Controversy Associated With Dissociative Disorders Paper

Controversy Associated With Dissociative Disorders Paper

 Controversy Associated With Dissociative Disorders Paper

Dissociative Disorders (DD) are characterized by disruption in the normal integration of memory, consciousness, perceptions, emotion, identity, motor control, body representation, and behavior. They are thought to develop after an individual undergoes an overwhelming, stressful event (Rafiq et al., 2018). The stress may be a result of traumatic events or unbearable inner conflict. DD is associated with trauma and stressor-related disorders, resulting in dissociative symptoms. The purpose of this paper is to discuss the controversy surrounding DD, professional views about DD, and ethical and legal considerations for the disorders.

The Controversy That Surrounds Dissociative Disorders

According to Loewenstein (2018), there has been controversy surrounding dissociation and DD since the start of modern psychiatry and psychology. Although DD is associated with a history of trauma, particularly childhood trauma, some professionals argue that there is no evidence supporting this. For instance, there are rare incidences of DD diagnosed in children with a history of abuse. Furthermore, some healthcare professionals argue that DD is not a real disorder and does not exist even though it is included in the DSM-V. They propose that the disorder should be removed from the DSM-V manual. In addition, there has been an argument that diagnosing and treating DD trigger memories of childhood abuse in individuals, which causes more harm than good (Loewenstein, 2018). Lastly, there have been arguments that criminals use DD as an excuse to escape responsibility for their criminal actions.

Professional Beliefs about Dissociative Disorders

My professional view of DD is that it is more of a coping mechanism for past trauma than a mental disorder. People dissociate from their memory and consciousness to block the intrusive painful memories of their childhood abuse. Rafiq et al. (2018) found that individuals who experienced childhood trauma had the highest levels of dissociation among persons with severe mental conditions. The study also identified significant positive relations between certain childhood difficulties and dissociation.

I believe that this form of coping is quite intense and negatively affects not only the individual but also those around them. Rinker (2019) explains that an individual’s vivid and broad imagination occurs mostly in childhood. The imagination is often used to cope with stress through a calm internalization. Besides, instead of a person having a single personality with diverse thoughts and emotions, the mind splits into sections, each with new ideas and attitudes that the person may agree or disagree with. Subramanyam et al. (2020) explain that dissociation is a means that allows the mind to sort out memories and thoughts from the normal consciousness. This explains my belief that DD occurs in the same way individuals usually detach themselves from an unpalatable or distressing event.

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Strategies for Maintaining a Therapeutic Relationship

Creating and sustaining a therapeutic relationship with patients with DD and a history of trauma is often difficult due to distrust from the patient. Therefore, the provider should identify approaches that will help build trust with the patient to maintain the therapeutic relationship. The PMHNP or mental health provider should explain to the patient that a strong working relationship is crucial to help them return to normal functioning (Firestone, 2018). Another strategy is for the provider to collaborate with the client to identify their health needs, set therapy goals, and identify the interventions necessary to achieve these goals. The therapeutic relationship becomes stronger and lasts longer when the provider and the client have the same beliefs on treatment goals and consider the therapeutic interventions that will be used to meet these goals as appropriate and effective (Firestone, 2018). Active listening by the provider is essential in maintaining a therapeutic relationship. The provider should also be empathetic when interacting with the client to make the patient feel that their concerns have been understood.

Ethical and Legal Considerations Related To Dissociative Disorders

Ethical and legal factors that should be considered by mental health providers when dealing with patients with dissociative disorders include informed consent, privacy and confidentiality, beneficence, and nonmaleficence. In my future PMHNP practice, I will need to always obtain informed consent from the patient before starting assessment and treatment to avoid legal consequences. I will also need to maintain the privacy and confidentiality of patients’ information and always seek consent before sharing patient information to avoid legal consequences (Deshpande et al., 2020). Furthermore, I will need to assess interventions provided to patients to ensure they promote the best possible outcomes with no potential harm to the client.

Conclusion

Controversies in Dissociative disorders include a lack of evidence supporting their association with childhood trauma, beliefs that the disorder is inexistent, and that its diagnosis causes more harm than good. I believe that DD is more of a coping mechanism than a mental disorder and occurs when individuals want to detach themselves from painful past experiences. The provider can collaborate with the client in setting goals and identifying interventions to maintain a therapeutic relationship.

References

Deshpande, S. N., Mishra, N. N., Bhatia, T., Jakhar, K., Goyal, S., Sharma, S., Sachdeva, A., Choudhary, M., Shah, G. D., Lewis-Fernandez, R., & Jadhav, S. (2020). Informed consent in psychiatry outpatients. The Indian journal of medical research, 151(1), 35–41. https://doi.org/10.4103/ijmr.IJMR_1036_18

Firestone, L. (2018). Dissociation and Therapeutic Alliance. In Phenomenology of Suicide (pp. 167-186). Springer, Cham.

Loewenstein, R. J. (2018). Dissociation debates: everything you know is wrong. Dialogues in clinical neuroscience, 20(3), 229–242. https://doi.org/10.31887/DCNS.2018.20.3/rloewenstein

Rafiq, S., Campodonico, C., & Varese, F. (2018). The relationship between childhood adversities and dissociation in severe mental illness: a meta-analytic review. Acta Psychiatrica Scandinavica, 138(6), 509–525. https://doi.org/10.1111/acps.12969

Rinker, K. (2019). Treatment of Trauma: Imaginative Minds of Dissociative Identify Disorder. Journal of Humanistic Psychology, 0022167819877038. https://doi.org/10.1177/0022167819877038

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. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_777_19

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Assignment: Controversy Associated With Dissociative Disorders
The DSM-5 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, 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.

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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.