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Pierorazio NA, Robertson JL, Snyder BL, Brand BL, Schielke HJ. Helpful and meaningful aspects of a psychoeducational programme to treat complex dissociative disorders: a qualitative approach. Eur J Psychotraumatol 2024; 15:2323421. [PMID: 38516929 PMCID: PMC10962306 DOI: 10.1080/20008066.2024.2323421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Purpose: Complex dissociative disorders (CDDs) are prevalent among psychotherapy clients, and research suggests carefully paced treatment for CDDs is helpful. The purpose of the present study is to qualitatively explore helpful and meaningful aspects of the TOP DD Network programme, a web-based adjunctive psychoeducational programme for the psychotherapeutic treatment of clients with CDDs.Methods: TOP DD Network programme participants (88 clients and 113 therapists) identified helpful and meaningful aspects of their participation in response to two open textbox questions. Framework analysis was used to qualitatively analyze client and therapist responses.Findings: Participants found the TOP DD Network programme helpful and meaningful in nuanced ways. Three themes were created: (1) Components of the Programme (subthemes: content, structure), (2) Change-Facilitating Processes (subthemes: heightened human connection, receiving external empathy and compassion, contributing to something bigger, improved therapeutic work and relationship), and (3) Outcomes (subthemes: insight, increased hope, self-compassion, increased safety and functioning). The most emphasized theme was components of the programme, which captured its content and structure.Conclusion: Clients and therapists in the TOP DD Network programme described the programme's components and processes as helpfully facilitating positive outcomes in the treatment of CDDs. Therapists may consider integrating the components and processes in the programme into their practice with clients with CDDs.
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Affiliation(s)
- Nicholas A. Pierorazio
- Department of Psychology, Towson University, Towson, MD, USA
- Psychology Department, University of Massachusetts Boston, Boston, MA, USA
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2
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Yeates S, Korner A, McLean L. A Systematic Review and Narrative Analysis of the Evidence for Individual Psychodynamically Informed Psychotherapy in the Treatment of Dissociative Identity Disorder in Adults. J Trauma Dissociation 2024; 25:248-278. [PMID: 38146918 DOI: 10.1080/15299732.2023.2293802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 09/30/2023] [Indexed: 12/27/2023]
Abstract
Dissociative Identity Disorder (DID) is a highly disabling diagnosis, characterized by the presence of two or more personality states which impacts global functioning, with a substantial risk of suicide. The International Society for the Study of Trauma and Dissociation (ISSTD) published guidelines for treating DID in 2011 that noted individual Psychodynamically Informed Psychotherapy (PDIP) was a cornerstone of treatment. This paper systematically reviews the evidence base for PDIP in the treatment of adults with DID according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thirty-five articles were located and reviewed: seven prospective longitudinal publications, 13 case series and 15 case studies. Results suggested that PDIP has been widely deployed in DID to reported good effect with a range of treatment protocols and using multiple theoretical models. Despite the positive findings observed, the evidence base remains at the level of observational-descriptive design. Creative approaches in recent years have been developed, which add empirical weight to the use of PDIP as an effective treatment. The elevation to observational-analytic designs in the Evidence-Based Medicine hierarchy has yet to take place. Bearing in mind the challenges of research in PDIP, suggestions are offered for how the evidence base might develop.
