Treatment Of Dissociative Disorders Research Articles

Pathways to care and barriers in treatment among patients with Dissociative disorders

IntroductionDissociative disorder patients often present with sudden and embarrassing symptoms, and it is difficult for the patient and care giver to understand initially, recognize the need for help and reach for appropriate treatment timely. This can result in high risk of engaging in dangerous behaviors such as self-harm and suicidal acts, impaired global functioning, and poor quality of life. Knowledge about the types of barriers which are there in treatment seeking, can help in planning strategies for their removal and to facilitate the treatment process. MethodsCross-sectional study among patients (n=133) with Dissociative disorders which were recruited from January 2023 to June 2023 in a tertiary care hospital. Pathways to care and barriers in treatment for Dissociative disorders were assessed by interviewing patients using semi-structured proforma. The Dissociative Experience Scale and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)) were used to assess disease severity and impact of illness on various domains of life respectively. Group comparison was made to assess differences in social- clinical profile of patients choosing different modalities of treatment. Results133 patients of Dissociative disorders with mean age 29.6±9.2, showed their first-choice of help seeking from general practitioner/ neurologist (40.6%), traditional faith healers (35.3%), psychiatrist (18.1%) and 5.2% preferred alternative treatments. This trend changed with 2nd and 3rd contact of help seeking with greater preference for psychiatrist in their 2nd (n=45, 33.8%) and 3rd (n=69, 51.8%) contact. The median duration of untreated illness was 56 weeks (IQR 24–182 weeks). Social-clinical profile of patients varied with their choice of treatment, having lower education level (P = 0.013), longer duration of untreated illness (p=0.003), more severity of symptoms (p=0.032) and greater disability scores(p=0.002) in patients whose first treatment choice was traditional faith healers. More than 70% patients faced availability barriers, stigma, unawareness about mental illness and influence of others in treatment of choice as barriers in initiating and continuing treatment. ConclusionPatients with Dissociative disorders seek treatment from a multitude of healthcare providers including traditional faith healers, general physicians, and alternative medicine practitioners before reaching psychiatrist and undergoes various barriers in treatment. There is need to implement necessary measures for sensitization and awareness about Dissociative disorders to prevent prolonged and undue delays in initiation of appropriate management.

Treatment for childhood and adolescent dissociation: A systematic review.

Dissociative symptoms are linked to experiences of trauma, often originating in childhood and adolescence. Dissociative disorders are associated with a high burden of illness and a poor quality of life. Despite evidence suggesting that early intervention can improve outcomes, little research exists on the treatment of dissociative disorders in childhood and adolescence. The current study aimed to systematically review the existing body of literature to identify current treatments applied within child and adolescent populations diagnosed with a dissociative disorder. This review was conducted in line with PRISMA guidelines. Databases were searched for relevant publications, resulting in 3,064 papers to be screened. Articles were included if they involved child or adolescent populations experiencing dissociation and undergoing treatment. Seven articles were included in the current review: two quantitative and five case studies. Treatment duration varied greatly, ranging from 1 to 29 months. Treatments were mostly combinations of psychotherapy, dialectical behavior therapy, eye movement desensitization and reprocessing, as well as adjunctive therapies such as mindfulness and psychoeducation. Our study demonstrated that the literature on current treatment for children and adolescents is clearly scarce, with only seven studies, five of which were case studies and two of which were over 20 years old. The treatments used for dissociation in children and adolescents experiencing dissociation were varied, but psychotherapy was the most used treatment method. This review has revealed that there is no clear framework that exists for the treatment of dissociation in child and adolescent patients, despite the need for one. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The integrative process promoted by EMDR in dissociative disorders: neurobiological mechanisms, psychometric tools, and intervention efficacy on the psychological impact of the COVID-19 pandemic.

