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Your response should be 1-2 pages, double spaced, following APA format. Please refer to the module content and readings in your response. You may also include outside research to support your writing. Remember to properly cite all
references.
As you have read, dissociative identity disorder (DID) is a very controversial disorder. The diagnosis of this disorder has created quite a stir among mental health professionals. The ongoing debate is the belief that this disorder is not real and is perpetuated by misguided clinicians. Some clients are extremely impressionable and vulnerable while in therapy and follow the lead of the therapist, consequently, buying into the suggestion of multiple personalities. On the other side, you have professionals who assert that clients create identities as a defense mechanism to avoid trauma. Clients diagnosed with DID tend to have horrific histories of abuse. Debate whether you agree that this disorder is real or imposed. Can a traumatic event cause the creation of an “alter” to protect oneself?
According to ANAD, the National Association of Anorexia Nervosa and Associated Disorders, eating disorders are rampant in our society, yet we rarely have adequate programs or services to combat these disorders. It is noted that very few schools and colleges have programs to educate our youth about the dangers of eating disorders. Many schools have extensive drug and alcohol prevention programs but not eating disorder prevention programs. Why? Eighty-six percent of those reported cases report their onset by age 20. Create a mock prevention program for your campus or develop a program for an elementary, middle, and high school. Discuss the differences among age groups and areas of focus.
Rubric
PSYC–Reading Response
PSYC–Reading Response
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeContent
What are the issues/ challenges? Clear identification of issues/ problems.
10 to >8.0 pts
Issues are clearly detailed and well analyzed.
8 to >4.0 pts
Only a few issues are identified.
4 to >0 pts
Some key components are present but insufficiently detailed. Some are missing.No Marks
10 pts
This criterion is linked to a Learning OutcomeAnalysis
Analysis of issue/s presented including questions in the text. Critical thinking is evident. Not mere regurgitation of text. Recommendations for action/ solutions to the issues and problems are presented
80 to >68.0 pts
All key components are clearly detailed.
68 to >58.0 pts
Most key components are detailed.Rating Description
58 to >0 pts
Some key components are present but some are missing.
80 pts
This criterion is linked to a Learning OutcomeStructure
– Grammar
– Spelling
– APA
10 to >8.0 pts
No APA, grammar or spelling errors.
8 to >4.0 pts
Only a few APA, grammar or spelling errors.
4 to >0 pts
More than 5 APA, spelling or grammar errors.
10 pts
Total Points: 100
Dissociative Identity Disorder
The possibility that an individual may not be responsible for actions committed while multiple personalities are in control of the person’s behavior leads to fascinating legal questions. Theoretically, of course, it’s possible for one alter to commit a crime while the other alters, or even the host, remain unaware. Obviously, however, convicting one alter means the host (along with all the other alters) is also put in prison. At another level, however, this question relates to the legal definition of insanity. Is a person with dissociative identity disorder able to control his or her own mind if part of the mind has split off and is acting independently?
There are three possible approaches to defending a client who legitimately has this diagnosis. In the “alter-in-control” approach, the defendant claims that an alter personality was in control at the time of the offense. In the “each-alter” approach, the prosecution must decide whether each personality met the insanity standard. In the “host-alter” approach, the issue is whether the host personality meets the insanity standard.
Dissociative identity disorder has rarely been successful as a legal defense after a public outcry following the ruling in 1974 that serial rapist Billy Milligan was insane due to lack of an integrated personality (State v. Milligan, 1978). Since that time, cases have had a variety of outcomes, ranging from the judgment that multiple personalities do not preclude criminal responsibility (State v. Darnall, 1980) to the ruling that alter personalities are not an excuse for inability to distinguish right from wrong (State v. Jones, 1998). The courts threw out two more recent cases in Washington State (State v. Greene, 1998) and West Virginia (State v. Lockhart, 2000) on the grounds that scientific evidence and/or adequate reliability standards do not exist in the diagnosis of the disorder (Farrell, 2010). The key issue for forensic psychologists and psychiatrists is identifying the difference between malingering and the actual disorder (Farrell, 2011).
