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Dissociation: the clinical realities

F H Frankel1

  • 1Department of Psychiatry, Beth Israel Hospital, Boston, USA.

The American Journal of Psychiatry
|July 1, 1996
PubMed
Summary
This summary is machine-generated.

The Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III) aimed for observable diagnoses but included dissociation, leading to increased reports of dissociative disorders. Environmental cues and suggestibility may influence these diagnoses.

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Area of Science:

  • Psychiatry
  • Psychology
  • Mental Health Diagnostics

Background:

  • The Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III) prioritized empirical, observable, and measurable criteria.
  • This approach aimed to reduce the influence of unproven theories and facilitate research on homogeneous diagnostic groups.
  • However, DSM-III incorporated dissociation, a concept linked to theoretical frameworks, as a basis for classifying conditions previously under 'hysteria'.

Purpose of the Study:

  • To examine the implications of DSM-III's inclusion of dissociation in diagnostic classification.
  • To explore the potential influence of environmental factors and suggestibility on the rise of dissociative disorder diagnoses.
  • To critique the limitations of a purely phenomenological perspective in understanding dissociative phenomena.

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Main Methods:

  • Literature review and critical analysis of diagnostic criteria evolution.
  • Examination of the historical context of dissociation and hysteria in psychiatric nosology.
  • Analysis of the impact of theoretical concepts and research methodologies on diagnostic categories.

Main Results:

  • Despite DSM-III's empirical focus, the inclusion of dissociation, a theoretically laden concept, broadened diagnostic scope.
  • Since DSM-III, there has been a notable increase in reported dissociative experiences and dissociative identity disorder.
  • The study highlights concerns that these diagnoses may be significantly influenced by therapist expectations and suggestibility.

Conclusions:

  • A narrow focus on observable phenomena is insufficient for complex psychological constructs like dissociation.
  • Suggestibility and imagination, influenced by environmental cues, may play a substantial role in the increasing reports of dissociative disorders.
  • The conceptualization and diagnosis of dissociation warrant further critical examination regarding potential biases.