Professional Beliefs about Dissociative Disorders

There are three major dissociative disorders defined in the DSM-5:

Dissociative identity disorder

Dissociative amnesia, and

Depersonalization-derealization disorder.

Dissociative disorders may be associated with traumatic events in order to help manage difficult memories or experiences. Patients with these types of disorders are likely to also exhibit symptoms of a variety of other dysfunctions, such as depression, alcoholism, or self-harm and may also be more susceptible to personality, sleeping, and eating disorders.

 

This week, you will analyze issues related to the diagnosis and treatment of dissociative disorders.

 

                                  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.

Controversy Surrounding Dissociative Disorders: Dissociative disorders have been a subject of controversy in the mental health field for several reasons. Some of the main points of contention include:

1. Validity and Overdiagnosis: Some critics argue that dissociative disorders are overdiagnosed and that there is a lack of objective evidence to support their existence as distinct disorders. They contend that symptoms attributed to dissociation might be better explained by other psychiatric conditions, such as mood disorders or personality disorders.
2. Trauma and Suggestion: Dissociative disorders are often associated with a history of trauma, particularly childhood abuse. However, there is debate about the role of suggestion and iatrogenic influences (therapist-induced) in shaping clients’ experiences and memories. Critics raise concerns about the potential for false memories or exaggerated dissociative symptoms resulting from therapeutic practices.
3. Media Portrayal and Misinformation: The media, particularly movies and television, have often portrayed dissociative identity disorder (formerly known as multiple personality disorder) in a sensationalized and inaccurate manner. This portrayal can lead to misunderstandings about the disorder and contribute to the controversy surrounding it.

Professional Beliefs about Dissociative Disorders:

As a mental health professional, I believe that dissociative disorders are valid and clinically significant conditions. My rationale is supported by the following points:

1. Empirical Evidence: While controversy exists, there is ample empirical evidence supporting the existence of dissociative disorders. Neuroimaging studies have shown differences in brain activation patterns between individuals with dissociative disorders and those without, suggesting that there are neurobiological underpinnings to these conditions.
2. Trauma Association: Research consistently links dissociative disorders to traumatic experiences, particularly in early childhood. The connection between severe trauma and dissociation is well-documented, and the dissociative response can be seen as a survival mechanism to cope with overwhelming experiences.
3. Treatment Outcomes: Therapeutic approaches, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR), have shown effectiveness in treating dissociative disorders. This suggests that interventions targeted at addressing trauma-related symptoms can lead to positive outcomes for clients.

Strategies for Maintaining the Therapeutic Relationship:

Working with clients who present with dissociative disorders requires sensitivity, patience, and a strong therapeutic alliance. Some strategies for maintaining the therapeutic relationship include:

1. Establishing Safety: Creating a safe and non-judgmental environment is crucial for clients with dissociative disorders. Letting them know that you are there to support them unconditionally can help build trust.
2. Psychoeducation: Providing clients with information about dissociation and its link to trauma can be empowering. Understanding their experiences can reduce feelings of isolation and shame.
3. Collaborative Approach: Involve the client in treatment planning and goal-setting. Collaboratively explore coping strategies and grounding techniques that they can use during distressing dissociative episodes.
4. Building Grounding Skills: Teach clients grounding techniques that can help them stay present and connected during dissociative episodes. These techniques might include deep breathing exercises, using sensory cues, or mindfulness practices.

Ethical and Legal Considerations:

In working with clients with dissociative disorders, several ethical and legal considerations need to be taken into account:

1. Informed Consent: Clients need to be fully informed about the nature of dissociative disorders and the potential risks and benefits of various treatment approaches. Informed consent is particularly important when dealing with therapies that might involve memory retrieval or trauma processing.
2. Confidentiality and Privacy: Given the sensitive nature of trauma-related experiences, maintaining confidentiality and privacy is crucial. Only share information with other professionals or third parties with the client’s explicit consent or as mandated by law.
3. Avoiding Harm: Mental health professionals must avoid practices that may retraumatize or exacerbate clients’ symptoms. This includes being cautious about memory retrieval techniques that could potentially create false memories.
4. Cultural Competence: Be aware of the cultural context in which dissociative symptoms are presented. Cultural factors can influence symptom expression and treatment preferences.

In conclusion, dissociative disorders are complex and controversial conditions. As a mental health professional, it is essential to approach these clients with empathy, understanding, and a commitment to evidence-based practices. Maintaining a strong therapeutic relationship and adhering to ethical principles are essential for providing effective and responsible care to individuals with dissociative disorders.