Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example

Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example

The Diagnostic and Statistical Manual for Mental Disorder- fifth edition (DSM-5) defines the dissociative disorder as “the disruption, interruption, and discontinuity of the normal subjective integration of behavior, identity, memory, emotion, consciousness, perception, motor control and body representation” (Loewenstein, 2018). These disorders include dissociative identity disorder, depersonalization or derealisation disorder, dissociative amnesia, unspecified dissociative disorder, and other specified disorders.(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example)

The controversies regarding dissociative disorders have existed since the beginning of modern psychology and psychiatry. These controversies are centered on whether these disorders are primarily related to psychological trauma or any other created conditions which bring up the trauma memories. According to Brand et al. (2017), the modern skepticism* towards dissociative disorders began in the early 1990s. The views surrounding the condition were viewed as False Memory Syndrome (FMS) and supported a support group whose members were accused of sexual abuse among children. As a result, there was an extensive backlash where these members sued the mental health providers for malpractice, arguing that these clinicians implanted false memories of sexual abuse to their children, which created dissociative disorders.(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example)

 A study conducted in 1999 shows that only 21% of American psychiatrists felt that there was enough evidence to include dissociative disorders as a valid diagnosis, while 58% of the psychiatrists surveyed were skeptical or felt that it should be included at all (Loewenstein, 2018). However, Brand et al.’s (2017) study show that children who reported child abuse have no proof that the dissociative disorders resulting from childhood trauma and the diagnosis and treatment of dissociative disorders created memories of child abuse. Some cases of dissociative disorders have been attributed to social contagion, misdiagnosis, and hypnotic suggestions (Moini et al., 2021). In this case, the patients with these conditions are highly hypnotizable, making them very suggestible. These authors found that patients with dissociative disorders are prone to follow implicit hypnotic or direct suggestions, and most of these diagnoses are made by a few psychiatrists specialized in the condition.(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example)

Professionally, I believe that dissociative disorders are real conditions. The cases of dissociative disorders have become more common in the recent past. It is a psychological condition that disrupts the brain’s normal functioning, where the patients struggle with having different personalities or identity states. Contrary to the popular belief that this condition is a personality disorder, research has shown that it is instead a dissociative disorder (Loewenstein, 2018). However, these conditions may develop after trauma, such as emotional detachment and disconnection, disconnection from the surroundings or reality, and disruption in the processes involving memory, perception, and identity (Brand et al., 2017).(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example)

In this regard, individuals may fall victim to dissociative disorders to cope with overwhelming events such as abuse and neglect. Additionally, Moini et al. (2021) define dissociative disorders as complex post-traumatic developmental behavior. Therefore, these patients may present mood, personality, anxiety, substance abuse, functional somatic, and eating disorders.(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example)

Ringrose (2018) also conducted a study to evaluate the belief that dissociative disorders are overdiagnosed. The study found that most of the patients who met the diagnosis criteria of dissociative disorders had received treatment from mental health facilities for at least six years before being diagnosed with dissociative disorders. In this regard, it is clear that rather than overdiagnosis, these patients were misdiagnosed, mainly with other similar conditions like anxiety disorders, somatic conditions, borderline personality disorders, anxiety disorders, depression,  eating and substance use disorders (Brand et al., 2017). The authors further state that the misdiagnosis was majorly contributed by most of these disorders unserved and unrecognized in the community.(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example)

Loewenstein (2018) adds that patients suffering from dissociative disorders are often not treated despite poor functionality and showing most symptoms. The researcher conducted a study on adolescents and young adults in the Netherlands. The findings show that the participants with dissociative disorders presented the highest level of functional impairment, but only 2.3% had received treatment in mental health facilities. In this regard, the low levels of diagnosis and treatment result from a lack of training and skepticism related to the condition (Loewenstein, 2018).(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example)

However, there is a need to focus on dissociative disorders, like other psychological conditions. Patients with dissociative disorders are highly stigmatized in society, affecting their ability to seek medical and therapeutic help. One of the most effective strategies to maintain a therapeutic relationship with a patient with this condition is to gain the patient’s trust. In this regard, these patients have to feel that they are safe to share their experiences and seek help on the same. Therefore, the therapist should calmly introduce themselves to the patient to build trust and respect.(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example)

Second, the therapist should ensure that the patient has privacy during the therapy sessions (Moini et al., 2021). Nonetheless, it is essential to ensure their basic needs are met to enhance comfort. Third, there is a need to maintain professional boundaries with the patient to ensure the proper treatment. However, one should be compassionate enough to deal with the patient’s confusion.(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example)

Moreover, therapists should consider several ethical and legal considerations when dealing with dissociative identity patients. Some of the considerations I would apply in practice are maintaining boundaries with the patient and the duty to warn on any threatening behavior (Ringrose, 2018). First, there is a need to enhance flexibility when dealing with dissociative disorders by gauging the risk-benefit of each analysis while discussing it with the patient. Also, I would ensure I discuss what information should be shared to maintain confidentiality with the patient. However, despite the need for confidentiality, as a therapist, I have a legal role in warning about any threatening words the patient may say, like they will kill somebody. Giving warnings on such information may help avoid incidences where the patient may cause harm to someone else (Ringrose, 2018).(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example)

References

Brand, B. L., Sar, V., Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A., & Middleton, W. (2017). Separating fact from fiction: An empirical examination of six myths about dissociative identity disorder. Harvard Review of Psychiatry, 24(4), 257-270(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example). https://doi.org/10.1097/hrp.0000000000000100

Loewenstein R. (2018). Dissociation debates: Everything you know is wrong. Controversies in Psychiatry, 20(3), 229-242.(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example) https://doi.org/10.31887/dcns.2018.20.3/rloewenstein

Moini, J., Koenitzer, J., & LoGalbo, A. (2021). Dissociative disorders. Global Emergency of Mental Disorders, 171-183. https://doi.org/10.1016/b978-0-323-85837-3.00018-2

Ringrose, J. L. (2018). Assessment and diagnosis. Understanding and Treating Dissociative Identity Disorder (or Multiple Personality Disorder), 11-22(Controversy Associated With Dissociative Disorders Comprehensive Nursing Paper Example). https://doi.org/10.4324/9780429484483-2