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Affiliation(s)
- Steven Yeates
- Psychotherapy Educator Westmead/Cumberland Hospitals, Faculty Westmead Psychotherapy Program for Complex Traumatic Disorders, Cumberland Hospital, North Parramatta, Australia
| | - Anthony Korner
- Westmead Psychotherapy Program for Complex Traumatic Disorders, University of Sydney, North Parramatta, Australia
| | - Loyola McLean
- Cumberland Hospital, Westmead Psychotherapy Program for Complex Traumatic Disorders, Course Co-Coordinator, Brain and Mind Centre, Discipline of Psychiatry, The University of Sydney, Research Psychiatrist (HMO) Consultation-Liaison Psychiatry, RNSH, Camperdown, Australia
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3
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Ford JD. Complex Trauma and Dissociation: Charting a Course Forward for the Journal and the Field. J Trauma Dissociation 2024; 25:145-152. [PMID: 38384168 DOI: 10.1080/15299732.2024.2307079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Julian D Ford
- Schools of Medicine and Law, University of Connecticut
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4
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Brewerton TD, Perlman MM, Gavidia I, Suro G. The treatment of dissociative identity disorder in an eating disorder residential treatment setting. Int J Eat Disord 2024; 57:450-457. [PMID: 38041242 DOI: 10.1002/eat.24106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Child maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co-occurrence generally is associated with greater morbidity, self-harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED + DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder. METHOD We report our experience with a case series of 18 patients with DSM-5 defined ED + DID (mean age (SD) = 32.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state-trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma-focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence-based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired t-tests. RESULTS Following integrated, trauma-focused RT, patients with ED + DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes. DISCUSSION These results provide positive proof of concept that patients with ED + DID can be effectively treated in a specialty, trauma-focused ED program at higher levels of care. PUBLIC SIGNIFICANCE EDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED + DID can be effectively treated in a specialty, trauma-focused ED program.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- LLC, Mt. Pleasant, South Carolina, USA
- Monte Nido and Affiliates, Miami, Florida, USA
| | - Molly M Perlman
- Monte Nido and Affiliates, Miami, Florida, USA
- Department of Psychiatry and Behavioral Health, Florida International University College of Medicine, Miami, Florida, USA
| | | | - Giulia Suro
- Monte Nido and Affiliates, Miami, Florida, USA
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Bækkelund H, Ulvenes P, Boon-Langelaan S, Arnevik EA. Group treatment for complex dissociative disorders: a randomized clinical trial. BMC Psychiatry 2022; 22:338. [PMID: 35578194 PMCID: PMC9112598 DOI: 10.1186/s12888-022-03970-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with complex dissociative disorders (CDD) report high levels of childhood- abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. The current study evaluates a structured protocolled group treatment delivered in a naturalistic clinical setting to patients with CDD, as an add-on to individual treatment. METHODS Fifty nine patients with CDD were randomized to 20 sessions of stabilizing group-treatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment was based on the manual Coping with Trauma-Related Dissociation. The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, and interpersonal difficulties. RESULTS Mixed effect models showed no condition x time interaction during the delayed treatment period, indicating no immediate differences between conditions in the primary outcome. Similar results were observed for secondary outcomes. Within-group effects were non-significant in both conditions from baseline to end of treatment, but significant improvements in psychosocial function, PTSD symptoms, and general psychopathology were observed over a 6-months follow-up period. CONCLUSION In the first randomized controlled trial for the treatment of complex dissociative disorders, stabilizing group treatment did not produce immediate superior outcomes. Treatment was shown to be associated with improvements in psychological functioning. TRIAL REGISTRATION Clinical Trials ( NCT02450617 ).
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Affiliation(s)
- Harald Bækkelund
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway. .,Section for Implementation and Treatment Research, Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway. .,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
| | - Pål Ulvenes
- grid.5510.10000 0004 1936 8921Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | | | - Espen Ajo Arnevik
- grid.55325.340000 0004 0389 8485Section for clinical addiction research, Oslo University Hospital, Oslo, Norway
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6
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Nester MS, Boi C, Brand BL, Schielke HJ. The reasons dissociative disorder patients self-injure. Eur J Psychotraumatol 2022; 13:2026738. [PMID: 35126883 PMCID: PMC8812737 DOI: 10.1080/20008198.2022.2026738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/07/2022] Open
Abstract
Background Most individuals with dissociative disorders (DDs) report engaging in self-injury. Objective The present study aimed to understand the reasons for self-injury among a clinical sample of 156 DD patients enrolled in the TOP DD Network study. Method Participants answered questions about self-injury, including a prompt asking how often they are aware of the reasons they have urges to self-injure, as well as a prompt asking them to list three reasons they self-injure. Results Six themes of reasons for self-injury, each with subthemes, were identified in the qualitative data: (1) Trauma-related Cues, (2) Emotion Dysregulation, (3) Stressors, (4) Psychiatric and Physical Health Symptoms, (5) Dissociative Experiences, and (6) Ineffective Coping Attempts. Participants reported that they were able to identify their reasons for self-injuring sometimes (60.26%) or almost always (28.85%), with only 3.20% unable to identify any reasons for their self-injury. Conclusion Results suggest that the vast majority of DD patients (92.31%) reported being at least partially unaware of what leads them to have self-injury urges, and many individuals with DDs experience some reasons for self-injury that are different from those with other disorders. The treatment implications of these findings are discussed.
