Dissociative disorders are a group of mental disorders that present with disruption in the normally integrated functions of memory, consciousness, sensations, identity, and control of body movements. Individuals have an impaired ability to effect a conscious and selective control over their symptoms, to a varying extent. The purpose of this paper is to explore the controversy on dissociative disorders and the clinical, ethical, and legal concerns when working with patients with dissociative disorders.
Dissociative disorders are controversial, with numerous arguments for and against these conditions. Questions arise on whether Dissociative disorders are real, with some healthcare professionals believing it does not exist despite being listed in the DSM-V. Dissociative disorders have been linked to past trauma, especially in childhood abuse. However, there is no evidence that they result from childhood trauma, and cases of Dissociative disorders in children are rarely reported (Reinders & Veltman, 2021). There is a debate that the diagnosis and treatment of Dissociative disorders cause the memories of childhood trauma (blatant iatrogenesis), and thus trying to diagnose causes more harm to the patient. Furthermore, diagnosis of Dissociative disorders has been blamed for misdiagnosis of other psychiatric conditions, mismanagement of patient, and under-treatment of depression.
I believe that dissociative disorders mostly form in individuals with a history of long-term exposure to physical, emotional, and sexual abuse. Besides, natural disasters and combat can contribute to dissociative disorders as individuals suppress traumatic memories. Rafiq et al. (2018) found that exposure to childhood trauma was connected with increased dissociation across individuals with severe mental illness. Besides, significant positive associations were identified between particular childhood adversities and dissociation. Fang et al. (2021) assert that dissociative disorders are associated with antecedent stressors such as adverse life events, social or family issues, and traumas like violence and abuse. Furthermore, Reinders and Veltman (2021) explain that Dissociative identity disorder (DID) is not likely to be a neurodevelopmental disorder but an outcome of environmental factors, such as early childhood trauma, which affect brain morphology.
Establishing a therapeutic relationship with a patient with a history of abuse and trauma is often challenging due to mistrust. Strategies to create and maintain a therapeutic relationship include focusing on the patient’s needs and making them a priority, which builds more trust. The therapist should work with the patient and agree on the therapy goals and the tasks needed to meet the goals. An optimal therapeutic relationship is achieved when the therapist and patient share beliefs on the therapy goals and perceive the interventions used to achieve them as effective and relevant (Bolsinger et al., 2020). In addition, the therapists should demonstrate empathy and unconditional positive regard.
The therapist should respect the client’s autonomy by accepting that the client has a right to self-determination and independence. Beneficence and nonmaleficence should be upheld by ensuring that the therapy provided will be good for the client and not cause harm, to avoid legal consequences. Privacy and confidentiality should be maintained, and this includes obtaining consent before sharing patient information.
The controversy on Dissociative disorders surrounds whether they are real if childhood trauma is the primary cause and whether it is associated with blatant iatrogenesis. My professional beliefs about dissociative disorders are that they develop as a coping mechanism to deal with past trauma. Therapists should prioritize the patients’ needs and agree on goals and interventions to maintain a therapeutic relationship.
Bolsinger, J., Jaeger, M., Hoff, P., & Theodoridou, A. (2020). Challenges and Opportunities in Building and Maintaining a Good Therapeutic Relationship in Acute Psychiatric Settings: A Narrative Review. Frontiers in psychiatry, 10, 965. https://doi.org/10.3389/fpsyt.2019.00965
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