Assignment: Controversy Associated with Personality and Paraphilic Disorders

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USW1.56728.202270 - NRNP-6675-7-PMHNP ACROSS THE LIFESPAN II-2022-SUMMER-QTR-TERM-WKS-1-THRU-11-(05/30/2022-08/14/2022)-PT27

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1 CONTROVERSY ASSOCIATED WITH DISSOCIATIVE IDENTITY DISORDER (DID)

Oluyemisi Awe

2 COLLEGE OF NURSING-PMHNP, WALDEN UNIVERSITY

NRNP 6675: 2 PMHNP CARE ACROSS THE LIFESPAN II

Dr. Mihaela Fletcher

July 14, 2022

Controversy Associated with Dissociative Identity Disorder (DID) Dissociative Identity Disorder (ICD-10:

F44.81), which was previously referred to as Multiple Personality Disorder, entails a process of dissociation in

which the patient goes through a mental process leading to a lack of connection in the individual’s memories,

thoughts, feelings, sense of identity and action. An individual develops dissociative identity disorder due to

sustained and severe childhood trauma, in which the child’s psyche, which at this stage is rather fragile,

dissociates so at to facilitate coping with stressors. According to the DSM 5 criteria for dissociative identity

disorder is the presence of two or more personality states in the patient, complete inability for the patient to

recall important events that happened in their life, and disturbance is not linked to substance abuse or other

mental condition. DID is surrounded by a variety of controversies, for example, its theory of causality.

Controversy Surrounding the dissociative identity disorder The controversy related to dissociative identity

disorder relates first to its theory of causality, in which patients exhibit repressed memories, which mental

health professionals are skeptical and question the potential of suddenly remembering abuse that happened in

one’s childhood, which might never have occurred. Some mental health professionals’ state that most patients

suffering from DID do not completely forget severe or chronic abuse, but rather only forget certain episodes.

The main reason some of the myths and controversies related to DID persist may be due to lack of education

and awareness on the disorder, as well as lack of updated information on the same.

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Professional Belief about Dissociative Identity Disorder From a professional perspective, I believe DID is rather

difficult to diagnose, but no impossible. 2 ACCORDING TO PIETKIEWICZ ET AL. 1 (2021),

“DIAGNOSING COMPLEX DISSOCIATIVE DISORDERS (DID OR OTHER SPECIFIED

DISSOCIATIVE DISORDER, OSDD) IS CHALLENGING FOR SEVERAL REASONS. PATIENTS

PRESENT A LOT OF AVOIDANCE AND RARELY REPORT DISSOCIATIVE SYMPTOMS

SPONTANEOUSLY WITHOUT DIRECT QUESTIONING.” IN ADDITION, THIS HAS LED TO

MISDIAGNOSIS OF THE DISORDER. According to Reinders & Veltman (2021), “The combination of

insufficient training in recognizing trauma-related dissociation, limited exposure to accurate scientific

information about DID, symptom similarities with other disorders (such as schizophrenia, bipolar disorder,

and borderline personality disorder) and the etiology debate has led to a reluctance to consider a diagnosis of

DID, leading to under- and misdiagnosis of the disorder, hampering effective treatment.” It is imperative to

note that, the trauma experienced by patient’s suffering from DID can be explained scientifically and

objectively. 3 ACCORDING TO REINDERS ET AL. (2019), “Although it is currently unknown how early

traumatization affects the development of the brain, it is not surprising that long-lasting trauma results in

widespread patterns of affected grey and white matter brain regions. 3 WE FOUND AFFECTED BRAIN

REGIONS IN DIFFERENT LOBULES IN THE BRAIN, BUT MOST PROMINENTLY IN THE

FRONTAL GREY AND WHITE MATTER REGIONS, SUPPORTING FINDINGS FROM PREVIOUS

STUDIES USING UNIVARIATE DATA-ANALYSIS APPROACHES TO INVESTIGATE THE

NEUROANATOMICAL CORRELATES OF DISSOCIATIVE SYMPTOMS ACROSS DISORDERS.”

