1. Select a disorder from those you have studied in lessons 3-6. Pretend you are a licensed
psychiatrist and you are seeing a new patient (a fictitious character you create) who is suffering
from that disorder.
1. Describe the patient’s symptoms and establish a treatment plan, including the use
of psychopharmacology as a treatment modality.
2. Consider the implications of treatment not only for the individual, but also for that
person’s family and community.
Dissociative disorders are complicated to understand, diagnose, and treat, as they affect every
aspect and dimension of one’s life. Dissociative identity disorder (DID) is one’s identity intruded
upon by other personalities separate from the “original person” (Sue, 2017, p. 160). It was
previously known as multiple personality disorder. The distinctive personality states can cause
changes in behavior, sense of self, memories, emotion, and one’s view of the world, as they are
completely separate people within one person. Since these personality states are independent
of one another, the person can experience frequent gaps in memory or their life. Typically, only
one personality is present at a time and one personality is considered the “primary personality”
(Sue, 2017, p. 164). Possession is also a symptom one could experience with DID, relating
directly to the cultural dimension of having DID. Psychologists believe that an altered personality
state exists to help shield the primary personality from trauma or stress, without the primary
personality always realizing the existence of the other.
DID typically presents itself during childhood to adolescence but can be commonly
misdiagnosed (Sue, 2017, p. 160). Unfortunately, the DSM-5 is unable to provide objective
criteria for diagnosing DID. Many of the symptoms experienced by someone with DID are
similar to fugues or dissociative amnesia, such as gaps in memories and an inability to recall
personal information. Within the medical community, controversy exists in the recognition and
diagnosis of DID, though it is still considered a rare mental disorder. Treatment for DID focuses
on managing stress and trauma, instead of directly addressing specific personalities within a
person (Sue, 2017, p. 168). Trauma-focused therapy is a commonly used approach to treating
DID, as it also validates all of one’s personalities while developing stress management
techniques across the board. The end result of trauma-focused therapy is to create a
cooperation and bond among all personality states, resulting in the merging of all personalities
into one. Psychologists like to adopt a hierarchical approach to treating DID, as the full success
of the treatment is difficult and long-term.
Many dimensions of one’s are affected by DID, including the social, cultural, and psychological.
It is a disorder that is extremely difficult to understand, both by the patient and the people in
their life. Treatment helps triage the most important factors contributing to the stress and trauma
in the patient’s life (Sue, 2017, p. 168).. Stress can be a result of a traumatic time during
childhood, one’s socioeconomic status, and more, so it truly infiltrates all aspects of one’s life.
Once the stress factors are identified and understood, it’s important to focus on stabilizing one’s
identity, learning how to develop positive relationships, and merging all of these factors together
into one identity. Throughout diagnosis and treatment, the patient can become distressed and
angered at their different personality states. One’s “circle” can be pivotal in creating this safe
and nurturing environment. As previously mentioned, DID can be alarming and difficult to
understand for all involved, so creating a safe and positive environment is crucial.
Reference
Sue, D., Sue, D. W., Sue, D., & Sue, S. (2017). Essentials of understanding abnormal
behavior (3rd ed.). Boston, MA, USA: Cengage Learning.
2. Much published psychological research has been conducted in North America, which has
influenced tools such as the DSM-5. Knowing what you know about sociocultural and cultural
influences:
1. Are the diagnostic criteria developed by Western countries valid for use in other
countries?
2. Describe an example of a disorder with far higher prevalence rates in the United
States and Europe when compared to Asian and African countries (or vice versa).
How could this impact the diagnosis and efficacy of treatment?
3. What can or should be done to reliably use assessment tools and knowledge with
other non-Western cultures?
The DSM-5, or the Diagnostic and Statistical Manual of Mental Disorders, helps to diagnose
mental disorders based on a myriad of criteria. As mentioned, many of the published tools and
research used to diagnose and treat mental disorders have been conducted in North America,
potentially creating a bias in the findings. I believe the diagnostic criteria developed by Western
countries is still valid for use across the globe because many dimensions of one’s life can affect
the onset, diagnosis, and treatment of mental disorders. The multipath model takes into account
the social, sociocultural, biological, and psychological dimensions as it relates to specific mental
disorders. The sociocultural and cultural dimensions are key in understanding the validity and
usefulness of diagnostic criteria globally. Cultural factors, such a religion, stereotypes, norms,
and more, can influence the onset, diagnosis, and treatment of a mental disorder; these factors,
however, are only one piece of the diagnostic story. Biologically, humans are similar across all
cultures, showing the similarities cross-culturally.
Bulimia nervosa is an example of a disorder that has higher prevalence rates in the United
States than compared to Asian or African countries. According to the National Institutes of
Health (2004), the prevalence rates for bulimia nervosa in females in Western countries was
7.3% versus 3.2% in non-Western countries. Bulimia nervosa is an eating disorder that involves
large amounts of food, eaten quickly, followed by purging or fasting (Sue, 2017, p. 238). Bulimia
nervosa, and eating disorders in general, are heavily influenced by cultural norms and mass
media creating the idealized body type. The social and sociocultural dimensions play a large
role in the etiology of bulimia nervosa through peer pressure, cultural attitudes, social
comparison, and more (Sue, 2017, p. 242). The treatment of bulimia nervosa can be carefully
crafted to Western countries, as the prevalence rate is higher, illustrating a larger need for
treatment emphasis. Unfortunately, this could cause a discrepancy and lack of importance for
non-Western countries, as the prevalence rate is lower. Cultural factors, such as stigmas and
stereotypes, could influence the diagnosis of bulimia nervosa and the readiness to seek
treatment among patients.
It is difficult to create assessment tools that are valid and applicable to all cultures, as mental
disorders are recognized and understood in different ways globally. It is crucial that culturespecific tests are created in non-Western countries, to take into account the difference in
cultural perceptions, norms, and understandings of mental disorders. It also could be helpful to
create a DSM for global regions that share more cultural characteristics than with Western
countries; this would attribute for the different dimensions that affect mental disorders, creating
for more consistency throughout the diagnostic process. The creation of this new DSM would be
length, but long-term could be extremely beneficial to the global understanding, diagnosis, and
treatment of mental disorders. Mental disorders are diseases that affect all cultures, some more
than others, so it’s imperative that the proper time and effort is given to the diagnosis and
treatment of these disorders worldwide.
Reference
Makino, M., Tsuboi, K., & Dennerstein, L. (2004). Prevalence of Eating Disorders: A
Comparison of Western and Non-Western Countries. MedGenMed, 49(6). Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1435625/
Sue, D., Sue, D. W., Sue, D., & Sue, S. (2017). Essentials of understanding abnormal behavior
(3rd ed.). Boston, MA, USA: Cengage Learning.