Controversy Associated with Dissociative Disorders

Question 1: Controversy Surrounding Dissociative Disorders 

Dissociative Identity Disorder (DID) is a controversial diagnosis previously referred to as multiple personality disorder (MPD). DID is classified under the Dissociative Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition . DID remains a controversial diagnosis among psychiatrists as there are no standardized measures of diagnosis, plaguing it with a history of fictionalized case studies (Blihar et al., 2020). Many critics of the diagnosis view it as a form of hysteria that mirrors pseudoseizures and conversion paralysis. DID’s diagnosis is based on the concept that memories of severe and sustained childhood abuse were “repressed” and could later be recovered through various forms of therapy (Peters & Treisman, 2017). Patients with DID are often misdiagnosed and offered the wrong treatment due to the unfamiliarity of psychiatrists with the disease 

Proponents of the disorder associate it with dissociation, which primarily is little or no connection in a person’s personality parts. Dissociating from the trauma allows the patient to cope until adulthood, when the trauma-based characteristics emerge. The controversy of the disorder is based on the following circular arguments: the trauma model and the fantasy model (Peters & Treisman, 2017). The trauma model, also known as the dynamic or developmental model, refers to the development of alternate personalities that occur due to the inefficacy of traumatized minors to develop a unified sense of calmness across their different personality states (Blihar et al., 2020). This model argues that adverse childhood trauma increases the risk of dissociation. Despite the existing studies and data that support this theory, many psychiatrists remain unconvinced. Another concern raised concerning this model is the difficulty of assessing trauma based on remembering memories. Many clinicians and the legal fraternity worry that the formal acceptance of DID might enable criminals get away with crimes by attributing their criminal behavior to another personality. Criminals might falsify the genuine trauma or even exaggerate their experience. The fantasy model, also known as the sociocognitive model, argues that DID is highly influenced by therapist’s suggestive questioning, media influences, or broader sociocultural expectation regarding the symptoms of DID (Blihar et al., 2020). It suggests that the patients are highly hypnotizable and can be easily influenced by their surroundings. 

Question 2 

Professional Beliefs about Dissociative Disorders 

I believe that DID is a complex valid diagnosis that should be taken seriously by mental health professionals to ensure that patients receive the necessary treatment. DID cases have been an interest for psychiatrist researchers for hundreds of years and have been formally accepted in four different editions of DSM. The formal acknowledgment of the disorder by DSM disputes the claim that it is a fad (Brand et al., 2016). There is a growing body of research about DID that contradicts critics’ opinion that it is just a passing wave. The research covers several areas of DID, such as phenomenology, assessment, cognitive patterns, prevalence, and its treatment (Reinders et al., 2012). I also do not believe that suggesting questions by therapists, fantasies, and media influences have a high chance of influencing vulnerable individuals to think that they have DID. A study conducted by Dalenberg et al. (2012) found little evidence supporting the sociocognitive model of dissociation. The relationship between trauma and dissociation was as convincing in studies that used objectively verified abuse as those that relied on abuse reported by the patient. According to Gillig (2009), several studies have concluded that DID is an actual diagnosis and that spontaneous auto hypnotic symptoms is basic to the phenomenology of DID. The spontaneous age regression symptoms in DID patients have been attributed to early trauma. 

Strategies for Maintaining Therapeutic Relationships 

DID patients are extremely sensitive, and their reaction to interpersonal trust and rejection issues is highly unpredictable. The sensitivity associated with the disorder makes it difficult to conduct brief treatments in managed care settings. The therapists need to ensure that they treat the patients weekly or biweekly to ensure that the personality states fuse seamlessly while retaining all the experiences related to the different personalities (Gillig, 2009). It is also helpful to the patient when the therapist uses the cognitive-behavioral therapy (CBT) approach. The approach incorporates more effective communication with the different personalities and assists the patient explore adaptive coping strategies when distressed (Gillig, 2009). The therapist can integrate relaxation exercises and having breaks in between sessions. The therapist should also try to determine the most prominent personality because sometimes the host personality might not be the patient’s true identity. 

Question 3: Ethical and Legal Considerations 

There are critical concerns that psychiatrists have raised regarding the validity of the DID diagnosis. There are ethical implications created in treating patients diagnosed with DID continuously without the proper tests and responses to the disconfirming evidence. All psychiatrists need to have standard diagnosis measures to ensure they are not contradicting any ethical obligations. Over time, DID has now become a vital consideration in criminal cases. Legal and mental health practitioners are divided as to whether DID warrants the court to acquit criminals or it is just an easy way out for criminals. DID is a complex diagnosis, and evidence of a dissociative state is difficult to offer in court. The disorder reduces a person’s capacity to contain their actions, clearing them of any criminal responsibility. However, some of the criminals feign alter personalities to evade punishment (Farell, 2011). In the recent past, courts have rejected the permissibility of DID evidence, including expert testimony, because the scientific evidence supporting DID does not meet reliability standards. The courts should consider the validity of the claims by setting up measures to distinguish genuine dissociation and malingering. 

References 

Blihar, D., Delgado, E., Buryak, M., Gonzalez, M., & Waechter, R. (2020). A systematic review of the neuroanatomy of dissociative identity disorder.  European Journal of Trauma & Dissociation ,  4 (3), 100148. https://doi.org/10.1016/j.ejtd.2020.100148 

Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardeña, E., Frewen, P. A., Carlson, E. B., & Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation.  Psychological Bulletin ,  138 (3), 550-588.  https://doi.org/10.1037/a0027447 

Farrell, H. M. (2011). Dissociative identity disorder: Medicolegal challenges.  Journal of the American Academy of Psychiatry and the Law Online ,  39 (3), 402-406. 

Gillig P. M. (2009). Dissociative identity disorder: a controversial diagnosis.  Psychiatry (Edgmont (Pa. : Township)) ,  6 (3), 24–29. 

Peters, M., & Treisman, G. (2017).  Dissociative Identity Disorder | Johns Hopkins Psychiatry Guide . Hopkinsguides.com. Retrieved 27 April 2021, from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787069/all/Dissociative_Identity_Disorder . 

Simone Reinders et al., (2012). Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states.  PLoS ONE ,  7 (6), e39279.  https://doi.org/10.1371/journal.pone.0039279