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Affiliation(s)
- M. Shae Nester
- Department of Psychology, Towson University, Towson, Maryland, USA
| | - Cinzia Boi
- Department of Psychology, Towson University, Towson, Maryland, USA
| | - Bethany L. Brand
- Department of Psychology, Towson University, Towson, Maryland, USA
| | - Hugo J. Schielke
- Traumatic Stress Injury & Concurrent Program, Homewood Health Centre, Guelph, Ontario, Canada
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7
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Gorman I, Nielson EM, Molinar A, Cassidy K, Sabbagh J. Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice. Front Psychol 2021; 12:645246. [PMID: 33796055 PMCID: PMC8008322 DOI: 10.3389/fpsyg.2021.645246] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
Psychedelic Harm Reduction and Integration (PHRI) is a transtheoretical and transdiagnostic clinical approach to working with patients who are using or considering using psychedelics in any context. The ongoing discussion of psychedelics in academic research and mainstream media, coupled with recent law enforcement deprioritization of psychedelics and compassionate use approvals for psychedelic-assisted therapy, make this model exceedingly timely. Given the prevalence of psychedelic use, the therapeutic potential of psychedelics, and the unique cultural and historical context in which psychedelics are placed, it is important that mental health providers have an understanding of the unique motivations, experiences, and needs of people who use them. PHRI incorporates elements of harm reduction psychotherapy and psychedelic-assisted psychotherapy, and can be applied in both brief and ongoing psychotherapy interactions. PHRI represents a shift away from assessment limited to untoward outcomes of psychedelic use and abstinence-based addiction treatment paradigms and toward a stance of compassionate, destigmatizing acceptance of patients' choices. Considerations for assessment, preparation, and working with difficult experiences are presented.
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Affiliation(s)
- Ingmar Gorman
- MAPS Public Benefit Corp, Santa Cruz, CA, United States
- Fluence, Woodstock, NY, United States
- Depression Evaluation Services, New York State Psychiatric Institute, New York, NY, United States
- Journey Clinical, Inc. Dover, DE, United States
| | - Elizabeth M. Nielson
- MAPS Public Benefit Corp, Santa Cruz, CA, United States
- Fluence, Woodstock, NY, United States
- Depression Evaluation Services, New York State Psychiatric Institute, New York, NY, United States
| | - Aja Molinar
- Todman Psychopathology Lab, Psychology Department, New School for Social Research, New York, NY, United States
| | - Ksenia Cassidy
- Todman Psychopathology Lab, Psychology Department, New School for Social Research, New York, NY, United States
- The Center for Attachment Research, Psychology Department, New School for Social Research, Attachment Lab, New York, NY, United States
| | - Jonathan Sabbagh
- Journey Clinical, Inc. Dover, DE, United States
- Todman Psychopathology Lab, Psychology Department, New School for Social Research, New York, NY, United States
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8
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Inviting Scientific Discourse on Traumatic Dissociation: Progress Made and Obstacles to Further Resolution. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09376-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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9
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Smith GP, Hartelius G. Resolution of Dissociated Ego States Relieves Flashback-Related Symptoms in Combat-Related PTSD: A Brief Mindfulness Based Intervention. MILITARY PSYCHOLOGY 2020; 32:135-148. [PMID: 38536266 PMCID: PMC10013259 DOI: 10.1080/08995605.2019.1654292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 08/07/2019] [Indexed: 10/25/2022]
Abstract
A novel understanding and therapeutic approach to the treatment of PTSD-related flashback triggers are described. Triggered responses are conceptualized as the result of latent dissociative structures of neural organization and psychodynamic functioning activated by current events. The dissociative structure - here described as a dissociated ego state (DES) - reflects a fracturing of executive functioning resulting in a delimited aspect of self that is not under cognitive control or subject to cognitive inhibition by the self of daily experience, and is the psychological construct behind intrusive PTSD symptoms. Use of a mindful attentional state permits regulated access to the DES (therapeutic engagement without risk of emotional dysregulation) so that dissociated cognitive resources can be recovered and the dissociated structure