Dissociative disorders (DDs) are characterized by a discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, bodily representation, motor control, and action. The life-threatening coronavirus disease 2019 (COVID-19) pandemic has been identified as a potentially traumatic event and may produce a wide range of mental health problems, such as depression, anxiety disorders, sleep disorders, and DD, stemming from pandemic-related events, such as sickness, isolation, losing loved ones, and fear for one's life. In our conceptual analysis, we introduce the contribution of the structural dissociation of personality (SDP) theory and polyvagal theory to the conceptualization of the COVID-19 pandemic-triggered DD and the importance of assessing perceived safety in DD through neurophysiologically informed psychometric tools. In addition, we analyzed the contribution of eye movement desensitization and reprocessing (EMDR) to the treatment of the COVID-19 pandemic-triggered DD and suggest possible neurobiological mechanisms of action of the EMDR. In particular, we propose that, through slow eye movements, the EMDR may promote an initial non-rapid-eye-movement sleep stage 1-like activity, a subsequent access to a slow-wave sleep activity, and an oxytocinergic neurotransmission that, in turn, may foster the functional coupling between paraventricular nucleus and both sympathetic and parasympathetic cardioinhibitory nuclei. Neurophysiologically informed psychometric tools for safety evaluation in DDs are discussed. Furthermore, clinical and public health implications are considered, combining the EMDR, SDP theory, and polyvagal conceptualizations in light of the potential dissociative symptomatology triggered by the COVID-19 pandemic.

Trauma-Related Dissociation and the Dissociative Disorders:

Trauma-related dissociation is a major public health risk warranting the attention of the healthcare professions. Severe dissociative pathology or dissociative disorders (DDs) are more prevalent than some commonly assessed psychiatric disorders (e.g., Bipolar Disorder, Obsessive Compulsive Disorder, Schizophrenia), yet are often under-recognized and undertreated, despite being associated with significant disability and chronic medical issues, among many other severe and costly public health consequences. In fact, people living with DDs spend an average of 5 to 12.4 years actively engaged in treatment before receiving an accurate diagnosis. Detection and treatment of trauma-related dissociation and DDs leads to a myriad of positive outcomes including improved quality of life, treatment outcomes, reduction in health and social risks, decreased healthcare utilization and costs (25-64% reduction), and significant economic advantages for society. It is imperative that healthcare professionals are trained in recognizing, assessing, and treating dissociation in service of preventing the discussed public health consequences. This article provides a comprehensive review of the important public health implications resulting from often neglected or untreated trauma-related dissociation and DDs while offering a summary of assessment methods, treatments, and resources to empower individuals and healthcare professionals to effect change.

Patient with functional disorder between psychiatry and neurology

The article analyzes the modern approach to hysteria and dissociative (conversion) disorders. The validity of their inclusion in the psychiatric or neurological section of disease classifications is assessed. Particular attention is paid to the diagnosis of functional neurological disorder, which is included in some classification systems. From the standpoint of scientific validity, the need for a neurological approach to the diagnosis and treatment of dissociative disorders is discussed.

Dissociation, Dissociative Disorders and Partial Psychosis

Background: Dissociation may be defined as a psychopathological process in which an individual’s psyche splits into two or more parts. The division of personality is a key element in trauma, especially if the patient is not able to cope with it. At least one part of personality may be relatively able to understand and function in the objective reality, whilst other part(s) of the psyche may be more or less disorganized, dysfunctional and less able to understand the truth. Methods: literature review; conceptualization of dissociation, dissociative disorders and partial psychosis from medical and philosophical perspective. Conclusion: The core of dissociation and dissociative disorders is usually psychological trauma, especially emotional trauma, although some individuals may experience dissociation without any obvious cause or trigger. Carefully designed trauma-focused psychotherapy and psychosocial support are considered and must be further studied as the cornerstone of multidisciplinary approach in the treatment of dissociative disorders. Dissociative identity disorder in its severe form may resemble characteristics of partial psychosis. Some patients suffering from partial psychosis have narcissistic personality traits, such as shamelessness, magical thinking, arrogance, envy, entitlement, exploitation and bad boundaries, and therefore, developing healthy self-love, which is based on healthy self-criticism, realistic thinking, humility, gratefulness, democratic behavior, altruism and good boundaries, might be helpful for these patients.

