Juan Aníbal González-Rivera

Resumen

La mayoría de los programas graduados de psicología no cuenta con una formación clínica adecuada y especializada en evaluación, diagnóstico y tratamiento del trastorno de identidad disociativo. El propósito de este artículo es presentar a estudiantes y profesionales de la psicología clínica una breve guía introductoria con los principios psicoterapéuticos básicos para tratar e intervenir con el trastorno de identidad disociativo. Para alcanzar este fin, se desarrollaron dos objetivos específicos para la elaboración de la guía: presentar las características de una persona psicoterapeuta capacitada para ofrecer tratamiento psicológico a personas con este diagnóstico, y exponer el principal enfoque psicoterapéutico recomendado por personas expertas internacionales y la International Society for the Study of Trauma and Dissociation.

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Keywords

diagnóstico, disociación, trastorno de identidad disociativo, tratamiento

References
American Psychiatric Association. (2010). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd.pdf

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. https://www.apa.org/ptsd-guideline/ptsd.pdf

Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. The Journal of Nervous and Mental Disease, 174(12), 727–735. https://doi.org/10.1097/00005053-198612000-00004

Bernstein, E. M., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation, 6(1), 16–27.

Beere, D. B. (2009). An EMDR protocol for dissociative identity disorder (DID). In M. Luber (Ed.), Eye Movement Desensitization and Reprocessing: EMDR Scripted Protocols (pp. 387-425). Springer.

Bozkurt, H., Duzman Mutluer, T., Kose, C., & Zoroglu, S. (2015). Adolescents with dissociative disorders. Psychiatry and Clinical Neurosciences, 69(6), 369-374. https://doi.org/10.1111/pcn.12256

Brand, B. L., Classen, C. C., McNary, S. W., & Zaveri, P. (2009). A review of dissociative disorders treatment studies. The Journal of Nervous and Mental Disease, 197(9), 646–654. https://doi.org/10.1097/NMD.0b013e3181b3afaa

Brand, B. L., Kumar, S. A., & McEwen, L. E. (2019). Coverage of child maltreatment and adult trauma in graduate psycho-pathology textbooks. Psychological Trauma: Theory, Research, Practice and Policy, 11(8), 919–926. https://doi.org/10.1037/tra0000454

Brand, B. L., Loewenstein, R. J., & Lanius, R. A. (2014). Dissociative identity disorder. In G. O. Gabbard (Ed.), Gabbard's treatments of psychiatric disorders (pp. 439–458). American Psychiatric Publishing, Inc.

Brand, B. L., McNary, S. W., Myrick, A. C., Classen, C. C., Lanius, R., Loewenstein, R. J., Pain, C., & Putnam, F. W. (2013). A longitudinal naturalistic study of patients with dissociative disorders treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 5(4), 301–308. https://doi.org/10.1037/a0’027654

Brand, B. L., Myrick, A. C., Loewenstein, R. J., Classen, C. C., Lanius, R., McNary, S. W., Pain, C., & Putnam, F. W. (2012). A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 490–500. https://doi.org/10.1037/a0026487

Brand, B. L., Sar, V., Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A., & Middleton, W. (2016). Separating fact from fiction: An empirical Examination of six myths about dissociative identity disorder. Harvard Review of Psychiatry, 24(4), 257–270.
https://doi.org/10.1097/HRP.0000000000000100

Brand, B. L., Schielke, H. J., Putnam, K. T., Putnam, F. W., Loewenstein, R. J., Myrick, A., Jepsen, E. K. K., Langeland, W., Steele, K., Classen, C. C., & Lanius, R. A. (2019). An online educational program for individuals with dissociative disorders and their clinicians: 1-year and 2-year follow-up. Journal of Traumatic Stress, 32(1), 156–166. https://doi.org/10.1002/jts.22370

Bride, B. E., Hatcher, S. S., & Humble, M. N. (2009). Trauma training, trauma practices, and secondary traumatic stress among substance abuse counselors. Traumato-logy, 15(2), 96–105. https://doi.org/10.1177/1534765609336362

Camacho, J., & Olmeda, M. S. (2019). Trastornos disociativos. Medicine - Programa de Formación Médica Continuada Acreditado, 12(84), 4938-4496. https://doi.org/10.1016/j.med.2019.07.004

Chaturvedi, S. K., Desai, G., & Shaligram, D. (2010). Dissociative disorders in a psychiatric institute in India-a selected review and patterns over a decade. The International Journal of Social Psychiatry, 56(5), 533–539. https://doi.org/10.1177/0020764009347335

Chien, W.T., & Fung, H. W. (2022). The challenges in diagnosis and treatment of dissociative disorders. Alpha Psychiatry, 23(2), 45-46.
https://doi.org/10.5152/alphapsychiatry.2022.0001

Cook, J. M., Simiola, V., Ellis, A. E., & Thompson, R. (2017). Training in trauma psychology: A national survey of doctoral graduate programs. Training and Education in Professional Psychology, 11(2), 108–114. https://doi.org/10.1037/tep0000150

Dalenberg, C. J., & Paulson, K. (2009). The case for the study of "normal" dissociation processes. In P. F. Dell & J. A. O'Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 145–154). Routledge/Taylor & Francis Group.

