Week 9: Dissociative Disorders Have you ever been driving ✓ Solved

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: dissociative identity disorder, dissociative amnesia, and 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.

Not all practitioners are in agreement with the content and structure of the DSM-5, 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.

Paper For Above Instructions

Dissociative disorders are a group of ailments characterized by a disconnection between thoughts, identity, consciousness, and memory, often triggered by trauma or stress. The DSM-5 categorizes three major dissociative disorders: Dissociative Identity Disorder (DID), Dissociative Amnesia, and Depersonalization/Derealization Disorder. Despite being formally recognized, these disorders remain subjects of controversy in the mental health community, particularly concerning diagnostic criteria, treatment protocols, and the authenticity of certain conditions such as DID.

Understanding the Controversy

The controversy surrounding dissociative disorders primarily stems from the difficulties associated with their diagnosis and the divergent opinions about the legitimacy of these conditions. Critics argue that DID, previously known as Multiple Personality Disorder, is often overdiagnosed and suggest that the presentations of these disorders may be influenced unnecessarily by suggestive therapeutic techniques. Studies indicate that the increase in DID diagnoses may correlate with heightened media portrayals, leading to skepticism among practitioners about its authenticity (Spanos, 1994; Gleaves, 1996).

Moreover, many mental health professionals question the validity of the DSM-5’s classification and criteria for diagnosing dissociative disorders. Several researchers have pointed out that dissociative symptoms can overlap with symptoms of other mental disorders, which complicates the diagnostic process. Hence, there is concern that clinicians may misdiagnose individuals or fail to accurately capture the complexities of dissociative disorders (Widyanto & Williams, 2004; Dalenberg et al., 2010).

Professional Beliefs about Dissociative Disorders

As a future practitioner, I believe that dissociative disorders are genuine and worthy of serious clinical consideration. These disorders signify complex psychological issues that arise from trauma or adverse experiences. It is essential that mental health professionals remain vigilant and informed about the latest research to ensure accurate diagnoses and effective treatment plans. The body of literature substantiating the existence of dissociative disorders supports a spectrum of presentations that require tailored therapeutic approaches (van der Hart et al., 2006; Putnam, 1989).

I advocate for a trauma-informed approach to treatment, recognizing that dissociation may serve as a coping mechanism for individuals who have experienced significant stress or trauma. Accepting dissociative disorders as real and valid conditions promotes empathy and understanding in the therapeutic context, facilitating a stronger therapeutic alliance and better patient outcomes (Herman, 1997; Courtois, 2008).

Maintaining Therapeutic Relationships

In maintaining a therapeutic relationship with clients who exhibit dissociative disorders, practitioners should employ several strategies. Firstly, establishing a safe and supportive environment is crucial. Clients with dissociative disorders have often experienced trauma, making them particularly sensitive to feelings of validation and safety (Cohen & Mannarino, 2008). Secondly, practitioners should utilize consistent routines and communication to help provide stability in the therapeutic process.

Active listening and validating the client’s experiences plays a pivotal role in building rapport. As individuals with dissociative disorders may struggle with their sense of identity, using non-threatening language and encouraging self-exploration can empower clients. Regular check-ins may help to assess their emotional state, ensuring that therapy remains a constructive space for exploration rather than re-experiencing trauma (Richards & Sweeney, 2011).

Ethical and Legal Considerations

Addressing ethical and legal considerations is paramount when working with clients who present with dissociative disorders. Clinicians must establish informed consent processes that clearly communicate the framework of treatment. Confidentiality is particularly significant, as clients may be hesitant to disclose their thoughts and experiences (Knox & Hill, 2003). Therapists should also be aware of the transient nature of identities in DID and approach documentation sensitively.

Furthermore, the risk of misdiagnosis increases the chance of improper treatment. Therefore, it is essential that practitioners seek continuing education and stay current with research in the field. Performing thorough assessments while applying ethical guidelines builds trust and respect, essential elements for effective therapeutic relationships (Zarelli & Hart, 2009).

Conclusion

Dissociative disorders illustrate the complexity of human psychological experiences, warranting recognition and rigorous investigation in their treatment and management. The surrounding controversies challenge practitioners to uphold high standards of clinical practice by properly distinguishing these disorders from other mental health issues, applying ethical guidelines, and maintaining supportive therapeutic relationships that foster healing for individuals impacted by trauma.

References

  • Cohen, J. A., & Mannarino, A. P. (2008). Trauma-focused cognitive-behavioral therapy for children. Journal of Clinical Child & Adolescent Psychology.

  • Courtois, C. A. (2008). Honoring the complex trauma and dissociation of survivors. Journal of Trauma & Dissociation.

  • Dalenberg, C. J., Brand, B. L., Gleaves, D. H., et al. (2010). Guidelines for the Evaluation of Dissociative Experiences. Psychological Trauma: Theory, Research, Practice, and Policy.

  • Gleaves, D. H. (1996). A conceptual history of dissociation: From Pierre Janet to the DSM-IV. Journal of Abnormal Psychology.

  • Herman, J. L. (1997). Trauma and Recovery. Basic Books.

  • Knox, S. & Hill, C. E. (2003). A qualitative analysis of the process of conducting therapy. Psychotherapy: Theory, Research, Practice, Training.

  • Putnam, F. W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. Guilford Press.

  • Richards, J., & Sweeney, A. (2011). Trauma, dissociation, and the role of the therapist. Trauma, Violence, & Abuse.

  • Spanos, N. P. (1994). Multiple identity and personality: A social psychological perspective. Psychological Bulletin.

  • Widyanto, L. & Williams, C. (2004). The experience of dissociation: Emerging evidence and psychological implications. Clinical Psychology Review.

  • van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. W.W. Norton & Company.

  • Zarelli, K. & Hart, O. (2009). Ethical considerations in assessing and treating patients with dissociative disorders. Journal of Trauma & Dissociation.