deactivated. This may relieve maladaptive responses and behaviors associated with the DES in a profound and durable way, without the need for exposure to or recovery of traumatic memories. Based on this understanding, a 9-step intervention is introduced with a case example of a Vietnam veteran suffering PTSD symptoms for 49 years with significant gains maintained at 21 months follow up. These findings demonstrate rapid and durable resolution of chronic PTSD symptoms through a mindfulness-based approach that focused on deactivation of dissociated ego states, in contrast to targeting trauma memories. If proven efficacious, this novel approach may result in reduced treatment costs and improved outcomes for veterans suffering with PTSD.
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Affiliation(s)
- Genine P. Smith
- Department of Integral and Transpersonal Psychology, California Institute of Integral Studies, San Francisco, California, USA
| | - Glenn Hartelius
- Department of Integral and Transpersonal Psychology, California Institute of Integral Studies, San Francisco, California, USA
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10
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Kinley JL, Reyno SM. The Price of Needing to Belong: Neurobiology of Working Through Attachment Trauma. Psychodyn Psychiatry 2019; 47:39-51. [PMID: 30840555 DOI: 10.1521/pdps.2019.47.1.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Belonging is fundamental to health and well-being. Complex relational trauma disrupts attachments, negatively impacting developing neurobiology and has significant implications for attachment behaviors, mental health, and treatment planning. We have developed a dynamic relational (DR) model of psychotherapy that aims to restore a healthy sense of belonging, targeting levels of activation and integration of large scale neural networks in the service of increasing the emotional capacities (attunement, processing, regulation, and expression) required to work through attachment trauma and establish healthy relationships. Our DR model provides an organizing framework through which to understand both the phenomenology observed in complex trauma and the mechanisms of therapeutic change. Our approach informs the weighting and timing of interventions to actively address capacity deficits, ego-syntonic symptoms, and unconscious resistance. The implications of this model also relate to the pathogenesis of mental disorder, and suggest prevention and early intervention efforts focus on modulation of subcortical (autonomic) responses and the encouragement of balanced cortical integration to enhance cognitive flexibility/psychological resilience. Ultimately, interventions based on our systematic model may modulate the genetic diathesis and comorbidities of relational trauma and increase psychological resilience.
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Affiliation(s)
- Jacqueline L Kinley
- Queen Elizabeth II Health Sciences Centre, and Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | - Sandra M Reyno
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia
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11
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Brand BL, Schielke HJ, Putnam KT, Putnam FW, Loewenstein RJ, Myrick A, Jepsen EKK, Langeland W, Steele K, Classen CC, Lanius RA. An Online Educational Program for Individuals With Dissociative Disorders and Their Clinicians: 1-Year and 2-Year Follow-Up. J Trauma Stress 2019; 32:156-166. [PMID: 30698858 PMCID: PMC6590319 DOI: 10.1002/jts.22370] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 10/18/2018] [Accepted: 10/21/2018] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
| | | | - Karen T. Putnam
- The Department of PsychiatryUniversity of North Carolina School of Medicine at Chapel HillChapel HillNorth CarolinaUSA
| | - Frank W. Putnam
- The Department of PsychiatryUniversity of North Carolina School of Medicine at Chapel HillChapel HillNorth CarolinaUSA
| | - Richard J. Loewenstein
- Sheppard Pratt Health System and University of Maryland School of MedicineBaltimoreMarylandUSA
| | - Amie Myrick
- Family and Children's ServicesBel AirMaryland
| | | | | | | | - Catherine C. Classen
- University of California San Francisco and Zuckerberg San Francisco General HospitalSan FranciscoCaliforniaUSA
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12
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Myrick AC, Webermann AR, Langeland W, Putnam FW, Brand BL. Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates. Eur J Psychotraumatol 2017; 8:1375829. [PMID: 29038681 PMCID: PMC5632785 DOI: 10.1080/20008198.2017.1375829] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/18/2017] [Indexed: 10/25/2022] Open
Abstract
Background: 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.
