[Solved 2025] In this Assignment you will examine the controversy surrounding dissociative disorders. You will also explore clinical, ethical, and legal consideration

In this Assignment you will examine the controversy surrounding dissociative disorders

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.

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.

Expert Answer and Explanation

Controversies Associated With Dissociative Disorders

The diagnosis of the psychiatric disorders including their treatment is marred by controversies, and this is particularly noticeable with the dissociative disorder (DDs). A person with these disorders exhibits various symptoms such as having distorted perceptions about others, and experiencing amnesia. People with history of trauma that particularly occurs early in one’s life, can expose them to the risk of developing these disorders (Subramanyam et al., 2020).

To effectively care for patients with DDs, a psychiatric should be aware of these controversies, adopt sound professional beliefs about the DDs, and embrace strategies that can help maintain therapeutic relationship with the client with a dissociative disorder as described in this paper.

The Controversy that surrounds Dissociative Disorder

Certain controversies are associated with the DDs. One of these controversies involves the tendency for people to see the manifestations as fake, and this is the reason why people would question whether these disorders represent the trend that individuals may want to associate with. The DDs are also mired in controversies because of their complex nature. In fact, one needs to conduct deep research to understand these disorders.

Unfortunately, peoples’ tendencies to dismiss the research on these disorders is the reason why there is limited understanding of the DDs among those affected by the disorders. Still, there are those who question the notion that trauma that occurs early in one’s life can cause the DDs because of the difficulty involved in proving the truthfulness of the memory of abuse.

My Professional Beliefs about Dissociative Disorders

My professional beliefs hinge on my knowledge about mental health, and these beliefs shape my interaction with a patient with a dissociative disorder (DD). I believe that DD is a mental condition like any other, and that the use of appropriate intervention, can help lessen the symptoms of this condition. I also believe that the evidence and psychiatric knowledge should inform the treatment of the DD.

My belief about the DD is informed by the fact that its manifestations affect one’s functioning (Meganck, 2017). It therefore, has the potential to exacerbate mental health issues ranging from depression to memory loss. Therefore, I don’t believe in the controversies linked to DD because they can affect my judgment, and cause poor diagnosis outcomes.

Strategies for maintaining Therapeutic Relationship with Client with Dissociative Disorder

As a therapist, I would maintain therapeutic relationship with a client with DD by avoiding skepticism that may affect how I perceive the client. This can also help me avoid judging the client which may cause them to feel I am stigmatizing them. Being empathetic to the client, and being clear in terms of how I share with them the information about their health, can make them feel comfortable. I would also try to ground them by introducing simple exercise (Agarwal, Sitholey, & Srivastava, 2019). An example is asking them to name the sounds as I play them.

Ethical and Legal Considerations related to Dissociative Disorders in Practice, and their Importance

The ethical considerations include administering treatment in a judicious manner, and ensuring that the treatment is safe or results to positive therapeutic outcomes for the client (Myrick et al., 2017). The main legal issue to consider is seeking the patient’s consent before sharing their information.

Conclusion

In conclusion, the controversies associated with the DDs can be attributed to lack of in-depth research concerning these disorders. As a physician, one’s professional beliefs should guide how they view any form of mental health disorder, be it the DD or any other psychiatric condition.

References

Agarwal, V., Sitholey, P., & Srivastava, C. (2019). Clinical Practice Guidelines for the management of Dissociative disorders in children and adolescents. Indian journal of psychiatry, 61(Suppl 2), 247–253. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_493_18.

Meganck, R. (2017). Beyond the Impasse – Reflections on Dissociative Identity Disorder from a Freudian-Lacanian Perspective. Frontiers in psychology, 8, 789. https://doi.org/10.3389/fpsyg.2017.00789.

Myrick, A. C., Webermann, A. R., Langeland, W., Putnam, F. W., & Brand, B. L. (2017). Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates. European journal of psychotraumatology, 8(1), 1375829. https://doi.org/10.1080/20008198.2017.1375829.

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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Dissociative Disorders: Understanding the Controversy and Clinical Considerations

Introduction

Dissociative disorders represent one of the most complex and controversial areas in modern psychiatry. These conditions, characterized by disruptions in consciousness, memory, identity, or perception, have sparked intense debate within the mental health community for decades. From the ongoing dissociative identity disorder debate to the clinical considerations dissociative disorders present, healthcare professionals continue to grapple with diagnostic challenges and treatment approaches.

