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- NRNP 6665 Assignment Week 9
Controversy Associated with Dissociative Disorders
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NRNP 6665: PMHNP Care across the Lifespan I
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Introduction
Dissociative disorders, in the context of the DSM-5-TR, are a group of disorders that involve impairments with consciousness, memory, and identity of emotion, perception, and behavior. Yes, these disorders do adversely impact the life of an individual and can also affect activities of daily living, so proper diagnosis and management of these disorders are important. However, the idea of dissociative disorders and the classification of such disorders have been a subject of debate in the mental health arena. This boils down to issues concerning whether or not some of these disorders, like DID, and are real and whether they can be distinguished from other disorders.
Controversy Surrounding Dissociative Disorders
The big question to probe when it comes to dissociative disorders is actually, as well as their diagnostic standards and the validity of them in general, dissociative identity disorder. DID, now known as multiple personality disorder, was once characterized as having two or more separate and stable ‘personality states or identities’ functioning within an individual (Sharp & Wall, 2021). Critics further say it is suggested that DID may be over-diagnosed or even iatrogenically created w, which means that it may actually be caused by therapeutic suggestions. This skepticism is driven by past incidents of an increase in the diagnosis of the disorder after being impressed and made aware of it from films and TV shows.
The other part of the controversy has to do with differential diagnosis. The following conditions are related that may present with the same symptoms mentioned above: Borderline personality disorder, PTSD disorder, nd some forms of psychosis. This overlap makes it difficult to diagnose the disease since there are many symptoms associated with it and extreme concerns about the right classification of the disease (Allsopp et al., 2019). Dissociative experiences (such as those that underlie diagnoses) are first subjective in nature and then are self-reported, which makes the diagnosis even more difficult. Clinicians are wholly dependent on the patient’s narratives, which can be affected by a variety of factors, including therapy setting and cultural background.
Professional Beliefs about Dissociative Disorders
I think as a health care clinician, Dissociative Disorders exist and are debilitating mental illnesses worthy of study and discussion. Based on multiple research studies, individual case reports, clinical experience and theoretical work, it can be concluded that these disorders are evolving in response to trauma, particularly early trauma (McKay et al. 2020). Unlike the psychological explanation, the trauma model is based on numerous empirical studies and accounts for the development of dissociative disorders in detail (Yifat Buchnik-Daniely et al., 2021). All of these studies analyze clients with a diagnosis of dissociative identity disorder (DID) and other dissociative disorders in relation to their history of extensive abuse and neglect, thus emphasizing the need for didactic trauma-informed work with these conditions.
I do, though, know I need to be “logical” and have an “open mind” when using the dissociative diagnostic criteria. Within the socio-cognitive model, it is worth noting the necessary socio-cultural consideration and the potential for iatrogenic issues in the presenting scenario of dissociative presentation (Dalenberg et al., 2020). Thus, particular therapeutic approaches would have to be avoided by the clinicians, potentially leading to an added exacerbation or distortion of dissociative processes.
Strategies for Maintaining the Therapeutic Relationship with a Client with a Dissociative Disorder
Services to a client with DID require a sense of trust, stability, and validation of emotions as well as empathy. Recurring sessions and interactions with the patients are extremely important because patterns will ease the clients’ apprehension, which is crucial for the patients suffering from DID (Huber et al., 2018). Also, implementing the safe environment that trauma-informed care (TIC) provides, such as avoiding words that may elicit triggering reactions and intruding into clients’ personal space, makes a healthy place for clients. Having empathy with the client by means of listening to him and acknowledging the things that he depletes emphasizes the positive treatment compliance.
Ethical and Legal Considerations Related to Dissociative Disorders
In clinical practice, privacy issues regarding dissociative disorders are one of the most relevant ones to ponder, considering both the safety of the patient and his/her rights and legal obligations of consent. Every clinician is still the same: ethically not allowed to exacerbate or even create dissociative symptoms, and should not use anything that they are not competent or professional in (Foote et al., 2020).
From a legal perspective, documentation and diagnosis are critical because dissociative disorders can impact legal matters, disability, and service issues. The principle of informed consent means that the client should be completely aware of the nature of the disorder, the range of treatment options, and the potential implications. These are very important elements to safeguard the patients’ rights as well as promote trust and confidence, and provide ethical, efficient services.
Conclusion
To recap, dissociative disorders do not exist as a myth but do have some controversy and challenges concerning the diagnosis and treatment of those who suffer from these types of mental health disorders. To witness the controversy regarding their existence as illustrated through DID, it was evident that critical evaluation and scientific assessment are significant in the treatment practice.
I am currently a professional with the following beliefs rooted in the trauma model, as I believe it is broad and incorporates diverse and interdisciplinary perspectives, trauma-informed approaches. Initially, a good working relationship is the foundation of any treatment process in which the patient needs to feel validated, consistent, and trust the therapists. Also, ethical and legal compliance helps in the protection of patients, understanding of and compliance with consent, as well as upholding a professional ethic. Therefore, by practicing these, clinicians can also aid in reaching the goal of health provision to persons with dissociative disorders and thus improve the quality of their lives.
References
Allsopp, K., Read, J., Corcoran, R., & Kinderman, P. (2019). Heterogeneity in psychiatric diagnostic classification. Psychiatry Research, 279(279), 15–22. https://doi.org/10.1016/j.psychres.2019.07.005
Therapeutic agency, in‐session behavior, and patient–therapist interaction. Journal of Clinical Psychology, 75(1), 66–78. https://doi.org/10.1002/jclp.22700
Sharp, C., & Wall, K. (2021). Annual Review of Clinical Psychology, 17(1), 313–337. https://doi.org/10.1146/annurev-clinpsy-081219-105402
