20 Feb NRNP 6665 Week 9 Assignment Controversy Associated with Dissociative Disorders – Detailed Study Notes

Introduction
Dissociative disorders (DDs) are a group of psychiatric conditions characterized by disruptions in memory, identity, consciousness, and perception. They include Dissociative Identity Disorder (DID), Dissociative Amnesia, Depersonalization/Derealization Disorder, and Other Specified Dissociative Disorder (OSDD). While recognized in the DSM‑5, dissociative disorders remain controversial in psychiatry due to debates about their etiology, validity, and treatment.

1. Overview of Dissociative Disorders
Dissociative Identity Disorder (DID): Presence of two or more distinct personality states with recurrent gaps in memory.

Dissociative Amnesia: Inability to recall important autobiographical information, usually related to trauma.

Depersonalization/Derealization Disorder: Persistent feelings of detachment from self or surroundings.

OSDD/Unspecified: Symptoms that do not fully meet criteria for other dissociative disorders.

2. Etiological Theories
Trauma Model: Dissociation arises as a coping mechanism for severe childhood trauma, especially abuse.

Sociocognitive Model: Symptoms are shaped by therapist suggestion, cultural narratives, and patient expectations.

Neurobiological Findings: Brain imaging shows differences in hippocampus, amygdala, and prefrontal cortex activity.

Genetic/Temperamental Factors: Some evidence suggests predisposition to dissociation.

3. Controversies
Validity of DID: Some clinicians argue DID is rare or iatrogenic (created by therapy).

Recovered Memories: Debate over whether traumatic memories can be repressed and later recovered.

Malingering: Concerns that patients may feign symptoms for attention or legal advantage.

Cultural Influence: Dissociative symptoms may reflect cultural or spiritual experiences rather than pathology.

Diagnostic Reliability: High comorbidity with PTSD, depression, and borderline personality disorder complicates diagnosis.

4. Clinical Presentation
Symptoms: Memory gaps, identity confusion, depersonalization, derealization, flashbacks, somatic complaints.

Course: Often chronic, with exacerbations during stress.

Comorbidities: PTSD, depression, anxiety, substance use, personality disorders.

5. Assessment
Clinical Interview: Detailed trauma history, symptom exploration.

Structured Tools: Dissociative Experiences Scale (DES), SCID‑D.

Collateral Information: Family reports, medical records.

Challenges: Differentiating dissociation from psychosis, malingering, or cultural phenomena.

6. Treatment Approaches
Psychotherapy (Primary):

Phase‑oriented therapy: stabilization, trauma processing, integration.

CBT and DBT adaptations.

EMDR (controversial but sometimes used).

Pharmacotherapy (Adjunct):

No FDA‑approved medications for DDs.

SSRIs, mood stabilizers, antipsychotics used for comorbid symptoms.

Supportive Interventions:

Psychoeducation, grounding techniques, mindfulness.

Safety planning for self‑harm risk.

7. Ethical Considerations
Informed Consent: Patients must understand risks of memory recovery techniques.

Avoiding Suggestion: Therapists must avoid unintentionally shaping patient narratives.

Cultural Sensitivity: Respecting spiritual or cultural interpretations of dissociation.

Risk Management: Monitoring suicidality and self‑harm.

8. Research Evidence
Support for Trauma Model: Many DID patients report severe childhood trauma.

Critiques: Some studies suggest therapist influence or media exposure contributes to symptom formation.

Neuroimaging: Shows distinct brain activation patterns in DID states, supporting biological basis.

Treatment Outcomes: Long‑term psychotherapy can reduce symptoms, but evidence is limited.

9. Implications for PMHNP Practice
Diagnostic Caution: Avoid over‑diagnosis; rule out other conditions.

Therapeutic Alliance: Build trust, validate experiences, avoid coercion.

Integrated Care: Address comorbidities alongside dissociation.

Advocacy: Educate patients and families about controversies and evidence.

10. Conclusion
Dissociative disorders remain one of the most debated areas in psychiatry. While evidence supports their existence and link to trauma, skepticism persists regarding diagnosis and treatment. PMHNPs must balance empathy, evidence, and ethical practice when caring for patients with dissociative symptoms.

Quiz: NRNP 6665 Week 9 – Dissociative Disorders (15 Questions)
Instructions
Select the best answer for each question. Each item is multiple choice.

1. Which dissociative disorder involves two or more distinct personality states? A. Dissociative Amnesia B. DID C. Depersonalization Disorder D. PTSD Answer: B

2. Which model explains dissociation as a coping mechanism for trauma? A. Sociocognitive B. Trauma C. Biological D. Genetic Answer: B

3. Which tool is commonly used to assess dissociation? A. PHQ‑9 B. DES C. GAD‑7 D. MMSE Answer: B

4. Which controversy questions the validity of recovered memories? A. Trauma model B. Memory repression debate C. Neurobiological findings D. Sociocognitive model Answer: B

5. Which comorbidity is most common with dissociative disorders? A. Hypertension B. PTSD C. Diabetes D. Schizophrenia Answer: B

6. Which therapy is most often used for DID? A. Phase‑oriented psychotherapy B. ECT C. Pharmacotherapy alone D. Surgery Answer: A

7. Which medication class is FDA‑approved for dissociative disorders? A. SSRIs B. None C. Antipsychotics D. Benzodiazepines Answer: B

8. Which ethical issue is central in dissociative disorder treatment? A. Informed consent B. Profitability C. Efficiency D. Competition Answer: A

9. Which neuroimaging finding supports DID? A. Distinct brain activation patterns B. No differences observed C. Only genetic markers D. Random variation Answer: A

10. Which disorder must be ruled out when diagnosing dissociation? A. Psychosis B. Hypertension C. Diabetes D. Asthma Answer: A

11. Which cultural factor complicates diagnosis? A. Spiritual experiences B. Diet C. Exercise D. Language Answer: A

12. Which therapy emphasizes stabilization before trauma processing? A. Phase‑oriented therapy B. EMDR only C. Pharmacotherapy D. Psychoanalysis Answer: A

13. Which symptom is NOT typical of dissociation? A. Memory gaps B. Identity confusion C. Hallucinations D. Depersonalization Answer: C

14. Which model suggests therapist suggestion shapes symptoms? A. Trauma model B. Sociocognitive model C. Neurobiological model D. Genetic model Answer: B

15. What is the PMHNP’s role in dissociative disorder care? A. Build therapeutic alliance and address comorbidities B. Focus only on medication C. Ignore controversies D. Avoid patient education Answer: A