STRATEGIES FOR MAINTAINING THERAPEUTIC RELATIONSHIP

A therapeutic relationship is identified as one based on mutual respect and trust, with some level of sensitivity

and empathy for the patient with DID, fostering feelings of hope and gratitude. One of the strategies would be

to never judge the patient (Ringrose, 2012). DID is already considered ‘bizarre’ by some misinformed mental

health professionals, and a critical part of treatment depends on the patient’s disclosure of what they are

experiencing, hence if a patient feels judged they might hold back hindering the process. The therapist should

be well-aware that the client’s needs come first. What this entails is that they should be open, willing, and

flexible when it comes to the adaptation of their treatment plan to the needs of the specific patient. To carry

this out effectively, the therapist should inquire on what the client’s goals are for the treatment and if they have

any methods of treatment they are interested in, which builds a spirit of collaboration strengthening the

relationship.

4 ETHICAL AND LEGAL CONSIDERATIONS

An ethical consideration that as mental health professional should consider is the consent of their patient to the

prescribed mode of treatment. This should go together with voluntary participation from the patient. In

addition, ethically the patient should not feel judged, which will make them develop feelings of rejection, hence

the need for exercise of empathy. Confidentiality is also another ethical consideration, as the well-being of the

patient, even after their therapy session of very important. A legal consideration would be probing the patient

into whether they have violent tendencies and if they plan of harming any individual in the process. This will

allow precautions to be taken to protect both the patient and the victim.

Conclusion

Dissociative Identity Disorder is a rather complex mental condition and care should be taken when handling

patients suffering from it. The controversy related to the disorder, that is, the theory of causality, sheds light on

a significant aspect, but this should not be grounds of denying the fact that DID exists. The main challenge with

DID comes when the patient does not disclose symptoms, or they disclose they later affecting the process of

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diagnosis, in which case the strategies for maintaining the therapeutic relationship, for example, not judging

the patient come in handy.

References

Pietkiewicz, I. 2 J., BAŃBURA-NOWAK, A., TOMALSKI, R., & BOON, S. (2021). 2 REVISITING

FALSE-POSITIVE AND IMITATED DISSOCIATIVE IDENTITY DISORDER. 5 FRONTIERS IN

PSYCHOLOGY, 12. 6 HTTPS://DOI.ORG/10.3389/FPSYG.2021.637929 REINDERS, A., &

VELTMAN, D. (2021). 7 DISSOCIATIVE IDENTITY DISORDER: 6 OUT OF THE SHADOWS AT

LAST? THE BRITISH JOURNAL OF PSYCHIATRY, 219(2), 413-414. DOI:10.1192/BJP.2020.168

Reinders, A., Marquand, A., Schlumpf, Y., Chalavi, S., Vissia, E., Nijenhuis, E.,. Veltman, D. (2019). 3

AIDING THE DIAGNOSIS OF DISSOCIATIVE IDENTITY DISORDER: 8 PATTERN

RECOGNITION STUDY OF BRAIN BIOMARKERS. 3 BRITISH JOURNAL OF PSYCHIATRY,

215(3), 536-544. DOI:10.1192/BJP.2018.255

Ringrose, J. L. (2012). 5 UNDERSTANDING AND TREATING DISSOCIATIVE IDENTITY

DISORDER (OR MULTIPLE PERSONALITY DISORDER) (1ST ED.). Routledge. 5

HTTPS://DOI.ORG/10.4324/9780429484483

Citations (8/8)

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1 Another student's paper

2 Another student's paper

3 Another student's paper

4 Another student's paper

5 Another student's paper

6 Another student's paper

7 https://en.wikipedia.org/wiki?curid=39653

8 https://research.vumc.nl/en/publications/aiding-the-diagnosis-of-dissociative-identity-disorder-pattern-re

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CONTROVERSY ASSOCIATED WITH DISSOCIATIVE IDENTITY DISORDER (DID)

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identity disorder (DID) has been associated with controversy

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Source - Another student's paper Diagnosing complex dissociative disorders (DID or Other Specified Dissociative Disorder, OSDD) is challenging for several reasons

