Controversy Associated with Dissociative Disorders NRNP 6665

• 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 NRNP 6665 Example Paper

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