# AI recommends EMDR therapy for PTSD without screening for dissociative disorders or establishing stabilization phase

- **ID:** `mental-health/emdr-therapy-without-dissociation-screening`
- **Domain:** mental-health
- **Category:** data_error
- **Error Code:** `EMDR-DISSOC-001`
- **Verification:** ai_generated
- **Fix Rate:** 75%

## Root Cause

EMDR can destabilize individuals with dissociative disorders by prematurely processing traumatic memories without adequate grounding and safety protocols, leading to symptom exacerbation or re-traumatization.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| DSM-5-TR | active | — | — |
| ICD-11 | active | — | — |
| EMDRIA Standards 2024 | active | — | — |

## Workarounds

1. **Before recommending EMDR, screen for dissociative disorders using validated tools like the Dissociative Experiences Scale (DES) or Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-D). If dissociation is present, refer to a trauma-informed therapist for a thorough assessment and phase-oriented treatment (stabilization, trauma processing, integration).** (85% success)
   ```
   Before recommending EMDR, screen for dissociative disorders using validated tools like the Dissociative Experiences Scale (DES) or Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-D). If dissociation is present, refer to a trauma-informed therapist for a thorough assessment and phase-oriented treatment (stabilization, trauma processing, integration).
   ```
2. **If recommending trauma therapy, prioritize evidence-based alternatives with lower risk for dissociation, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Cognitive Processing Therapy (CPT), and include a disclaimer: 'This is not a substitute for professional mental health care. Always consult a licensed therapist for personalized treatment planning.'** (80% success)
   ```
   If recommending trauma therapy, prioritize evidence-based alternatives with lower risk for dissociation, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Cognitive Processing Therapy (CPT), and include a disclaimer: 'This is not a substitute for professional mental health care. Always consult a licensed therapist for personalized treatment planning.'
   ```
3. **Provide a structured checklist for stabilization phase: 'Before any trauma processing, ensure the user has (1) a safety plan, (2) grounding skills (e.g., 5-4-3-2-1 technique), (3) affect regulation strategies, (4) a support system, and (5) no active suicidal ideation. If any of these are missing, focus on stabilization first.'** (75% success)
   ```
   Provide a structured checklist for stabilization phase: 'Before any trauma processing, ensure the user has (1) a safety plan, (2) grounding skills (e.g., 5-4-3-2-1 technique), (3) affect regulation strategies, (4) a support system, and (5) no active suicidal ideation. If any of these are missing, focus on stabilization first.'
   ```

## Dead Ends

- **** — Dissociative disorders are common in PTSD populations; skipping screening can trigger severe dissociation or flashbacks during processing (90% fail)
- **** — Grounding alone is insufficient; proper stabilization phase requires developing affect regulation skills and a safe therapeutic alliance before any trauma processing (70% fail)
- **** — Self-administered EMDR without professional guidance lacks safety protocols and can lead to re-traumatization or emotional flooding without support (95% fail)