Controversy Associated With Dissociative Disorders Have You

Controversy Associated with Dissociative Disorders Have you ever been driving and realized you don’t remember the last few minutes of driving? Or have you gotten so wrapped up in a book or movie that you lose some awareness of your surroundings? These are examples of common and very mild dissociation, or a disconnect or lack of continuity between thoughts, feelings, actions, and sense of self. There are three major dissociative disorders defined in the DSM-5-TR : 1.

Dissociative identity disorder, 2. dissociative amnesia, and 3. depersonalization-derealization disorder. Dissociative disorders may be associated with traumatic events in order to help manage difficult memories or experiences. Patients with these types of disorders are likely to also exhibit symptoms of a variety of other dysfunctions, such as depression, alcoholism, or self-harm and may also be more susceptible to personality, sleeping, and eating disorders. This week, you will analyze issues related to the diagnosis and treatment of dissociative disorders as well as associated legal and ethical considerations. 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.

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. See below required media and links. · Locate at least four scholarly articles that you can use to support your Assignment. Instructions - The Assignment (3-4 pages) · Explain the controversy that surrounds dissociative disorders. · Explain your professional beliefs about dissociative disorders, supporting your rationale with at least four 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. · APA 7 · At least four scholarly references

The controversy surrounding dissociative disorders, particularly dissociative identity disorder (DID), has persisted for decades within both the clinical community and the broader society. Central to this debate are issues related to the legitimacy of dissociative disorders as genuine psychiatric conditions versus their potential as products of suggestibility, iatrogenesis, or cultural influences. Additionally, the diagnostic criteria and prevalence rates remain points of contention, complicating efforts for consistent diagnosis and treatment.

Historical skepticism about dissociative disorders originates from debates over whether DID represents a true disorder or is artificially created through therapeutic suggestion and media influence. Critics argue that DID may be overdiagnosed or even fabricated, often influenced by therapists' framing or patients' fantasies. Conversely, proponents contend that traumatic experiences, especially severe childhood abuse, underpin dissociative disorders, and emphasize that clinical observations, neurobiological research, and case histories support their validity (Ross, 2011; Spiegel et al., 2013).

The diagnostic controversy also involves the high comorbidity of dissociative disorders with post-traumatic stress disorder (PTSD) and other trauma-related conditions, which challenges the distinctness of dissociative identities from symptom overlap or cultural syndromes. Some researchers argue that diagnostic inflation or misdiagnosis could lead to inappropriate treatments or stigmatization of victims of trauma (Foote et al., 2006). Nonetheless, neuroimaging studies show brain activity differences in individuals with DID compared to controls, lending support to its biological correlates and legitimacy (Reinders et al., 2012).

From a personal perspective, based on extensive review of the literature, I believe that dissociative disorders are valid and complex responses to severe trauma, especially in childhood. While caution must be exercised to avoid overdiagnosis, dismissing these disorders as mere suggestibility neglects substantial evidence of their traumatic roots and clinical significance (Brand & Loewenstein, 2011). Ethical practice necessitates a balanced approach that respects patient experiences, avoids suggestive diagnostic practices, and emphasizes trauma-informed care.

Maintaining a therapeutic relationship with clients exhibiting dissociative symptoms requires a sensitive, validating, and structured approach. Establishing safety and trust is paramount, given the often profound history of trauma. Clinicians should employ a nonjudgmental stance, actively listen to clients’ narratives, and validate their experiences to foster rapport (International Society for the Study of Trauma and Dissociation, 2011). Techniques such as grounding exercises and stabilization strategies help clients stay connected to the present and reduce dissociative episodes. Incorporating psychoeducation about dissociation demystifies symptoms and encourages client engagement.

Legal and ethical considerations include issues of confidentiality, informed consent, and avoiding harm, especially when dissociative states may impair decision-making capacity. Clinicians must document carefully and recognize that dissociative episodes can be misunderstood legally, potentially affecting the client's rights or autonomy. Ethical practice requires remaining vigilant against implementing suggestive or confrontational methods that could retraumatize clients or exacerbate dissociation (American Psychological Association, 2019). Furthermore, culturally sensitive assessment and treatment are critical, as dissociative symptoms may be expressed differently across diverse populations, and misdiagnosis could lead to stigmatization or ineffective intervention.

In conclusion, the controversy over dissociative disorders reflects ongoing debates about their etiology, diagnosis, and treatment efficacy. Recognizing the traumatic origins and validating clients’ experiences are essential for effective, ethical practice. Clinicians must be aware of the legal implications inherent in working with dissociative patients and employ trauma-informed, culturally sensitive approaches to foster recovery and safeguard client rights.

References

• American Psychological Association. (2019). Publication manual of the American Psychological Association (7th ed.).
• Brand, B. L., & Loewenstein, R. J. (2011). Dissociative identity disorder: An empirical overview. Psychiatry, 74(5), 375-386.
• Foote, B., Smolin, Y., & Kasl, G. (2006). Dissociative experiences in outpatient trauma survivors. Journal of Trauma & Dissociation, 7(3), 3-17.
• International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults.
• Reinders, A. A. T. S., Nijenhuis, E. R. S., & Van der Hart, O. (2012). Neuroimaging in dissociative disorders. Current Opinion in Psychiatry, 25(3), 262-267.
• Ross, C. A. (2011). The identity disturbance controversy: Dissociative identity disorder and its critics. Journal of Trauma & Dissociation, 12(4), 331-344.
• Spiegel, D., Lewis-Fernández, R., Lanius, R., Vermetten, E., Simeon, D., & Friedman, M. (2013). Dissociative disorders in DSM-5. Depression and Anxiety, 30(9), 764–772.