Applications of somatic psychology: movement and body experience in the treatment of dissociative disorders

ABSTRACT Somatic psychology is a powerful tool to address clinical dissociative disorders. Somatic modalities offer interventions to manage intense effect, offer corrective experience and build a coherent self-narrative. Using physical movement helps facilitate safety, strength and connection in dissociative disorder treatment. Clinicians can facilitate somatic regulation of dissociated experience by using somatic-based interventions with clients, therefore helping patients to re-pattern traumatic experiences and maladaptive coping strategies. Using case study examples from this author’s in-office experience treating patients with dissociative disorders using movement, this paper will address how bringing movement interventions into the treatment room addresses integration of psychological and physical systems. It will also discuss the foundations of somatic psychology and outline how somatic processing is important to the integration of insight and reconnection with the client’s sense of self as a whole.

The economic burden of dissociative disorders: A qualitative systematic review of empirical studies.

Dissociative disorders (DDs) are associated with intensive, long-term treatment, suicidality, recurrent hospitalizations, and high rates of disability. However, little is known about the specifics of the economic burden associated with DDs. This worldwide, systematic review examines the results of studies in adults on direct and indirect costs associated with DDs. We searched 6 databases and the reference lists of articles. We also approached researchers to identify unpublished studies. No language restrictions were imposed. A total of 1,002 records met the search criteria, of which 29 papers were selected for full-text inspection. Ultimately, of these, we reviewed four empirical studies. We provide a narrative discussion of study findings. Our findings suggest that DDs are costly to society, and that there is a reduction in service utilization and associated costs over time with diagnosing of and specialized treatment for DDs. However, the overall quality of the economic evaluations was low; several types of DDs, comorbid conditions, and costs were not included; and men were underrepresented. Due to the heterogeneity among studies, we could not perform a meta-analysis. Due to the heterogeneity and low quality of the identified economic evaluations, no firm conclusions about the economic burden of DDs alone can be drawn. Higher quality research, including a detailed description of the study design, population, and primary outcome measures used, utilizing appropriate clinical alternatives and including major comorbidities, is urgently needed to more rigorously assess the economic impact of DDs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

An Online Educational Program for Individuals With Dissociative Disorders and Their Clinicians: 1-Year and 2-Year Follow-Up.

Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and posttraumatic stress disorder (PTSD) symptoms with significant disability. Patients with DD have high rates of nonsuicidal self‐injury (NSSI) and suicide attempts. Despite this, there is a dearth of training about DDs. We report the outcome of a web‐based psychoeducational intervention for an international sample of 111 patients diagnosed with dissociative identity disorder (DID) or other complex DDs. The Treatment of Patients with Dissociative Disorders Network (TOP DD Network) program was designed to investigate whether, over the course of a web‐based psychoeducational program, DD patients would exhibit improved functioning and decreased symptoms, including among patients typically excluded from treatment studies for safety reasons. Using video, written, and behavioral practice exercises, the TOP DD Network program provided therapists and patients with education about DDs as well as skills for improving emotion regulation, managing safety issues, and decreasing symptoms. Participation was associated with reductions in dissociation and PTSD symptoms, improved emotion regulation, and higher adaptive capacities, with overall sample |d|s = 0.44–0.90, as well as reduced NSSI. The improvements in NSSI among the most self‐injurious patients were particularly striking. Although all patient groups showed significant improvements, individuals with higher levels of dissociation demonstrated greater and faster improvement compared to those lower in dissociation |d|s = 0.54–1.04 vs. |d|s = 0.24–0.75, respectively. These findings support dissemination of DD treatment training and initiation of treatment studies with randomized controlled designs.