Dell, P. F. (2006). The multidimensional inventory of dissociation (MID): A comprehensive measure of pathological dissociation. Journal of Trauma & Dissociation: The Official Journal of the International Society for the Study of Dissociation (ISSD), 7(2), 77–106. https://doi.org/10.1300/J229v07n02_06

Dissociative Identity Disorder Research. (s.f.). Cooperation, integration, and fusion. https://did-research.org/treatment/integration
Dorahy, M. J., Brand, B. L., Sar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., Lewis-Fernández, R., & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. The Australian and New Zealand Journal of Psychiatry, 48(5), 402–417. https://doi.org/10.1177/0004867414527523

Fung, H. W., Ross, C. A., Yu, C. K., & Lau, E. K. (2019). Adverse childhood experiences and dissociation among Hong Kong mental health service users. Journal of Trauma & Dissociation: The Official Journal of the International Society for the Study of Dissociation (ISSD), 20(4), 457–470. https://doi.org/10.1080/15299732.2019.1597808

Gold, S. N., Elhai, J. D., Rea, B. D., Weiss, D., Masino, T., Morris, S. L., & McIninch, J. (2001). Contextual Treatment of Dissociative Identity Disorder. Journal of Trauma & Dissociation, 2(4), 5–36. https://doi.org/10.1300/J229v02n04_02

González-Rivera, J. A. (2023a). Dissociative Experiences Scale: Psychometric analysis in Puerto Rico and contributions to the discussion of the factor structure. Interacciones, 9, e360. http://dx.doi.org/10.24016/2023.v9.260

González-Rivera, J. A. (2023b). Escala de Experiencias Disociativas – Taxón (DES-T): Evidencias de validez y uso clínico en Puerto Rico. Revista Caribeña de Psicología, 7(1), e7245. https://doi.org/10.37226/rcp.v7i1.7245

International Society for the Study of Dissociation Task Force on Children and Adolescents. (2004). Guidelines for the evaluation and treatment of dissociative symptoms in children and adolescents. Journal of Trauma & Dissociation, 5(3), 119–150. https://doi.org/10.1300/J229v05n03_09

International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115–187. https://doi.org/10.1080/15299732.2011.537247

Kluft, R. P. (1993). Clinical approaches to the integration of personalities. In R. P. Kluft & C. G. Fine (Eds.), Clinical perspectives on multiple personality disorder (pp. 101–133). American Psychiatric Association.

Krüger, C. (2020). Culture, trauma and dissociation: A broadening perspective for our field. Journal of Trauma & Dissociation, 21(1), 1–13. https://doi.org/10.1080/15299732.2020.1675134

Lazrove, S., & Fine, C. G. (1996). The use of EMDR in patients with dissociative identity disorder. Dissociation, 9, 289-299.

Lewis-Fernández, R., Garrido-Castillo, P., Bennasar, M. C., Parrilla, E. M., Laria, A. J., Ma, G., & Petkova, E. (2002). Dissociation, childhood trauma, and ataque de nervios among Puerto Rican psychiatric outpatients. The American Journal of Psychiatry, 159(9), 1603–1605. https://doi.org/10.1176/appi.ajp.159.9.1603

Loewenstein, R. J. (2018). Dissociation debates: Everything you know is wrong. Dialogues in Clinical Neuroscience, 20(3), 229–242.
https://doi.org/10.31887/DCNS.2018.20.3/rloewenstein

Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018). Dissociation in psychiatric disorders: A meta-analysis of studies using the dissociative experiences scale. The American Journal of sychiatry, 175(1), 37–46.
https://doi.org/10.1176/appi.ajp.2017.17010025

Martínez-Taboas, A. (1988). Casos de personalidad múltiple en Puerto Rico. Revista Interamericana de Psicología, 22, 57-66.

Martínez-Taboas, A. (1991). Multiple personality in Puerto Rico: Analysis of fifteen cases. Dissociation, 4, 189-192.

