Dissociative Disorder Monica Castelao Walden University Dr.

5dissociative Disordermonica Castelaowalden University Dr Hopkinsaug 1

Discuss the controversies that surround dissociative disorders, ethical and legal considerations when treating patients with these disorders, and strategies for maintaining therapeutic relationships. Include an overview of professional beliefs about dissociative disorders and the evidence supporting or refuting common myths and misconceptions. Provide a comprehensive discussion grounded in current research, addressing diagnostic challenges, trauma associations, treatment outcomes, and ethical issues encountered by mental health practitioners.

Paper For Above instruction

Dissociative disorders (DD), including dissociative identity disorder (DID), dissociative amnesia, and derealization/depersonalization disorder, represent complex psychological conditions characterized by disruptions in memory, identity, perception, and consciousness. These disorders have long been the subject of significant controversy, particularly regarding their etiology, diagnosis, treatment, and legal considerations. Understanding these controversies and prevailing professional beliefs is essential for effective clinical practice and for advancing research in this domain.

Controversies Surrounding Dissociative Disorders

One of the most contentious issues in dissociative disorders pertains to their origins, specifically the debate over whether dissociative states, especially DID, have iatrogenic influences. Critics argue that certain therapeutic practices, such as suggestive psychotherapy, may inadvertently induce false memories or create dissociative identities, leading to overdiagnosis. Empirical studies, however, largely refute this notion, indicating that dissociative disorders predominantly result from severe trauma, particularly in childhood (Loewenstein, 2018). Nonetheless, the possibility that some diagnostic presentations could be artificially fabricated cannot be entirely dismissed, emphasizing the need for rigorous assessment techniques.

Another controversy concerns the diagnostic criteria, particularly whether existing manuals like the DSM-IV and DSM-5 are sufficiently sensitive or specific. Skeptics assert that these criteria may lead to overdiagnosis or misdiagnosis, partly due to symptom overlap with other psychotic or personality disorders. Consequently, clinicians are advised to utilize comprehensive clinical interviews and assessments rather than relying solely on checklists (Bailey et al., 2019).

A further debate revolves around the nature of memories in dissociative disorders, especially regarding psychogenic amnesia and repressed memories of sexual abuse. Critics question whether these memories are genuine or are false, often induced in therapy. Laboratory studies on false memory production reveal that while false memories can be artificially created, the massive amnesia reported in DD often lacks empirical support, raising concerns about veracity and suggestibility (Bailey et al., 2019).

Professional Beliefs and Myths About Dissociative Disorders

Current professional consensus recognizes dissociative disorders as trauma-related conditions, predominantly resulting from early and chronic abuse or neglect. Nevertheless, myths persist. Some believe DD are rare, fleeting, or merely a fad, while others erroneously categorize them as malingering or fabricated conditions. Empirical research indicates that DID occurs in approximately 1–1.5% of community samples, refuting the myth of rarity. This prevalence is consistent across diverse populations globally, supporting the understanding that DD are genuine and often severe (Brand et al., 2016).

Furthermore, the misconception that dissociative identities are artificially induced by therapists has been debunked. Evidence suggests a strong correlation between trauma history and dissociative symptomatology, particularly severe childhood abuse. Studies show that individuals with DID often recount extensive trauma histories, and symptoms tend to diminish with trauma-focused therapy (Sar et al., 2017).

Myths about treatment harm are also challenged by longitudinal research illustrating significant symptom reduction over time. For example, therapeutic interventions that foster a strong therapeutic alliance and address trauma have led to decreased dissociative symptoms, hospitalization, and self-harm behaviors, contradicting claims that treatment is inherently harmful (Lowenstein, 2018).

Strategies for Maintaining Therapeutic Relationships

Effective treatment of dissociative disorders primarily involves psychotherapy, emphasizing the importance of establishing and maintaining a strong therapeutic alliance. Building trust is crucial, given that many patients with DD have histories of trauma and abuse that impair their ability to trust others. Clinicians should develop a genuine affective bond, agree on goals and tasks, and demonstrate flexibility and empathy during sessions (Cronin et al., 2014).

Early assessment of alliance strength predicts treatment outcomes, underscoring the need for consistent, validating engagement. Therapists must be skilled in recognizing and managing transference and countertransference issues, particularly as DD patients may respond unpredictably or regress during therapy (Subramanyam et al., 2020). Maintaining a nonjudgmental stance, providing safety, and fostering a collaborative environment facilitate symptom reduction and integration of dissociative identities.

Legal and Ethical Considerations

Treating patients with dissociative disorders raises numerous legal and ethical issues. One primary concern involves assessing decision-making capacity, as dissociative states may impair the patient's ability to provide informed consent. Because of the presence of multiple identities or alters, determining which personality is dominant at a given time becomes complex. Practitioners must balance respect for patient autonomy with protective measures, especially when minor or vulnerable individuals are involved (Rocchio, 2020).

Ethically, clinicians are obligated to maintain confidentiality while ensuring safety. This includes managing situations where dissociative symptoms may lead to self-harm or pose risks to others. Legal issues may arise if a patient with DID commits a criminal act; the mental health provider must navigate the intricacies of mental illness defenses and the defendant's competency (Rocchio, 2020). Moreover, clinicians are responsible for staying current with evidence-based practices, avoiding suggestive or suggestibility-inducing techniques that could further traumatize patients or distort memories.

Conclusion

In conclusion, dissociative disorders embody a complex interplay of psychological trauma, neurobiological mechanisms, and social factors. While controversies concerning their etiology, diagnosis, and treatment persist, current research supports their validity as trauma-related disorders. Addressing myths and misconceptions through evidence-based practice is vital to improve outcomes. Building strong therapeutic alliances and carefully managing ethical and legal issues can facilitate effective intervention, reduce suffering, and foster healing for individuals with dissociative disorders.

References

• Bailey, T. D., Boyer, S. M., & Brand, B. L. (2019). Dissociative disorders. In D. H. Barlow (Ed.), Diagnostic interviewing (pp. 123-145). Springer.
• 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, 24(4), 257-270.
• Cronin, E., Bethany L., & Jonathan F. M. (2014). The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders. European Journal of Psychotraumatology, 5(0), 1-9.
• Ducharme, E. L. (2017). Best practices in working with complex trauma and dissociative identity disorder. Practice Innovations, 2(3), 150-161.
• Loewenstein, R. J. (2018). Dissociation debates: Everything you know is wrong. Dialogues in Clinical Neuroscience, 20(3), 229-242.
• Martínez, A. P., Dorahy, M. J., Nesbit, A., Palmer, R., & Middleton, W. (2020). Delusional beliefs and their characteristics: A comparative study between dissociative identity disorder and schizophrenia spectrum disorders. Journal of Psychiatric Research, 131, xx-xx.
• Rocchio, L. M. (2020). Ethical and professional considerations in the forensic assessment of complex trauma and dissociation. Psychological Injury and Law, 13(2), 150-161.
• Sar, V., Alioğlu, F. M., Akyüz, G. M., Tayakış, E., Akgülmş, E. F., & Şönmez, D. (2017). Awareness of identity alteration and diagnostic preference between borderline personality disorder and dissociative disorders. Journal of Trauma & Dissociation, 18(5), 693–709.
• Subramanyam, A. A., Somaiya, M., Shankar, S., Nasirabadi, M., Shah, H. R., Paul, I., & Ghildiyal, R. (2020). Psychological interventions for dissociative disorders. Indian Journal of Psychiatry, 62(Suppl 2), S280–S289.