Tools are now available for expert clinicians to use in aiding accurate diagnosis. The Structured Clinical Interview for DSM–IV Dissociative Disorders–Revised (SCID-D-R) (Steinberg, 1994; see Table 1), which the profession has rigorously standardized,230includes a careful structuring, presentation, and scoring of questions. The professionals who developed and conducted research on this instrument emphasize that only experienced clinicians and evaluators who understand dissociative diagnosis and treatment issues must administer and score it.
TABLE 1Items from the SCID-D-R
Scale Items
Amnesia Have you ever felt as if there were large gaps in your memory?
Depersonalization Have you ever felt that you were watching yourself from a point outside of your body, as if you were seeing yourself from a distance (or watching a movie of yourself)?
Have you ever felt as if a part of your body or your whole being was foreign to you?
Have you ever felt as if you were two different people, one going through the motions of life and the other part observing quietly?
Derealization Have you ever felt as if familiar surroundings or people you knew seemed unfamiliar or unreal?
Have you ever felt puzzled as to what is real and what’s unreal in your surroundings?
Have you ever felt as if your surroundings or other people were fading away?
Identity confusion Have you ever felt as if there was a struggle going on inside of you?
Have you ever felt confused as to who you are?
Identity alteration Have you ever acted as if you were a completely different person?
Have you ever been told by others that you seem like a different person?
Have you ever found things in your possession (for instance, shoes) that belong to you, but you could not remember how you got them?
SOURCE: Steinberg, M. (1994). Structured clinical interview for DSM-IV dissociative disorders—Revised (SCID-D-R). Washington, DC: American Psychiatric Association.
The DSM-5 considers the diagnosis of dissociative identity disorder to be valid. The precedents created by rulings that the diagnosis is not admissible due to failure to meet scientific standards may in time be overturned. Nevertheless, the diagnosis is challenging at best and potentially easy to feign, particularly if a clinician inadvertently plants the idea of using it as a defense.
Q: You be the judge: Should dissociative identity disorder be considered admissible in criminal cases? Why or why not?
Assuming that people with dissociative disorders are reacting to trauma by developing dissociative symptoms, the treatment goal becomes primarily one of integrating the disparate parts of self, memory, and time within the person’s consciousness. Treatment guidelines for dissociative identity disorder emphasize best practices such as establishing and maintaining a strong therapeutic alliance, not playing favorites with any of the alters, and, from a positive psychology perspective, helping clients see themselves and their worlds in a more favorable manner by restoring their shattered assumptions (Ducharme, 2017).
As a specific technique, cognitive-behavioral therapy is well suited to helping clients with dissociative identity disorder develop a coherent sense of themselves and their experiences. To help clients view themselves more favorably, clinicians can stimulate them to question long-held core assumptions about themselves that are contributing to their symptoms. For example, they may believe they are responsible for their abuse, or that it is wrong for them to show anger toward their abusers, or that they can’t cope with their painful memories. By confronting and then changing these cognitions, clients can gain a sense of control that will allow them to incorporate those memories into their sense of self.
Clinicians should also attend to the comorbidity of a dissociative disorder with other symptoms, including post-traumatic stress disorder (Tsai, Armour, Southwick, & Pietrzak, 2015). Treatment of dissociative disorders often addresses not only these disorders themselves but also associated disorders of mood, anxiety, and post-traumatic stress.
MINI CASE
Depersonalization/Derealization Disorder
Robert is a 49-year-old heterosexual African American male. He entered the psychiatrist’s office in a state of extreme agitation, almost panic. He described the terrifying nature of his “nervous attacks,” which began several years ago but had now reached catastrophic proportions. During these “attacks,” Robert feels as though he is floating in the air, above his body, watching everything he does but feeling totally disconnected from his actions. He reports that he feels as if his body is a machine controlled by outside forces: “I look at my hands and feet and wonder what makes them move.” However, Robert’s thoughts are not delusions. He is aware that his altered perceptions are not normal. The only relief he experiences from his symptoms comes when he strikes himself with a heavy object until the pain finally penetrates his consciousness. His fear of seriously harming himself adds to his main worry that he is losing his mind.
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