Martínez-Taboas, A. (1995). The use of the Dissociative Experiences Scale in Puerto Rico. Dissociation, 8(1), 14–23.

Martínez-Taboas, A. (1999). A case of spirit possession and glossolalia. Culture, medicine and psychiatry, 23(3), 333–348. https://doi.org/10.1023/a:1005504222101

Martínez-Taboas, A. (2004). A case study illustrating the interplay between psychological and somatic dissociation. Revista Interamericana de Psicología, 38, 113-118.

Martínez-Taboas, A., & Rodríguez-Cay, J. (1997). Case study of a Puerto Rican woman with dissociative identity disorder. Dissociation, 10(3), 141–147.

Martínez-Taboas, A., Canino, G., Wang, M. Q., García, P., & Bravo, M. (2006). Prevalence and victimization correlates of pathological dissociation in a community sample of youths. Journal of Traumatic Stress, 19(4), 439–448. https://doi.org/10.1002/jts.20144

Maxwell, R., Merckelbach, H., Lilienfeld, S. O., & Lynn, S. J. (2018). The treatment of dissociation: An evaluation of effectiveness and potential mechanisms. In D. David, S. J. Lynn, & G. H. Montgomery (Eds.), Evidence-based psychotherapy: The state of the science and practice (pp. 329–361). Wiley Blackwell. https://doi.org/10.1002/9781119462996.ch13

Méndez, N., Martínez-Taboas, A., & Pedrosa, O. (2000). Experiencias, creencias y actitudes de los psicólogos en Puerto Rico con el trastorno de identidad disociativa. Ciencias de la Conducta, 15(1), 69-84.

Nijenhuis, E. R., Spinhoven, P., Van Dyck, R., Van der Hart, O., & Vanderlinden, J. (1996). The development and psychometric characteristics of the somatoform dissociation questionnaire (SDQ-20). The Journal of Nervous and Mental Disease, 184(11), 688–694. https://doi.org/10.1097/00005053-199611000-00006

Paulsen, S. (1995). Eye movement desensitization and reprocessing: Its cautious use in the dissociative disorders. Dissociation, 8, 32–44.

Ross, C. A., Heber, S., Norton, G. R., Anderson, D., Anderson, G., & Barchet, P. (1989). The dissociative disorders interview schedule: A structured interview. Dissociation, 2(3), 169–189.

Shapiro, F. (2001). Eye movement desensitisation and reprocessing: Basic principles, protocols, and procedures (2nd Edition). The Guilford Press.

Spiegel, D. (2010). Dissociation in the DSM-5. Journal of Trauma & Dissociation, 11(3), 261-265. https://doi.org/10.1080/15299731003780788

Steele, K., Boon, S., & van der Hart, O. (2017). Treating trauma-related dissociation: A practical, integrative approach. W. W. Norton & Co.

Steinberg, M. (1994). Structured clinical interview for DSM-IV dissociative disorders–Revised (SCID-D-R) (2nd ed.). American Psychiatric Press.

Steinberg, M. (1995). Handbook for the assessment of dissociation: A clinical guide. American Psychiatric Press.

Swart, S., Wildschut, M., Draijer, N., Langeland, W., Hoogendoorn, A. W., & Smit, J. H. (2020). The course of (comorbid) trauma-related, dissociative and personality disorders: Two year follow up of the Friesland study cohort. European Journal of Psychotraumatology, 11(1), 1750171. https://doi.org/10.1080/20008198.2020.1750171

Twombly, J. (2000). Incorporating EMDR and EMDR adaptations into the treatment of clients with dissociative identity disorder. Journal of Trauma & Dissociation, 1(2), 61–81.

Vanderlinden, J., Van Dyck, R., Vandereycken, W., Vertommen, H., & Jan Verkes, R. (1993). The dissociation questionnaire (DIS-Q): Development and characteristics of a new self-report questionnaire. Clinical Psychology & Psychotherapy, 1(1), 21–27.

World Health Organization. (2022). ICD-11: International classification of diseases (11th revision).
https://icd.who.int/
Cómo citar
Tratamiento psicológico para el trastorno de identidad disociativo: Guías generales. (2024). Revista Puertorriqueña De Psicologia, 34(3), 466-479. https://doi.org/10.55611/reps.3403.12
Sección
Artículo de investigación

Cómo citar

Tratamiento psicológico para el trastorno de identidad disociativo: Guías generales. (2024). Revista Puertorriqueña De Psicologia, 34(3), 466-479. https://doi.org/10.55611/reps.3403.12