This comprehensive guide explores the multifaceted nature of dissociative disorders, examining the dissociative disorders controversy, clinical best practices, and ethical considerations that shape modern treatment approaches.

What Are Dissociative Disorders?

Dissociative disorders are psychological conditions marked by disruptions in consciousness, often serving as a defense mechanism against trauma. According to the DSM-5, these disorders typically arise in response to extreme stress or traumatic events, enabling individuals to detach from painful emotions or memories.

The five primary types of dissociative disorders include:

• Dissociative Identity Disorder (DID) – Previously known as Multiple Personality Disorder
• Dissociative Amnesia – Including dissociative fugue
• Depersonalization/Derealization Disorder
• Other Specified Dissociative Disorders
• Unspecified Dissociative Disorders

Prevalence and Demographics

Research indicates that DID has an estimated lifetime prevalence of around 1.5%, meaning that at least one million people in the UK will suffer from DID during their life, highlighting the clinical relevance of these conditions.

The Dissociative Disorders Controversy

The controversy surrounding dissociative disorders stems from several key areas of debate within the mental health community:

Historical Context of the Debate

The diagnosis of dissociative identity disorder (DID) has been associated with controversy and remains an area of dispute among clinicians to this day. This controversy has deep historical roots, with debates intensifying during the 1990s and continuing into the present day.

After a sharp decline in publications in the early 2000s from the initial peak in the 90s, some authors claimed the disorder to be an academic fad. A subsequent review in 2024 found that research in the field increased 60% afterwards, reaching steady levels with somewhat reduced controversy.

Key Areas of Controversy

1. Diagnostic Validity

The primary controversy centers on whether dissociative disorders, particularly DID, represent genuine psychiatric conditions or are iatrogenic (treatment-induced) phenomena. Critics argue that:

• Symptoms may be inadvertently suggested by therapists
• Media portrayals may influence symptom presentation
• ICD-10 and DSM-5 do not provide clear diagnosing guidelines for DID, making it difficult to distinguish ‘genuine’ DID from imitated or false-positive cases

2. Comorbidity Concerns

Research has revealed significant overlap between dissociative disorders and other psychiatric conditions:

• 64 percent of patients diagnosed with DID met criteria for borderline personality disorder, but of those who did not, they met many of the criteria for borderline personality
• This overlap raises questions about differential diagnosis and treatment approaches

3. Cultural and Religious Considerations

In many cultures around the world, experiences of being possessed are a normal part of spiritual practice and are not dissociative disorders, highlighting the importance of cultural competence in diagnosis.

Professional Perspectives

Clinical Considerations in Dissociative Disorders

Diagnostic Challenges

Diagnosing dissociative disorders requires specialized expertise and careful consideration of multiple factors:

Assessment Tools and Instruments

Several validated instruments assist in diagnosis:

• Dissociative Experiences Scale (DES)
• Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-5-D)
• Clinician-Administered Dissociative States Scale (CADSS)

Differential Diagnosis Considerations

Clinicians must differentiate dissociative disorders from:

• Psychotic disorders
• Mood disorders with psychotic features
• Personality disorders (particularly borderline)
• Substance-induced conditions
• Medical conditions affecting consciousness

Treatment Approaches

Generally, the main goal of treatment in dissociative/conversion disorders is improvement in the patient’s adaptive functioning via psychotherapy techniques focusing on the stressors rather than the dissociative episodes.

Evidence-Based Treatment Modalities

Medication Considerations

The family should be tactfully made to understand that medications are neither required nor approved for dissociative symptoms. However, medications may be used to address:

• Comorbid depression or anxiety
• Sleep disturbances
• Specific symptom clusters

Emergency Management

An acute dissociative episode, especially in those with a hitherto undiagnosed illness, can be an extremely harrowing experience for the patient as well as their family members. Apart from this, certain cases can also present a considerable risk of harm to self or others.

