociative disorders have a long-standing controversy in the field of psychiatry. However, recent evidence demystifies any falsely held traditional models about their existence. It supports my professional recognition of the prevalence of DID all over the world among trauma patients. Like other psychiatric conditions, treatment for patients requires unique skills to maintain an effective relationship while adhering to the ethical considerations of psychiatric care.

 

 

References

Brand, B., Classen, C., Lanins, R., Loewenstein, R., McNary, S., Pain, C., & Putnam, F. (2009). A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 1(2), 153.

Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian & New Zealand Journal of Psychiatry, 48(5), 402-417.

Foote, B., Smolin, Y., Kaplan, M., Legatt, M. E., & Lipschitz, D. (2006). Prevalence of dissociative disorders in psychiatric outpatients. American Journal of Psychiatry, 163(4), 623-629.

Loewenstein, R. J. (2018). Dissociation debates: Everything you know is wrong. Dialogues in clinical neuroscience, 20(3), 229.

Subramanyam, A. A., Somaiya, M., Shankar, S., Nasirabadi, M., Shah, H. R., Paul, I., & Ghildiyal, R. (2020). Psychological Interventions for Dissociative disorders. Journal of Psychiatry, 62(Suppl 2), S280. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001344/

Zelechoski, A. D. (2019). Working with Trauma: Clinical, Legal, and Ethical Considerations. https://cpd.aurora.org/sites/default/files/Ethics%20PPT.pdf

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