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Controversy Associated with Dissociative Disorders

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Controversy Associated with Dissociative Disorders

The DSM-5 defines the dissociative disorder as a discontinuity in the normal

synthesis of consciousness, behavior, recall, emotions, motor control, and cognition. Signs

and symptoms of dissociation are mostly caused by psychological trauma where the

disturbance may be slowed, short-term, long-term chronic, or sudden. This qualitative study

explores various controversies, professional beliefs, ethical and legal considerations pertinent

to dissociative disorders. In addition, it discusses various strategies therapists can incorporate

to maintain therapeutic relationships with their clients.

Controversy Surrounding Dissociative Disorders

Despite a long history of classifications and criteria in the Diagnostic and Statistical

Manual, controversy and debate continue to spark regarding the existence of certain

dissociative disorders such as dissociative identity disorder, formerly known as multiple

personality disorder. Although the disorder appears on the DSM-5, many clinicians are hell-

bent on the legitimacy and causality of dissociation. While understanding trauma from

theoretical and practical angles remains a persistent issue, dissociation has been highly linked

to childhood trauma. Controversy is centered on whether dissociative disorders result from

psychological trauma or imaginary events resulting from memory loss (Loewenstein, 2018).

Modern skepticism emerged with the rise of false memory syndrome, where victims were

thought to seek explanations for their woes externally. Additionally, it is argued that the

crafting of diagnostic scales increases false and invalid diagnostics. For example, a question

such as "Do you get so immersed in a book that you disconnect with your surroundings?"

would more likely be true for many people. While clinicians and academics argue that

dissociation is an overdiagnosed unscientific fad, it is important to note that these disorders

tend to affect a wide population and are, in fact, under-diagnosed.

Professional Beliefs About Dissociative Disorders

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The origin, cause, diagnosis, and treatment of dissociative disorders (DD) are often

misunderstood. Dissociative disorders are highly associated with personality, substance use,

eating, sleeping, and self-destructive disorders (Okano, 2019). The causative factor for DD is

childhood trauma. Gerge (2020) posits that the rigid nature of traumatized brains affects

response patterns. Additionally, dissociation can be viewed from neuronal or psychological

levels (Scalabrini et al., 2020). Patients may feel detached from their thoughts, perceptions,

actions, and physical environments. Patients are often likely to report detached interludes of

autobiographical recall such that different alters tend to dominate their bodies. Research

shows that treatment should incorporate therapeutic approaches that focus on stabilization

and symptom reduction, such as psychotherapy (Okano, 2019). Additionally, patients must be

educated upon diagnosis regarding their neural and personality systems.

Maintaining Therapeutic Relationship

Graham et al. (2018) explain that counselors should treat each patient as an individual

unit. Counselors must also remain sensitive to the environment each patient exists in, such as

the existence or non-existence of family connections, consistent physical environments, and

access to economic resources. A dissociating client may need to be engaged in creative

activities that ground them (0kano, 2019). Therapists must be ready to explore a myriad of

psychotherapeutic interventions such as cognitive and behavioral therapy. The patient's safety

and stabilization must be guaranteed such that therapists stay hyper-vigilant on suicidal risks.

It is vital that as therapists explore the client's unconscious conflicts, they can identify

countertransference that jots to the original trauma and manage it sensitively so that trust is

not broken.

Ethical and Legal Considerations

The diagnosis of DD poses important medicolegal implications. Defendants of crimes

such as murder and sexual assault may claim to have been in a dissociative state and that their
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altered personalities dominated them. Debates have sparked over whether DD truly exists as

defendants of serious crimes plead guilty because of insanity (Rocchio, 2020). It is important

to discern which personality was in control at the time of the event, whether they meet the

insanity threshold, and whether the dominant or host alter warrant an acquittal for insanity.

While dealing with dissociative patients, ethical standards such as confidentiality and

informed consent must be adhered to. Ethical considerations cut across diagnosis to treatment

stages. Where clinicians face damning situations, the patient's interests precede research

interests. In the event of involuntary treatment, clinicians should respect informed consent

procedures from legal guardians, and all must act in the patient's best interests. Given that

patients suffer from cognitive detachment, clinicians must uphold confidentiality at all times.

Controversies surrounding dissociative disorders continue to compromise patient care

and research. More efforts should be forged to increase awareness of the relationship between

trauma and dissociation lest the diagnosis and treatment of dissociation remain unprogressive.

Mental disorders are associated with myths, stigma, and bias. Hence, it is upon the clinician

to protect the patient's information at all times. Confidentiality and privacy yields trust. In

summation, professionals must arm themselves with evidence-based knowledge regarding

dissociative disorders.
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References

Gerge, A. (2020). What neuroscience and neurofeedback can teach psychotherapists in the

fieid of complex trauma: Interoception, neuroception and the embodiment of

unspeakable events in treatment of complex PTSD, dissociative disorders and

childhood traumatization. European Journal of Trauma & Dissociation, 4(3), 100164.

10.1016/j.ejtd.2020.100164

Graham Jr, J. M., Hundley, G., Zeligman, M. R., Bloom, Z. D., & Ayres, K. (2018).

Counseling Clients with Dissociative Identity Disorder: Experts Share their

Experiences. Journal of Counselor Practice, 9(1), 39-63.

https://www.journalofcounselorpractice.com/uploads/6/8/9/4/68949193/greene_et_al_

vol9_iss1.pdf

Okano, K. (2019). The origin of so-called "shadowy personalities" in patients with

dissociative identity disorder. European Journal of Trauma & Dissociation, 3(2), 95-

102.

https://doi.org/10.1016/j.ejtd.2018.07.003

Rocchio, L. M. (2020). Ethical and professional considerations in the forensic assessment of

complex trauma and dissociation. Psychological injury and law, 13, 124-134.

https://link.springer.com/article/10.1007/s12207-020-09384-9

Scalabrini, A., Mucci, C., Esposito, R., Damiani, S., & Northoff, G. (2020). Dissociation as a

disorder of integration–On the footsteps of Pierre Janet. Progress in Neuro-

Psychopharmacology and Biological Psychiatry, 101, 109928.

https://static1.squarespace.com/static/528facb6e4b0a18b7e9cde91/t/

5e933d5f66e5423c207d748e/

1586707811673/08_Scalabrini_et_al_dissociation+as+a+disorder+of+integration_Pro

gress+in+neuropsychopharmacology_2020.pdf
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