Emergency management priorities include:

1. Safety assessment and stabilization
2. Symptom reduction
3. Support for patient and family
4. Appropriate referral for specialized care

Ethical Issues in Treating Dissociative Disorders

The treatment of dissociative disorders presents unique ethical challenges that require careful consideration:

Informed Consent Challenges

• Capacity Assessment: Determining decision-making capacity across different identity states
• Treatment Consent: Ensuring all aspects of the person consent to treatment
• Information Disclosure: Balancing transparency with potential harm

Confidentiality Considerations

Unique confidentiality challenges arise when treating dissociative disorders:

Multi-State Confidentiality

• Information shared by one identity state may not be known to others
• Maintaining confidentiality while ensuring safety
• Documentation challenges across identity states

Family and Support System Involvement

• Balancing patient autonomy with family support needs
• Managing conflicting wishes across identity states
• Protecting patient privacy while enabling support

Therapeutic Relationship Dynamics

Boundary Management

Professional boundaries become complex when treating dissociative disorders:

• Multiple therapeutic relationships: Managing relationships with different identity states
• Consistency across states: Maintaining professional boundaries consistently
• Countertransference: Managing reactions to different presentations

Treatment Goals and Autonomy

• Respecting patient autonomy across identity states
• Addressing conflicting treatment goals
• Ensuring collaborative treatment planning

Competency and Training Requirements

Ethical treatment requires specialized competency:

Legal Considerations

Forensic Implications

Dissociative disorders raise complex legal questions:

• Criminal responsibility: Determining accountability across identity states
• Competency to stand trial: Assessing legal competency
• Testimony reliability: Evaluating witness credibility

Documentation Requirements

The whole of the legal matter as regards the status of dissociation and pathological dissociation is that it is more than nine parts lore and less than one part law, highlighting the evolving legal landscape.

Mandatory Reporting

Healthcare providers must navigate reporting requirements while maintaining therapeutic relationships:

• Child abuse reporting
• Duty to warn situations
• Involuntary commitment procedures

Current Research and Future Directions

Neurobiological Research

Recent neuroimaging studies have provided insights into the biological basis of dissociative disorders:

• Brain structure differences in individuals with DID
• Functional connectivity patterns
• Neuroplasticity and treatment response

Treatment Outcome Studies

Research on treatment effectiveness continues to evolve:

• Long-term outcome studies
• Comparative effectiveness research
• Technology-assisted interventions

Prevalence and Epidemiology

Updated epidemiological data helps inform clinical practice:

• Population-based prevalence studies
• Risk factor identification
• Protective factor research

Best Practices for Healthcare Professionals

Assessment Guidelines

1. Comprehensive History: Detailed trauma and symptom history
2. Standardized Instruments: Use validated assessment tools
3. Differential Diagnosis: Careful consideration of alternative explanations
4. Cultural Factors: Assessment of cultural and religious background

Treatment Planning

Phase-Oriented Treatment Model

Professional Development

Ongoing education and training requirements:

• Specialized dissociation training
• Trauma-informed care principles
• Cultural competency development
• Legal and ethical education

Supporting Patients and Families

Patient Education

Effective patient education includes:

• Understanding dissociative symptoms
• Treatment options and expectations
• Coping strategies and self-care
• Support resources and advocacy

Family Support

Families require specialized support:

• Education about dissociative disorders
• Communication strategies
• Coping with uncertainty
• Accessing support services

Community Resources

Conclusion

The field of dissociative disorders continues to evolve, with ongoing research providing new insights into diagnosis, treatment, and ethical considerations. While the dissociative disorders controversy persists, the growing body of evidence supports the validity of these conditions and the importance of specialized treatment approaches.

Healthcare professionals must navigate complex clinical considerations dissociative disorders present, balancing evidence-based practice with ethical treatment principles. The ethical issues treating dissociative disorders require ongoing attention to ensure patients receive appropriate, culturally sensitive care while maintaining professional boundaries and legal compliance.

As our understanding of dissociative disorders deepens, continued research, education, and clinical innovation will be essential to improving outcomes for individuals affected by these complex conditions. The dissociative identity disorder debate may continue, but the commitment to providing compassionate, effective care remains paramount.

The journey toward better understanding and treatment of dissociative disorders requires collaboration between researchers, clinicians, patients, and families. By maintaining focus on evidence-based practice, ethical principles, and patient-centered care, the mental health community can continue to advance the field while serving those most in need of specialized support.