NRNP 6665 WEEK 9 ASSIGNMENT: Controversy Associated With Dissociative Disorders
NRNP 6665 WEEK 9 ASSIGNMENT: Controversy Associated With Dissociative Disorders
Dissociative disorders are characterized by a disturbance in the normal functions of memory, identity, motor behavior, consciousness, and environmental awareness. The disturbance can be gradual or sudden and transient or chronic (Agarwal et al., 2019). The types of Dissociative disorders include dissociative identity disorder (DID), dissociative amnesia (DA), dissociative fugue, depersonalization disorder, and dissociative disorder not otherwise specified (DDNOS). The purpose of this paper is to explore the controversy surrounding dissociative disorders and the ethical and legal considerations related to working with patients with dissociative disorders.
Controversy That Surrounds Dissociative Disorders
Dissociative disorders are controversial diagnoses with crucial medico-legal implications. There has been a long history of controversy and debates surrounding DID and dissociation in particular. Besides, many clinicians still do not believe in Dissociative disorders. There is a controversy on the interpretation of the symptoms of dissociative disorders. Questions arise on whether dissociative disorders have unique and subtle symptoms and behaviors such that providers cannot recognize them when examining the patient (Loewenstein, 2018). There is a debate on whether patients exhibit intentional malingering or induced symptoms created by other clinicians who believe something is there, but it is not. Furthermore, there is a controversy because criminals use dissociative disorders to evade punishment from the naïve justice system, which associates obnoxious behavior to another personality. Thus the perpetrator is not held accountable for their action (Loewenstein, 2018). For instance, defendants have contended committing grave crimes, such as rape and murder, while in a dissociated state.
Professional Beliefs about Dissociative Disorders
My professional belief about dissociative disorders is in line with the Trauma Model, which proposes that dissociation is a psychobiological trait or state that serves as a protective response t
NRNP 6665 WEEK 9 ASSIGNMENT Controversy Associated With Dissociative Disorders
o overwhelming and traumatic experiences. I conceptualize dissociation disorders as a spectrum from normal to pathological, with periods of deep absorption. Besides, dissociation disconnects from ordinary awareness of the entire meaning and effect of traumatic events on an individual. Firestone (2018) asserts that dissociation develops alongside trauma and is sustained by the trauma experiences. Dissociative reactions transpire with regard to acute trauma reactions, acute stress reactions, PTSD, and panic attacks. The Trauma Model hypothesizes that dissociation alleviates the effect of trauma by psycho-biologically impounding trauma-related information by protectively activating an altered state of consciousness (Loewenstein, 2018). Subramanyam et al. (2020) argue that dissociation is a mechanism that allows the mind to sift undesirable thoughts and memories from a person’s normal consciousness.
Strategies for Maintaining the Therapeutic Relationship
A patient’s potential to dissociate can adversely impede the creation and continuity of a therapeutic relationship,
NRNP 6665 WEEK 9 ASSIGNMENT Controversy Associated With Dissociative Disorders
making it difficult to achieve successful psychotherapy outcomes. The aim of creating and maintaining a therapeutic relationship with patients with dissociative disorders is to assist them in coming up with a consistent sequence of events of their early life, perceive the emotional pain related to the trauma experiences, and understand their past (Firestone, 2018). Approaches to maintaining a therapeutic relationship with patients include employing a patient-oriented approach, purposed to understand the client’s suicidality from their identity or personality issues. Another strategy is to draw the client’s narrative about their experience as crucial in creating and maintaining the therapeutic relationship and collaborating to develop a mutual understanding of the patient’s dissociation. Firestone (2018) recommends using collaborative and narrative strategies since they improve the provider’s capacity to empathize and assist the client in restoring a sense of mastery, thus strengthening the therapeutic relationship.
Ethical and Legal Considerations Related To Dissociative Disorders
Treating patients with dissociative disorders needs definite attention to various ethical and legal issues. Clinicians dealing with these clients need to obtain informed consent either from the client or the patient’s guardian by explaining the diagnosis and treatment interventions (Deshpande et al., 2020). The clinician can avoid legal implications by obtaining consent to share the client’s information with other providers. The patient’s right to autonomy should be brought into practice by involving the patient in determining treatment interventions and discussing any controversies surrounding the interventions (Deshpande et al., 2020). Discussing the controversies helps mitigate psychological distress that may arise when the client learns them from another source. Clinicians should also respect clients’ decisions on their preferred treatment options to avoid ethical implications.
Conclusion
Controversies surrounding dissociative disorders include whether they are actual disorders and if patients exhibit intentional malingering or induced symptoms. Besides, defendants have used dissociative disorders to plead not guilty for grave offenses. Using a patient-oriented approach and collaborative and narrative strategies can help establish and maintain a therapeutic relationship with a client. Legal and ethical considerations in dissociative disorders include informed consent and respect for autonomy.
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
Deshpande, S. N., Mishra, N. N., Bhatia, T., Jakhar, K., Goyal, S., Sharma, S., Sachdeva, A., Choudhary, M., Shah, G. D., Lewis-Fernandez, R., & Jadhav, S. (2020). Informed consent in psychiatry outpatients. The Indian journal of medical research, 151(1), 35–41. https://doi.org/10.4103/ijmr.IJMR_1036_18
Firestone, L. (2018). Dissociation and Therapeutic Alliance. In Phenomenology of Suicide (pp. 167-186). Springer, Cham.
Loewenstein, R. J. (2018). Dissociation debates: everything you know is wrong. Dialogues in clinical neuroscience, 20(3), 229–242. https://doi.org/10.31887/DCNS.2018.20.3/rloewenstein
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