Controversy Associated With Dissociative Disorders
The Assignment (2 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.
Controversy Associated With Dissociative Disorders
Dissociative disorders refer to mental health conditions that manifest through the disruption of a person’s memory, emotion, identity, motor control, behavior, perception, and consciousness (Nester et al., 2022). People that develop the disorders usually develop the symptoms as a reaction to trauma with the disassociation helping them to avoid the emotions and the memories. Some of the signs and symptoms that patients present with include but are not limited to a blurred sense of identity, memory loss, detachment from oneself and emotions, inability to cope with stress, and mental health problems (Lyssenko et al., 2017). The three types of disorders where patients develop dissociative symptoms include dissociative identity disorder, dissociated amnesia, and depersonalization-derealization disorder.
Professional Beliefs about Dissociative Disorders
Despite the existing controversies on dissociative disorders, some of the professional beliefs that I have for the disorders is that they can be accurately diagnosed with the existing tools thereby resulting in the provision of quality and patient-centered care. Some of the tools that can be used include The Structured Clinical Interview for Dissociative Disorders-Revised (SCID-D-R (Brand et al., 2016). Another diagnostic tool that can be used is the Dissociative Disorders Interview Schedule (DDIS). With the two tools above, I believe that patients with dissociative disorders can be accurately identified in diverse settings like outpatient, in-patient, and community settings. Accurate diagnosis subsequently would facilitate the adoption of the correct management strategies allowing for better symptom management as well as an improved quality of life among the patients.
Controversies Surrounding the Dissociative Disorders
Dissociative disorders are surrounded by controversies relating to the presentation of the disorders. One controversy is that dissociative disorders could be artifacts due to iatrogenic influences with nursing literature showing that iatrogenic influences highly influence the presentation of the symptoms. Loewenstein (2018) asserts that the controversies and the anxiety surrounding these disorders emanate from the bizarre clinical manifestation, which individuals barely accept. A good example is dissociative identity disorder where individuals present with more than one personality result in changes in thinking, behavior, and even memory. Another controversy concerns the use of mandatory structured interviews hence limiting other channels for diagnosis. It would be reliable to use several modalities for diagnosis to minimize errors while at the same time ensuring the results are accurate for the initiation of treatment.
Strategies to Maintain Therapeutic Relationships with Patients
The goal of establishing therapeutic relationships with patients is to ensure that the patient feels safe and most importantly to ensure that the patient expresses himself/herself openly without the fear of receiving judgment. Therapeutic relationships have been associated with better clinical outcomes, reduced duration of stay in hospitals, a lower re-hospitalization rate, and better patient satisfaction rates (Bolsinger et al., 2020) Through therapeutic relationships, the therapist is likely to provide a listening ear, show empathy, and compassion. It is also vital to note that in situations where the physicians maintain professional relations with the patients, automatically there exists professional boundaries. Therefore, the two interact at a professional level with high-level professionalism being maintained by the two parties.
Legal and Ethical Aspects related to Dissociative Disorders
Legal and ethical issues related to dissociative disorders touch on the limitation of diagnostic procedures and the beliefs surrounding the clinical manifestation of the disorders. Therefore, there could be a gap for misdiagnosis resulting in poor management of the condition. A wrong diagnosis could result in adverse events emanating from the use of medications intended for other conditions.
Conclusion
Dissociative disorders are prevalent among patients appearing in three sub-types dissociated amnesia, dissociative identity disorder, and depersonalization-derealization disorder. Despite the existing controversies, healthcare professionals should work with the patients during diagnosis with the goal of accurate diagnosis and proper diagnosis.
References
Bolsinger, J., Jaeger, M., Hoff, P., & Theodoridou, A. (2020). Challenges and Opportunities in Building and Maintaining a Good Therapeutic Relationship in Acute Psychiatric Settings: A Narrative Review. Frontiers in psychiatry, 10, 965. https://doi.org/10.3389/fpsyt.2019.00965
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. https://doi.org/10.1097/HRP.0000000000000100
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
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. American Journal of Psychiatry, 175(1), 37-46.
Nester, M. S., Boi, C., Brand, B. L., & Schielke, H. J. (2022). The reasons dissociative disorder patients self-injure. European journal of psychotraumatology, 13(1), 2026738.