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Affiliation(s)
| | | | | | - Frank W Putnam
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Bethany L Brand
- Department of Psychology, Towson University, Towson, MD, USA
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13
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Freyd JJ. A brief report on the status of the Journal of Trauma & Dissociation. J Trauma Dissociation 2016; 17:523-526. [PMID: 27440470 DOI: 10.1080/15299732.2016.1215126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jennifer J Freyd
- a Department of Psychology , University of Oregon , Eugene , Oregon , USA
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14
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Brand BL, Sar V, Stavropoulos P, Krüger C, Korzekwa M, Martínez-Taboas A, Middleton W. Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder. Harv Rev Psychiatry 2016; 24:257-70. [PMID: 27384396 PMCID: PMC4959824 DOI: 10.1097/hrp.0000000000000100] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/27/2015] [Accepted: 05/22/2015] [Indexed: 01/08/2023]
Abstract
Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve. The myths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients but for the whole support system in which they reside. Empirically derived knowledge about DID has replaced outdated myths. Vigorous dissemination of the knowledge base about this complex disorder is warranted.
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Affiliation(s)
- Bethany L Brand
- From Towson University (Dr. Brand); Koç University School of Medicine (Istanbul) (Dr. Sar); Blue Knot Foundation, Sydney, Australia (Dr. Stavropoulos); University of Pretoria (Dr. Krüger); McMaster University (Dr. Korzekwa); Carlos Albizu University (San Juan) (Dr. Martínez-Taboas); Latrobe University, University of New England, University of Canterbury (New Zealand), and University of Queensland (Australia) (Dr. Middleton)
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15
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Webermann AR, Myrick AC, Taylor CL, Chasson GS, Brand BL. Dissociative, depressive, and PTSD symptom severity as correlates of nonsuicidal self-injury and suicidality in dissociative disorder patients. J Trauma Dissociation 2016. [PMID: 26211678 DOI: 10.1080/15299732.2015.1067941] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The present study investigates whether symptom severity can distinguish patients diagnosed with dissociative identity disorder and dissociative disorder not otherwise specified with a recent history of nonsuicidal self-injury (NSSI) and suicide attempts from those patients without recent self-harm. A total of 241 clinicians reported on recent history of patient NSSI and suicide attempts. Of these clinicians' patients, 221 completed dissociative, depressive, and posttraumatic stress disorder symptomatology measures. Baseline cross-sectional data from a naturalistic and prospective study of dissociative disorder patients receiving community treatment were utilized. Analyses evaluated dissociative, depressive, and posttraumatic stress disorder symptom severity as methods of classifying patients into NSSI and suicide attempt groupings. Results indicated that dissociation severity accurately classified patients into NSSI and suicidality groups, whereas depression severity accurately classified patients into NSSI groups. These findings point to dissociation and depression severity as important correlates of NSSI and suicidality in patients with dissociative disorders and have implications for self-harm prevention and treatment.
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Affiliation(s)
- Aliya R Webermann
- a Department of Psychology , Towson University , Towson , Maryland , USA
| | - Amie C Myrick
- b Family and Children's Services of Central Maryland , Bel Air , Maryland , USA
| | | | - Gregory S Chasson
- a Department of Psychology , Towson University , Towson , Maryland , USA
| | - Bethany L Brand
- a Department of Psychology , Towson University , Towson , Maryland , USA
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