Cognitive Behavior Therapy for Management of Emotional Intelligence among Patient with Dissociative Disorder

The authors colorfully declare this paper to bear not conBackground: Dissociative disorder (DD) is characterized by an involuntary escape from reality characterized by a disconnection between thoughts, consciousness and memory. People from all age groups can be experienced dissociative disorder. It’s estimated that 2% of people experience DD, with women being more likely than men to be diagnosed. Studies of cognitive behavior therapy (CBT) have shown it to be effective for treatment of DD. Aim: The aim of the study was to see the effectiveness of CBT on improvement of emotional intelligence and anxiety level of the patient. Methodology: Study involves A 18 years old, unmarried, Hindu, female, educated up to 12th, from middle socio economic status and hailing from urban area who was brought by her parents with chief complaints of restlessness, breathing problem, fearfulness, nervousness, concentration difficulty, sudden sub consciousness. She was referred for psychological intervention. The 12 weekly and individual session of CBT of 45-60 minutes duration was implemented with the patient. A pre and post assessment was done using Hamilton anxiety rating scale, emotional intelligence scale. Result: The finding demonstrates a reduction in anxiety score from 29 to 17 on post assessment and improvement in patient’s emotional intelligence level from 46 to 69 on post assessment. Conclusion: CBT has effectively showed improvement in the patient’s emotional intelligence in terms of self-regulation, self-awareness as well as reduce anxiety i.e., reduced nervousness, fearfulness, stop panic attacks.flict of interests

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

ABSTRACTBackground: Interpersonal trauma and trauma-related disorders cost society billions of dollars each year. Because of chronic and severe trauma histories, dissociative disorder (DD) patients spend many years in the mental health system, yet there is limited knowledge about the economic burden associated with DDs.Objective: The current study sought to determine how receiving specialized treatment would relate to estimated costs of inpatient and outpatient mental health services.Method: Patients’ and individual therapists’ reports of inpatient hospitalization days and outpatient treatment sessions were converted into US dollars. DD patients and their clinicians reported on use of inpatient and outpatient services four times over 30 months as part of a larger, naturalistic, international DD treatment study. The baseline sample included 292 clinicians and 280 patients; at the 30-month follow-up, 135 clinicians and 111 patients. Missing data were replaced in analyses to maintain adequate statistical power. The substantial attrition rate (>50%) should be considered in interpreting findings.Results: Longitudinal and cross-sectional analyses of cost estimates based on patient reported inpatient hospitalization significantly decreased over time. Longitudinal cost estimates based on clinician-reported outpatient services also significantly decreased over time. Cross-sectional cost estimates based on patient and clinician reported inpatient hospitalization were significantly lower for patients in later stages of treatment compared to those struggling with safety and stabilization. Cross-sectional cost estimates based on clinician-reported outpatient services were significantly lower for patients in later stages of treatment compared to those in early stages.Conclusions: This pattern of longitudinal and cross-sectional reductions in inpatient and outpatient costs, as reported by both patients and therapists, suggests that DD treatment may be associated with reduced inpatient and outpatient costs over time. Although these preliminary results show decreased mental health care utilization and associated estimated costs, it is not clear whether it was treatment that caused these important changes.

Six-year follow-up of the treatment of patients with dissociative disorders study*

ABSTRACTObjective: Literature on the treatment of dissociative disorders (DDs) suggests that these individuals require long-term and specialized treatment to achieve stabilization and functionality. There is considerable empirical support for specialized phasic, dissociation-focused treatment in reducing a myriad of psychological symptoms and self-harm in this population. However, until recently, there has been a paucity of longitudinal treatment research on DD patients.Method: In the present six-year follow-up study, 61 therapists who participated in the initial phase of the Treatment of Patients with Dissociative Disorders (TOP DD) study answered questionnaires about their study patient’s stressors, quality of life, global functioning, victimization, and safety. These results provided a view of patients’ progress six years since the beginning of the TOP DD study.Results: Longitudinal analyses demonstrated patients had significantly fewer stressors (Χ2(6) = 18.76, p < .01, canonical r = .48, N = 76), instances of sexual revictimization (X2(1) = 107.05, p < .001) and psychiatric hospitalizations (t(54) = 2.57, p < .05, Cohen’s d = .43), as well as higher global functioning (Χ2(2) = 59.27, p < .001, canonical r = .65, N = 111).Conclusions: These findings continue to support the initial results of the TOP DD study that, despite marked initial difficulties and functional impairment, DD patients benefit from specialized treatment.

