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

Abstract

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.

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

“…At baseline, the sample included 292 clinicians and 280 patients; at the 30-month follow-up, the sample included 135 clinicians and 111 patients. The rate of attrition in this study was approximately 50% by 30-month follow-up, and varied by time period and patient characteristics; it was higher during the first six months and among patients with higher dissociation scores at baseline as well as those who had a substance use/dependence disorder (Brand et al, 2013). Only those who completed the last survey were considered retained.…”

“…Many times, these patients have spent years in the mental health system receiving treatment based on inaccurate diagnoses such as schizophrenia. Once diagnosed correctly, DD patients can begin receiving appropriate, trauma- and dissociation-focused treatment, which can lead to reductions in symptoms and improvements in functioning (Brand et al, 2009; Brand, Classen, McNary, & Zaveri, 2009; Brand et al, 2013). However, years of treatment are typically required due to the chronicity and severity of these patients’ impairments (ISSTD, 2011).…”

“…Clinicians provided trauma- and dissociation-focused outpatient treatment. Additional details on the study’s recruitment, methodology, and outcomes are available (Brand et al, 2009, 2013). At baseline, the sample included 292 clinicians and 280 patients; at the 30-month follow-up, the sample included 135 clinicians and 111 patients.…”

“…Because these participants demonstrated improvements in dissociative, posttraumatic, and depressive symptoms, decreased rates of hospitalization and suicidality, and increased adaptive functioning over the course of the study (e.g. Brand & Loewenstein, 2014; Brand et al, 2013; Brand & Stadnik, 2013; Myrick et al, 2012), we hypothesized that inpatient and outpatient treatment estimated costs would decrease over time. Furthermore, we expected that patients in the earlier stages of treatment, who struggle with safety issues such as self-injurious behaviour and suicidality (e.g.…”

Trauma-related altered states of consciousness in post-traumatic stress disorder patients with or without comorbid dissociative disorders

“…Finally, the 4-D model can inform the limited literature on treatment of CDDs. Although psychotherapeutic treatment of these disorders has been shown to be beneficial (Brand et al, 2012), little is known about specific interventions and change mechanisms. Interventions aimed at symptoms of TRASC, as well as the proposed underlying non-self referential processing, may have promise for this patient group.…”