Chapter 10. To Begin With ―Psychoeducation (1)

In this first chapter of the part III for treatment, I would like to discuss psychoeducation. The term psychoeducation has been used quite often in the medical field for a while. It is very important that clinicians communicate to their patients, and their family members if necessary, about the disease: its cause, symtoms, clinical course, prognosis, and treatment options. It has been a long time since “patients were supposed to take whatever is prescribed by their doctors”.
Fist I would like to make some points which are necessary to keep in our mind so we conceptualize psychoeducation for dissociative disorder more properly. You can think of this part as a “psychoeducation about psychoeducation” for dissociative disorder.
Confusing factors for the diagnosis and treatment
Why is psychoeducation for dissociative disorder necessary? Because there are so many confusing factors for the diagnosis and understanding of dissociative disorder. As I already stated, dissociative disorder may involve so many symptoms that it is not quite easy to comprehend it as one disease entity, even for medical professionals. In reality, many dissociative patients initially visit neurologists or internists without clear diagnosis being made, at least in the initial phase of the assessment.
Even in psychiatry, dissociation is not a well understood condition among clinicians. As I amply discussed in the chapter 4, what we understand as dissociative disorder should have existed for such a long time in human history, most of the time under the name of hysteria, and it has long been a subject of misunderstanding and maltreatment. Amazingly enough, that tendency is still lingering in this modern world.
As was discussed in the chapter 2, in the early part of 20th century schizophrenia became a star diagnosis, and people with dissociative symptoms were paid much less attention, or misdiagnosed as having schizophrenia. Recent boom of dissociation lead us to pay more careful attention to the symptoms of dissociation, but correct diagnosis is not satisfactorily made by modern clinicians yet. Below are several characteristics of dissociative disorder which makes it difficult to be diagnosed properly.

①　Their somatic (conversion) symptoms make it look like medical/neurological condition

Conversion disorder can be very confusing for both neurologists and psychiatrists. Typical one is seizure. To make the diagnosis more confounding, patients with dissociative seizure (nonepileptic seizure, or “pseudoseizure”) often have epileptic seizure as well. According to a study, 50% of pseudoseizure patient is reported to have true seizure as well (Mohmad, et al. 2010)
Mohmad, AH., Gadour, MO., Omer, FY., et al (2010) Pseudoepilepsy among adult Sudanese epileptic patients. Scientific Research and Essays Vol. 5(17), pp. 2603–2607.
②　They often have psychotic-like symptoms.
Another problem contributing to its misdiagnosis is that dissociative disorder often accompany psychotic-like symptoms. In the case of DID, patient might hear voices of other identities and converse with them out laud. In that case, the patient might give an impression to others that he or she is in a psychotic state and is displaying a monologue typically seen in schizophrenia. Psychiatrist quite often makes a premature diagnosis without asking the patient since when she is hearing voices. (Typically, hearing voices of DID starts quite early in life, a major distinguishing point). At that point the patient might be found to be in need of acute inpatient treatment. When we take a history of a dissociative patient and find that the patient had acute commitment to a psychiatric unit in the past and large amount of antipsychotic medications are prescribed thereafter, it might be the case.