Exploring Dissociation and Dissociative Identity Disorder: A Roundtable Discussion

In a lively and wide-ranging roundtable discussion, five seasoned clinicians versed in the treatment of dissociative disorders discuss the importance of recognizing dissociative phenomena: why they happen, how to recognize them, how to work with dissociation and Dissociative Identity Disorder. The panel emphasizes the point that dissociative processes are not exclusive to those suffering from an extreme dissociative disorder and can germinate from other experiences such as attachment trauma, for example. The case is made that dissociation has important implications for work with all patients, as it conveys a more experientially near conceptualization for a model of the mind.

Chronic complex dissociative disorders and borderline personality disorder: disorders of emotion dysregulation?

Emotion dysregulation is a core feature of chronic complex dissociative disorders (DD), as it is for borderline personality disorder (BPD). Chronic complex DD include dissociative identity disorder (DID) and the most common form of dissociative disorder not otherwise specified (DDNOS, type 1), now known as Other Specified Dissociative Disorders (OSDD, type 1). BPD is a common comorbid disorder with DD, although preliminary research indicates the disorders have some distinguishing features as well as considerable overlap. This article focuses on the epidemiology, clinical presentation, psychological profile, treatment, and neurobiology of chronic complex DD with emphasis placed on the role of emotion dysregulation in each of these areas. Trauma experts conceptualize borderline symptoms as often being trauma based, as are chronic complex DD. We review the preliminary research that compares DD to BPD in the hopes that this will stimulate additional comparative research.

For Better or Worse: The Role of Revictimization and Stress in the Course of Treatment for Dissociative Disorders

Revictimization and life stressors are common among dissociative disorder (DD) patients, yet no studies have examined the prevalence rates for these experiences or their relationships with treatment outcome. This study aimed to examine the rates of revictimization and victimization of others using therapist–DD patient pairs from the naturalistic Treatment of Patients with Dissociative Disorders (TOP DD) study while also considering the role of revictimization and life stressors among 49 patients who greatly improved or worsened during 30 months of treatment. Therapists reported that sexual and physical revictimization in the previous 6 months was high among the patients (3.5%–7.0% and 4.1%–7.1% in the overall TOP DD sample, respectively), and emotional revictimization was quite high (29%–36%). Revictimization showed a decreasing trend over the 30 months of the study. Therapists reported that more than a quarter of the patients who were revictimized were also occasionally emotionally or physically abusive to others. More patients showed sudden improvement versus sudden worsening in patient-reported symptoms at 1 or more time point(s). Patients who improved had significantly fewer revictimizations and stressors overall than patients who worsened, suggesting that revictimization and/or stressors may contribute to worsening in treatment. Further research is needed to learn more about the roles of revictimization, victimization of others, and stressors in DD treatment. [Supplementary material is available for this article. Go to the publisher's online edition of Journal of Trauma & Dissociation for the following supplemental resource: Baseline Demographic Information of TOP DD Improving and Worsening Subgroups]

A longitudinal naturalistic study of patients with dissociative disorders treated by community clinicians.

Severe dissociative disorders (DD) are associated with high levels of impairment, treatment utilization, and treatment costs, yet relatively little systematic research has focused on treatment for these challenging patients. The goal of this naturalistic observational 30-month follow-up study of an international sample of patients with dissociative disorders was to determine if treatment provided by community providers was associated with improvements in symptoms and adaptive functioning. The patients were diagnosed with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). The patients and their therapists completed surveys at study entry and at 6-, 18-, and 30-month follow-up. At the 30-month follow-up, 119 of the original 226 patients completed the surveys. According to patients’ reports, they showed decreased levels of dissociation, posttraumatic stress disorder symptoms, general distress, drug use, physical pain, and depression over the course of treatment. As treatment progressed, patients reported increased socializing, attending school or volunteering, and feeling good. According to therapists’ reports, patients engaged in less self-injurious behavior and had fewer hospitalizations as well as increased global assessment of functioning scores (American Psychiatric Association, 2000) and adaptive capacities over time. These results suggest that treatment provided by therapists who have training in treating DID/DDNOS appears to be beneficial across a number of clinical domains. Additional research into the treatment of DD is warranted.