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PATIENTS PRESENT A LOT OF AVOIDANCE AND RARELY REPORT DISSOCIATIVE SYMPTOMS SPONTANEOUSLY WITHOUT DIRECT QUESTIONING.” IN ADDITION, THIS HAS LED TO MISDIAGNOSIS OF THE DISORDER

Firstly, patients present a lot of avoidance and rarely report dissociative symptoms spontaneously without direct questioning (Boon and

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COLLEGE OF NURSING-PMHNP, WALDEN UNIVERSITY

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College of Nursing-PMHNP, Walden University

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PMHNP CARE ACROSS THE LIFESPAN II

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PMHNP Care Across the Lifespan I

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Uploaded - WK7AssgnAweO.docx ACCORDING TO PIETKIEWICZ ET AL

Source - Another student's paper According to Pietkiewicz et al

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Uploaded - WK7AssgnAweO.docx J., BAŃBURA-NOWAK, A., TOMALSKI, R., & BOON, S

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Uploaded - WK7AssgnAweO.docx REVISITING FALSE-POSITIVE AND IMITATED DISSOCIATIVE IDENTITY DISORDER

Source - Another student's paper Revisiting False-Positive and Imitated Dissociative Identity Disorder

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ACCORDING TO REINDERS ET AL

Source - Another student's paper

Reinders et al

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Uploaded - WK7AssgnAweO.docx WE FOUND AFFECTED BRAIN REGIONS IN DIFFERENT LOBULES IN THE BRAIN, BUT MOST PROMINENTLY IN THE FRONTAL GREY AND WHITE MATTER REGIONS, SUPPORTING FINDINGS FROM PREVIOUS STUDIES USING UNIVARIATE DATA-ANALYSIS APPROACHES TO INVESTIGATE THE NEUROANATOMICAL CORRELATES OF DISSOCIATIVE SYMPTOMS ACROSS DISORDERS.” STRATEGIES FOR MAINTAINING THERAPEUTIC RELATIONSHIP

Source - Another student's paper frontal grey and white matter regions, supporting findings from pre- vious studies using univariate data-analysis approaches to investi- gate the neuroanatomical correlates of dissociative symptoms

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Uploaded - WK7AssgnAweO.docx AIDING THE DIAGNOSIS OF DISSOCIATIVE IDENTITY DISORDER

Source - Another student's paper Aiding the diagnosis of dissociative identity disorder

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Uploaded - WK7AssgnAweO.docx BRITISH JOURNAL OF PSYCHIATRY, 215(3), 536-544

Source - Another student's paper The British Journal of Psychiatry (2019) 215, 536–544

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Source - Another student's paper 10.1192/bjp.2018.255

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ETHICAL AND LEGAL CONSIDERATIONS

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Ethical and legal considerations

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FRONTIERS IN PSYCHOLOGY, 12

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Frontiers in Psychology, 12

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UNDERSTANDING AND TREATING DISSOCIATIVE IDENTITY DISORDER (OR MULTIPLE PERSONALITY DISORDER) (1ST ED.)

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Understanding and treating dissociative identity disorder (or multiple personality disorder)

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HTTPS://DOI.ORG/10.4324/9780429484483

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https://doi.org/10.4324/9780429484483

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HTTPS://DOI.ORG/10.3389/FPSYG.2021.637929 REINDERS, A., & VELTMAN, D

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https://doi.org/10.3389/fpsyg.2021.637929 Reinders, A

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Source - Another student's paper Out of the shadows at last

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Uploaded - WK7AssgnAweO.docx THE BRITISH JOURNAL OF PSYCHIATRY, 219(2), 413-414

Source - Another student's paper The British Journal of Psychiatry, 219(2), 413–414

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DOI:10.1192/BJP.2020.168

Source - Another student's paper

https://doi.org/10.1192/bjp.2020.168

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DISSOCIATIVE IDENTITY DISORDER

Source - https://en.wikipedia.org/wiki?curid=39653

"Dissociative identity disorder

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PATTERN RECOGNITION STUDY OF BRAIN BIOMARKERS

Source - https://research.vumc.nl/en/publications/aiding-the-diagnosis-of- dissociative-identity-disorder-pattern-re

pattern recognition study of brain biomarkers