NRNP6665 Week 9 Assignment Controversy Associated with Dissociative Disorders

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NRNP6665 Week 9 Assignment Controversy Associated with Dissociative Disorders

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Student Name

Walden University

NRNP 6665: PMHNP Care Across the Lifespan I

Professor Name

Date

Introduction

Dissociative disorders, in the context of the DSM-5-TR, are a group of disorders that involves impairments with consciousness, memory, and identity of emotion, perception and behavior. These disorders indeed have a serious impact on one’s life and can affect his daily functioning, which is why correct diagnosis and management are critical.

Yet, the concepts of dissociative disorders and their categorization has been a topic of debate in the mental health sphere. This boils down to issues concerning whether or not some of these disorders like DID are real and whether they can be distinguished from other disorders.

Controversy Surrounding Dissociative Disorders

The major issue of discussion with reference to dissociative disorders is their validity along with their diagnostic criteria, specifically dissociative identity disorder. Earlier called multiple personality disorder, DID is defined by the existence of two or more enduring and clinically significant identity personalities in one person (Sharp & Wall, 2021).

Critics further say it is suggested that DID may be over-diagnosed or even iatrogenically created which means that it may be actually caused by therapeutic suggestions. This skepticism is fueled by earlier serving incidents in which there was an increase in diagnoses of the disorder following impressions and awareness created by film and television shows.

Another aspect of the controversy is related to the problem of differential diagnosis. The following are related conditions where the presented dissociative symptoms may be seen: border line personality disorder, PTSD disorder and some types of psychosis. This overlap makes it difficult to diagnose the disease since there are very many symptoms associated with it and extremely concerns on the right classification of the disease (Allsopp et al., 2019).

Firstly, due to its subjective nature, dissociative experiences, including those that form the basis of diagnoses, are self-reported, consequently, making the diagnosis even more difficult. Clinicians are wholly dependent on the patient’s narratives, which can be affected by a variety of factors, including therapy setting and cultural background.

Professional Beliefs about Dissociative Disorders

As a healthcare professional, I believe that dissociative disorders are real, severe mental illnesses that should be studied and discussed. From the perspective of numerous studies, single case reports, clinical experience, and theoretical contributions, it can be stated that these disorders are developing as a reaction to trauma, and early trauma, in particular (McKay et al. 2020).

Unlike the psychological explanation, the trauma model is based on the numerous empirical studies and accounts for the development of dissociative disorders in detail (Yifat Buchnik-Daniely et al., 2021). All these studies explain that clients diagnosed with dissociative identity disorder (DID) and other dissociative disorders come from backgrounds characterized by severe abuse and neglect; therefore, didactic trauma-informed approaches are essential in diagnosing and managing the conditions.

However, I also know that I need to remain rational and open-minded when applying the diagnostic criteria for dissociative disorders. The socio-cognitive model raises relevant issues about the possibility of iatrogenic consequences as well as cultural and social factors in patients’ dissociative presentations (Dalenberg et al., 2020).

Consequently, the clinicians would need to refrain from invoking certain therapeutic strategies which, in turn, might distort or aggravate dissociative processes. This equal view makes certain that when looking at the matters with the patients that have dissociative ailments that realistic experiences are acknowledged but prejudice and other influences outside the domain are not given room. 

Strategies for Maintaining the Therapeutic Relationship with a Client with a Dissociative Disorder

Attending to a client with DID involve trust, consistency and acknowledgement of feelings as well as empathy. Confidentiality is the initial aspect; clinicians should provide a relationship with no prejudice to allow the client to open up on some issues. Stable sessions and interactions with the clients are essential, as recurring patterns make clients more comfortable, which is vital for patients with DID (Huber et al., 2018).

Also, applying the framework of trauma-informed care (TIC), which includes not getting trigger by certain words and avoiding any intrusion of the client’s personal space, contributes to the creation of a safety atmosphere. Having empathy with the client by means of listening to him, and acknowledging the things that he depletes emphasize the positive treatment compliance.

Ethical and Legal Considerations Related to Dissociative Disorders

In clinical practice, privacy concerns concerning dissociative disorders are among the most important issues that need to be considered in light of the patient’s safety and legal rights and regulatory requirements regarding consent. Clinicians still are ethically prohibited to use suggestion to worsen or even to manufacture dissociative symptoms and should practice only those techniques that is evidence based that they are competent in and professional (Foote et al., 2020).

In a legal point of view, proper documentation and diagnosis are necessary since dissociative disorders may affect legal proceedings, disability, and service issues. The concept of informed consent requires the client to fully understand the type of the disorder, the available treatment options and likely repercussions. Such aspects are crucial to protect the patients’ rights, and to build trust and confidence and deliver ethical and efficient care.

Conclusion

In conclusion, dissociative disorders are real disorders of the mental health that is not a myth, even if there are some controversies and difficulties in the diagnosis and treatment of such patients. The controversy around their existence such as DID illustrated how scientific and critical assessment is important in the treatment practice. Some socio-cognitive considerations are taken as the foundation of my current professional beliefs which are based on the trauma model: diverse, interdisciplinary, and trauma-informed approach.

A good working relationship forms the basis of any treatment process since patients have to trust the therapists, be consistent in their appointments and feel validated by them. Also, ethical and legal compliance helps in the protection of patients, understanding of and compliance with consent as well as upholding of a professional ethic. Thus, by engaging in such principles, clinicians contribute to the achievement of the objective of providing adequate care to individuals with dissociative disorders hence enhancing the quality of life.

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References

Allsopp, K., Read, J., Corcoran, R., & Kinderman, P. (2019). Heterogeneity in psychiatric diagnostic classification. Psychiatry Research, 279(279), 15–22. https://doi.org/10.1016/j.psychres.2019.07.005 

Dalenberg, C. J., Brand, B. L., Loewenstein, R. J., Frewen, P. A., & Spiegel, D. (2020). Psychological Injury and Law, 13(2), 135–154. https://doi.org/10.1007/s12207-020-09376-9 

Foote, W. E., Goodman-Delahunty, J., & Young, G. (2020). Civil forensic evaluation in psychological injury and law: Legal, professional, and ethical considerations. Psychological Injury and Law, 13(4), 327–353. https://doi.org/10.1007/s12207-020-09398-3 

Huber, J., Born, A., Claaß, C., Ehrenthal, J. C., Nikendei, C., Schauenburg, H., & Dinger, U. (2018). Therapeutic agency, in‐session behavior, and patient–therapist interaction. Journal of Clinical Psychology, 75(1), 66–78. https://doi.org/10.1002/jclp.22700 

McKay, Michael T., et al. “Childhood trauma and adult mental disorder: a systematic review and meta‐analysis of longitudinal cohort studies.” Acta Psychiatrica Scandinavica, vol. 143, no. 3, 18 Jan. 2020, pp. 189–205, pubmed.ncbi.nlm.nih.gov/33315268/, https://doi.org/10.1111/acps.13268. 

Sharp, C., & Wall, K. (2021). Annual Review of Clinical Psychology, 17(1), 313–337. https://doi.org/10.1146/annurev-clinpsy-081219-105402 

Yifat Buchnik-Daniely, Vannikov-Lugassi, M., Shalev, H., & Nirit Soffer‐Dudek. (2021). Clinical Psychology & Psychotherapy, 28(5), 1091–1102. https://doi.org/10.1002/cpp.2559