Structure with Engagement: Toward an Integration of Trauma and Relational Psychoanalytic Models in the Treatment of Dissociative Disorders

Trauma model approaches to the treatment of dissociative disorders may provide containment and direction and yet, these same approaches may be constricting and limit exploration. However, relational psychoanalytic approaches may allow for engagement and exploration while potentially failing to provide containment and structure. This article provides an overview of key elements of both models and considers the question of whether it is possible to creatively resolve theoretical and clinical tensions between trauma model and relational psychoanalytic responses to dissociation. A review of the history of the study of dissociation in the field of psychoanalysis and concerns about psychoanalytic practice in the context of dissociation is followed by comparing contrasting conceptualizations of the assumptions of normality, definitions of dissociation, theories of etiology, goals of treatment, and theorized mechanisms of action. The review ends with a discussion of potential possibilities for clinical integration.

An Exploration of Young Adults' Progress in Treatment for Dissociative Disorder

Although treatment outcome research on dissociative disorders (DD) is increasing, an examination of treatment progress in young adults with these disorders remains noticeably absent from the literature. Many studies of DD patients report mean ages over 35. The present study examined the response to treatment of a subsample of young adults ages 18–30 with dissociative identity disorder and dissociative disorder not otherwise specified who participated in a naturalistic, longitudinal study of DD treatment outcome. Over 30 months, these patients demonstrated decreases in destructive behaviors and symptomatology as well as improved adaptive capacities. Compared to the older adult participants in the study, the young adults were more impaired initially. However, these younger patients improved at a rapid pace, such that their clinical presentations were similar to or more improved than those of the older adults at the 30-month follow-up. This brief report suggests not only that young adult DD patients can benefit from a trauma-focused, phasic treatment approach but that their treatment may progress at a faster pace than that of older adults with DD.

Where Are We Going? An Update on Assessment, Treatment, and Neurobiological Research in Dissociative Disorders as We Move Toward the DSM-5

This article provides an overview of the process of developing the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association with a focus on issues related to the trauma-related disorders, particularly the dissociative disorders (DD). We also discuss the highlights of research within the past 5 years in the assessment, treatment, and neurobiological basis of trauma disorders. Recent research shows that DD are associated with severe symptoms as well as a higher rate of utilization of mental health treatment compared with other psychiatric disorders. As a result, DD, like other complex posttraumatic disorders, exact a high economic as well as personal burden for patients and society. The latest research indicates that DD patients show a suboptimal response to standard exposure-based treatments for posttraumatic stress disorder as well as high levels of attrition from treatment. An emerging body of research on DD treatment, primarily of naturalistic and open trials, indicates that patients who receive specialized treatment that addresses their trauma-based, dissociative symptoms show improved functioning and reduced symptoms. Recent studies of the underlying neurobiological basis for dissociation support a model of excessive limbic inhibition in DD that is consistent with the phenomenology and clinical presentation of these patients. We are optimistic that the forthcoming DSM-5 will stimulate research on dissociation and the DD and suggest areas for future studies.

A Review of Dissociative Disorders Treatment Studies

This review examines empirical reports of treatment for Dissociative Disorders (DD), including 16 DD treatment outcome studies and 4 case studies that used standardized measures. Collectively, these reports suggest that treatment for DD is associated with decreased symptoms of dissociation, depression, posttraumatic stress disorder, distress, and suicidality. Effect sizes, based on pre/post measures, are in the medium to large range across studies. Patients with dissociative disorder who integrated their dissociated self states were found to have reduced symptomatology compared with those who did not integrate. The magnitude of pre/post effect sizes for these DD studies are comparable to pre/post effect sizes in treatment studies of complex PTSD. There are significant methodological limitations in the current DD treatment outcome literature that reduce internal and external validity including regression towards the mean, limited sample sizes, and nonrandomized research designs. Implications for future research and treatment planning for patients suffering from DD are discussed.