Deciphering Dissociative Disorders: Exploring Complexities, Controversies, and Therapeutic Approaches
What are some of the challenges and controversies surrounding dissociative disorders (DID), and how do they impact the diagnosis and treatment of individuals with this condition?
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People with dissociative disorders (DID) feel a disconnection between their body and their feelings. When taken literally, the person feels as if they live outside their body. DIDs are considered controversial for several reasons. First, the origin or cause of DID is very unclear. There are people who relate them to previous traumatic experiences like accidents, violence, or loss of loved ones; while others claim that DID stem from anxiety and conflicting personalities. As such, there lack clarity on the shape and form of DIDs among experts. Therefore, it is difficult to describe the disorder in its truth and clarity without placing assumptions into the description.
Dissociative disorder is primarily a state of consciousness. Whereas some people will rarely experience a different personality to whom they are, there is the possibility of others experiencing multiple personalities from time to time. Swart et al. (2020) observed that there is high comorbidity between dissociative disorders and stress-related illnesses. As a result, the person develops multiple personalities that are difficult to define. They manifest depending on the prevailing conditions and circumstances of the environment. Therefore, they are difficult to define and place a correct personality on an individual suffering from any type of DID.
The prevalence rate of DIDs is scary, at 50% in the United States. However, only about 12% meet the criteria for treatment of dissociative disorders(Kate et al., 2019). The high prevalence rate is related to the commonness of the symptoms used to diagnose the disease. Signs like nightmares, flashbacks, strong emotions and impulses are used to diagnose other disorders like posttraumatic stress(Dell, 2018). As such, people end up suffering from dissociative disorders without knowledge.
When a patient presenting DID symptoms visits a clinician, it is fundamentally important to build a strong therapeutic relationship. This relationship should lead to a positive end for the patient. It is important to ease the relationship from the onset, and ensure that the patient is comfortable opening up to the clinician on issues taking a toll on them. As a clinician, the most important phase for me is the pre-interaction stage. This prepares the way for the introduction between the DID patient and the professional. If it is not well-handled, there is a chance of losing the client’s trust from the onset.
When a therapeutic relationship has already been established, the more difficult task comes in maintaining it. At this point, I always ensure frequent communication with the patient, even beyond the therapeutic sessions. The relationship advances to friendship, such that communication happens at all times and beyond the walls of therapy. Nonetheless, this makes the final stage of therapy very difficult to handle. Termination of therapeutic relationships can be emotionally draining for the patient. It is important to prepare the patient way in advance that the relationship is coming to an end, such that they are mentally prepared towards the end. If handled abruptly, it can easily negate the gains made across time during the relationship.
Ethics and legal considerations are compulsory in any psychiatric practice. As a practicing professional, I have to always ensure that the privacy and confidentiality of patient issues are never compromised. The integrity and honesty of practice is measured by how well the issues of patients are protected. Further, it is my duty as the clinician to ensure that there is no harm that reaches the patient as a result of my diagnosis and treatment. The end result should always be a win for the patient. The law requires that one practices within the doctrines and policies established by the agencies and authorities within the discipline. One legal requirement is obtaining a valid practicing license before commencement of services.
References (APA 6th Ed.)
Dell, P. (2018). Reconsidering the autohypnotic model of the dissociative disorders. Journal of Trauma & Dissociation, 20(1), 48-78. https://doi.org/10.1080/15299732.2018.1451806
Kate, M., Hopwood, T., & Jamieson, G. (2019). The prevalence of Dissociative Disorders and dissociative experiences in college populations: a meta-analysis of 98 studies. Journal of Trauma & Dissociation, 21(1), 16-61. https://doi.org/10.1080/15299732.2019.1647915
Swart, S., Wildschut, M., Draijer, N., Langeland, W., & Smit, J. (2020). Dissociative subtype of posttraumatic stress disorder or PTSD with comorbid dissociative disorders: Comparative evaluation of clinical profiles. Psychological Trauma: Theory, Research, Practice, and Policy, 12(1), 38-45. https://doi.org/10.1037/tra0000474
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