CONTROVERSY ASSOCIATED WITH DISSOCIATIVE DISORDERS

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.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

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.

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.

BY DAY 7 OF WEEK 9

Submit your Assignment

SUBMISSION INFORMATION

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LEARNING RESOURCES

  • Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
    • Chapter 11, “Dissociative Disorders”
  • Osmosis. (2017, November 20). Dissociative disorders – causes, symptoms, diagnosis, treatment, pathologyLinks to an external site. [Video]. YouTube. https://youtu.be/XF2zeOdE5GY
  • Mad Medicine. (2019, August 18). Dissociative disorders (Psychiatry) – USMLE Step 1Links to an external site. [Video]. YouTube. https://youtu.be/Iz03M9pwhs0
  • 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

Controversy Associated with Dissociative Disorders Example Paper

Introduction

Dissociative disorders involve problems with behavior, sense of self, memory, identity, perception, and emotion. Dissociative disorders include conditions such as dissociative amnesia and dissociative identity disorder.

Controversy.

Most of the controversy Dissociative Identity Disorder (DID) is whether it is a real disorder. This is despite the availability of research to validate this disorder. Dissociative identity disorder is listed as an official mental disorder in the DSM-5.

Another controversy arises from the confusion in diagnosing dissociative and personality disorders, especially borderline personality disorders. Both of these disorders have some similarities in symptoms.

The controversy around the causality of DID is also common. Many people believe that the disorder exists but is not caused by trauma but by sociocultural factors, sometimes called iatrogenic factors (Şar et al., 2017). People who believe in the existence of the disorder agree that the symptoms can be observable.

However, the side is inclined towards sociocultural factors as the causality argues that sometimes these symptoms are being faked, and patients give in to social influence. It is called iatrogenic because it is believed that clinicians could be causing the symptoms and reward patients when they manifest these symptoms.

DID is also mischaracterized in the media. In movies and TV shows, characters usually have an extreme characterization of DID, with characters showing extremely distinct personalities that operate for days on end. They typically have characteristics that are markedly different from the primary personality. DID used to be referred to as multiple personality disorder, which may have contributed to the mischaracterization and misunderstanding of this disorder.

Professional beliefs about dissociative disorders.

Dissociative disorders are not easy to diagnose. A disruption of normal identity, memory, consciousness, and behavior classically characterizes these disorders. Persons with DID are often misdiagnosed with other personality disorders, especially borderline personality disorder (Joos et al., 2017).  This is because of the overlap in the symptoms seen in both dissociative and personality disorders.

The criteria for the diagnosis of DID include the existence of more than one distinct personality state. Changes in memory, thinking, and behavior accompany these personalities. Another criterion is the presence of persistent gaps in memory, which are recurrent in nature. Another criterion is the presence of significant impairment in social, occupational, and other areas of functioning (Mychailyszyn et al., 2021)

Patients diagnosed with dissociative disorders have been exposed to extreme trauma and abuse coupled with some form of denial of the trauma (Lyssenko et al., 2018). Diagnosis of DID requires experienced psychiatric practitioners and psychologists. Diagnosis of these disorders involves assessment over a long period of time. A detailed history should be taken from the patient as well as from other sources, e.g., close friends and relatives.

Maintaining the Therapeutic Relationship.

Patients with DID tend to be very sensitive to interpersonal trust and rejection issues. Therefore, long-term treatment in an outpatient setting is ideal for handling such patients. Therapists who treat DID patients should see them once or twice weekly. This should go on for years, with the primary goal being the fusion of the personality states.

Cognitive-behavioral therapy (CBT) can effectively communicate with the alters and help the patient find better coping strategies than switching between alters (Ganslev et al., 2020).

Ethical and legal considerations

Diagnosis of Dissociative disorders requires experienced psychiatric practitioners. Therefore, a referral is necessary to avoid a misdiagnosis whenever the DID diagnosis is unclear. The patient should be informed once the correct diagnosis has been made. Because patients with DID have multiple alters, education must be done with all the alters. Patients’ privacy must be respected, and their diagnoses should not be shared publicly.

