Dissociative disorders are those mental disorders that involve the patient experiencing a lack of continuity in their memories and thoughts, resulting in a disconnect in their perception of their surroundings, actions, and their own identity (Ada et al., 2018). People who suffer from dissociative disorders may experience involuntary lapses that interfere with their normal brain functioning hence maybe at times becoming unresponsive during interactions. According to Mychailyszyn et al. (2021), people who have dissociative disorders also struggle with self-identity. While there are many controversies surrounding the dissociative disorder, it has been confirmed to be real and said to develop as a way to cope with trauma, especially in children who have been subjected to long-term physical, sexual or emotional abuse.
Part of the reason that there exists a lot of controversy around dissociative disorders is that it is assumed that there are very valid cases and that they are not even real disorders. Some psychologists state that the issue of dissociative disorders is an American phenomenon that contributed in part due to role-playing by people whom therapists have manipulated. They argue that the so-called dissociative disorders simply manifest anxiety common with fantasy-prone, suggestible and sleep-deprived people. In addition, dissociative disorders are considered unreal as they have been used in the past to avoid the consequences of their wrong behavior.
I, however, believe that dissociative disorders are real and that the only reason why there are many controversies around the subject is that there is a lack of health professional education around associative disorders. Furthermore, the symptoms of dissociative disorders are less obvious to observers, especially to those with no psychological training. This makes it difficult to differentiate it from other types of disorders and properly diagnose it with 100% accuracy. Well, it is rare, only affecting about 1.5% of the global population. Dissociative disorder has been medically proven to be a real problem, especially among children. In fact, it is safe to assume that if we are to stick with the DSM-5 criteria for diagnosing the disorder, the numbers could be more.
According to the DSM-5 guidelines, people suffering from dissociative disorders are bound to experience repeated cases of amnesia, loss of memory, and difficulty remembering their personal details and events, like how to perform simple tasks. In addition, they may suffer from a self-identity crisis, in which case they might exist in two or more personality states normally evidenced by sudden changes in attitudes and behavior (Zimmermann et al., 2019). As a result of these symptoms, they experience emotional distress and confusion. Dissociative disorders must be given adequate attention as failure to do so exposes those suffering from the disorder to trauma and real dangers such as bodily harm to themselves and others, as well as suicidal thoughts.
To effectively deal with dissociative disorders, it is important that the therapist maintains a therapeutic relationship with the client. This calls for strategies that promote safety for both the therapist and the client and also target individual symptoms. The first and most critical strategy is to enhance the safety of the treatment setting. It is important that the therapist realizes that most dissociative disorders’ symptoms are triggered by feelings of fear and uncertainty (George, 2020). As such, the therapist should, before everything else create a reassuring atmosphere and that their presence signifies protection. Creating a safe environment helps the client to feel self and relaxed and is critical to help them recall lost memories. The therapist should also ensure that there is minimal noise, as this could trigger dissociative reactions. George (2020), suggests that to better manage these dissociative episodes, the therapist should help the client acknowledge and process them.
Psychotherapy is the ideal treatment for dissociative disorder as it helps the client to gain control of their dissociative processes and symptoms. Also referred to as talk therapy, psychotherapy involves having a discussion between the therapist and the client about their experiences and, in so doing, enables the client to improve their behavior, memories, and emotions and become more self-aware (Ganslev et al., 2020). As a result, psychotherapy helps people overcome painful experiences and destructive behaviors and instead develop new coping skills that are not harmful to their health.
Another strategy that may be effective is the use of individualized therapy as opposed to group therapy. People who suffer from dissociative identity may experience difficulty in participating in group therapies because they cannot properly communicate with the rest of the group members (Öztürk et al., 2021). In addition, having to discuss traumatic experiences may lead to further confusion and trigger dissociative reactions when they feel distressed. However, individualized therapy sessions are ideal because they increase confidentiality and allow for ample time for the client to understand their thoughts and behavior patterns.
In addition to these strategies, therapists must also consider the ethical and legal considerations related to dissociative disorders. It is important that therapists get informed consent from their clients and the first thing in therapy. The benefits of this practice are that it ensures that patients are aware of what to expect during therapy and that the client is aware of any risks (Rocchio, 2020). In addition, obtaining consent protects the therapist against legal issues arising from the client’s participation in therapy. However, questions have been asked about dissociative disorder patients’ decision-making capacity and what should happen when such a patient receives their consent and claims that they did not understand the procedure. Other issues for legal consideration have been raised when defendants in criminal cases state that they were in a dissociated state and, therefore, not guilty by reason of insanity. While the debate continues concerning these ethical and legal issues, therapists must uphold professional values as they are critical in building a therapeutic relationship which is necessary in helping patients work through their mental health problems (Rocchio, 2020).
References
Ada, Khush, et al. “Study of parenting styles and attachment in adolescents with dissociative disorder.” Journal of Indian Association for Child and Adolescent Mental Health 14.4 (2018): 58-73. https://journals.sagepub.com/doi/10.1177/0973134220180404
Ganslev, C. A., Storebø, O. J., Callesen, H. E., Ruddy, R., & Søgaard, U. (2020). Psychosocial interventions for conversion and dissociative disorders in adults. Cochrane Database of Systematic Reviews, (7). https://doi.org/10.1002/14651858.CD005331.pub3
George, 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. https://doi.org/10.1016/j.ejtd.2020.100164
Mychailyszyn, M. P., Brand, B. L., Webermann, A. R., Şar, V., & Draijer, N. (2021). Differentiating Dissociative from Non-Dissociative Disorders: A Meta-Analysis of the Structured Clinical Interview for DSM Dissociative Disorders (SCID-D) Journal of Trauma and Dissociation. Journal of Trauma & Dissociation, 22(1), 19-34. https://doi.org/10.1080/15299732.2020.1760169
Öztürk, E. R. D. İ. N. Ç., Erdoğan, B., & Derin, G. (2021). Psychotraumatology and dissociation: A theoretical and clinical approach. Medicine-Science, 10(1), 246-254.
Rocchio, L. M. (2020). Ethical and professional considerations in the forensic assessment of complex trauma and dissociation. Psychological injury and law, 13(2), 124-134. https://link.springer.com/article/10.1007/s12207-020-09384-9
Zimmermann, J., Kerber, A., Rek, K., Hopwood, C. J., & Krueger, R. F. (2019). A brief but comprehensive review of research on the alternative DSM-5 model for personality disorders. Current psychiatry reports, 21(9), 1-19. https://link.springer.com/article/10.1007/s11920-019-1079-z
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