References

Ganslev, C. A., Storebø, O. J., Callesen, H. E., Ruddy, R., & Søgaard, U. (2020). Psychosocial interventions for conversion and dissociative disorders in adults. The Cochrane Database Of Systematic Reviews, 7(7), CD005331. https://doi.org/10.1002/14651858.CD005331.pub3

Joos, A., Baumann, K., Scheidt, C. E., Lahmann, C., König, R., Busch, H. J., & Schulze-Bonhage, A. (2017). Differenzialdiagnose dissoziativer Anfälle [Differential diagnosis of dissociative seizures]. Der Nervenarzt, 88(10), 1147–1152. https://doi.org/10.1007/s00115-017-0401-4

Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018). Dissociation in Psychiatric Disorders: A Meta-Analysis of Studies Using the Dissociative Experiences Scale. The American Journal Of Psychiatry, 175(1), 37–46. https://doi.org/10.1176/appi.ajp.2017.17010025

Mychailyszyn, M. P., Brand, B. L., Webermann, A. R., Şar, V., & Draijer, N. (2021). Differentiating Dissociative from Non-Dissociative Disorders: A Meta-Analysis of the Structured Clinical Interview for DSM Dissociative Disorders (SCID-D). Journal of Trauma & Dissociation: The Official Journal of the International Society for the Study of Dissociation (ISSD), 22(1), 19–34. https://doi.org/10.1080/15299732.2020.1760169

Şar, V., Dorahy, M. J., & Krüger, C. (2017). Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective. Psychology Research And Behavior Management, 10, 137–146. https://doi.org/10.2147/PRBM.S113743

Rubric

NRNP_6665_Week9_Assignment_Rubric
NRNP_6665_Week9_Assignment_Rubric
Criteria Ratings Pts

In 2–3 pages, address the following:• Explain the controversy that surrounds dissociative disorders.

15 to >13.0 pts

Excellent
The response includes an accurate and concise explanation of the controversy within the field related to dissociative disorders.

13 to >11.0 pts

Good
The response includes an accurate explanation of the controversy within the field related to dissociative disorders.

11 to >10.0 pts

Fair
The response includes a somewhat vague or inaccurate explanation of the controversy within the field related to dissociative disorders.

10 to >0 pts

Poor
The response includes a vague or inaccurate explanation of the controversy within the field related to dissociative disorders. Or the response is missing.
15 pts

• Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.

25 to >22.0 pts

Excellent
The response includes a thorough and well-organized explanation of the student’s professional beliefs about dissociative disorders. Rationale demonstrates critical thinking and is strongly supported with three scholarly references.

22 to >19.0 pts

Good
The response includes a well-organized explanation of the student’s professional beliefs about dissociative disorders. Rationale is clear and appropriately supported with three scholarly references.

19 to >17.0 pts

Fair
The response includes a somewhat vague explanation of the student’s professional beliefs about dissociative disorders. Rationale is somewhat unclear and references either provide weak support for the rationale or are not scholarly/current.

17 to >0 pts

Poor
The response includes a vague explanation of the student’s professional beliefs about dissociative disorders. Rationale is unclear and references are inappropriate. Or the response is missing.
25 pts

• Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.

30 to >26.0 pts

Excellent
The response includes an accurate and concise explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.

26 to >23.0 pts

Good
The response includes an accurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.

23 to >20.0 pts

Fair
The response includes a somewhat vague or incomplete explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.

20 to >0 pts

Poor
The response includes a vague or inaccurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder. Or the response is missing.
30 pts

• Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.

15 to >13.0 pts

Excellent
The response includes an accurate and concise explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important.

13 to >11.0 pts

Good
The response includes an accurate explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important.

11 to >10.0 pts

Fair
The response includes a somewhat vague or incomplete explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important.

10 to >0 pts

Poor
The response includes a vague and inaccurate explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important. Or, response is missing.
15 pts

Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 to >4.0 pts

Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.5 pts

Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5 to >3.0 pts

Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

3 to >0 pts

Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
5 pts

Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.0 pts

Excellent
Uses correct grammar, spelling, and punctuation with no errors

4 to >3.5 pts

Good
Contains one or two grammar, spelling, and punctuation errors

3.5 to >3.0 pts

Fair
Contains three or four grammar, spelling, and punctuation errors

3 to >0 pts

Poor
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5 to >4.0 pts

Excellent
Uses correct APA format with no errors

4 to >3.5 pts

Good
Contains one or two APA format errors

3.5 to >3.0 pts

Fair
Contains three or four APA format errors

3 to >0 pts

Poor
Contains many (five or more) APA format errors
5 pts
Total Points: 100