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.

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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BackgroundChildhood maltreatment (CM) is a risk factor for subsequent intimate partner violence (IPV) in adulthood, with high rates of retrospectively reported CM among IPV victims and perpetrators. A theorized mechanism of the link between CM and IPV is dissociation. Dissociation may allow perpetrators of violence to remain emotionally distant from their behavior and minimize empathy toward those they victimize, enabling them to commit acts of violence similar to their own experiences. Indeed, elevated rates of dissociation and dissociative disorders (DD) have been found among IPV survivors and perpetrators. In addition, in pilot studies, DD clinicians have reported high levels of violent behavior among DD patients.ObjectiveThe present study investigates IPV among DD patients with Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified, a group with CM rates of 80–95% and severe dissociative symptoms.MethodsDD clinicians reported on rates of CM and IPV among 275 DD patients in outpatient treatment. DD patients also completed a self-report measure of dissociation. Analyses assessed the associations between CM typologies and IPV, as well as trait dissociation and IPV.ResultsPhysical and emotional child abuse were associated with physical IPV, and childhood witnessing of domestic violence (DV) and childhood neglect were associated with emotional IPV.ConclusionsThe present study is the first to provide empirical support for a possible CM to adult IPV developmental trajectory among DD patients. Future research is needed to better understand the link between CM and IPV among those with trauma and DD.

The TOMM shows promise as useful in clinical and forensic contexts to detect memory malingering among DID simulators without sacrificing specificity. Accurate distinction between genuine and feigned complex trauma-related symptoms, including dissociative memory, is integral to the accurate diagnosis of traumatized populations. (PsycINFO Database Record

Objective:The event centrality model indicates that the development and maintenance of posttraumatic stress symptoms (PTSSs) occurs when a traumatic event becomes central to one's identity, marking a key turning point in one's life narrative and influencing the meaning assigned to subsequent posttrauma events. Previous research has shown that event centrality is associated with PTSSs among survivors of intimate partner violence (IPV). However, research has not yet determined whether event centrality may explain associations between trauma exposure and IPV among perpetrators of IPV. Trauma and PTSSs are key risk factors for IPV perpetration, but many questions remain about the mechanisms that explain these associations. Method: Study participants came from a sample of 134 men presenting for treatment at a community-based relationship violence intervention program in the Baltimore-Washington, DC metro area between July 2013 and July 2015 during routine program intake. In the hypothesized serial model, exposure to potentially traumatic events predicted event centrality, which predicted PTSSs, which predicted IPV perpetration and relationship problems. Results: The serial mediation model was significant for physical assault, psychological aggression, emotional abuse, and relationship problems, but not for sexual coercion. Conclusions: The results indicate that the extent to which a trauma becomes central to one's identity is important in understanding the links between trauma exposure, PTSSs, and IPV perpetration. These findings support the development and application of trauma-informed interventions to reduce IPV perpetration and reduce event centrality in this population. Clinical Impact StatementIndividuals with posttraumatic stress disorder are at a heightened risk for use of intimate partner violence (IPV), yet many relationship violence intervention programs do not provide traumainformed treatment. The current study highlights the important role of event centrality, the degree to which trauma is perceived as a central component of someone's life story, in IPV perpetration. Specifically, neither trauma exposure nor posttraumatic stress symptoms (PTSSs) in and of themselves appear to predict IPV, but high event centrality predicts PTSSs and subsequent use of IPV. These findings suggest that intervention may be enhanced by decentering trauma within the individual's autobiographical narrative or by challenging beliefs related to event centrality. The current study emphasizes that event centrality increases the risk for use of violence.

BackgroundThe role of mental illness in violent crime is elusive, and there are harmful stereotypes that mentally ill people are frequently violent criminals. Studies find greater psychopathology among violent offenders, especially convicted homicide offenders, and higher rates of violence perpetration and victimization among those with mental illness. Emotion dysregulation may be one way in which mental illness contributes to violent and/or criminal behavior. Although there are many stereotyped portrayals of individuals with dissociative disorders (DDs) being violent, the link between DDs and crime is rarely researched.MethodsWe reviewed the extant literature on DDs and violence and found it is limited to case study reviews. The present study addresses this gap through assessing 6-month criminal justice involvement among 173 individuals with DDs currently in treatment. We investigated whether their criminal behavior is predicted by patient self-reported dissociative, posttraumatic stress disorder and emotion dysregulation symptoms, as well as clinician-reprted depressive disorders and substance use disorder.ResultsPast 6 month criminal justice involvement was notably low: 13% of the patients reported general police contact and 5% reported involvement in a court case, although either of these could have involved the DD individual as a witness, victim or criminal. Only 3.6% were recent criminal witnesses, 3% reported having been charged with an offense, 1.8% were fined, and 0.6% were incarcerated in the past 6 months. No convictions or probations in the prior 6 months were reported. None of the symptoms reliably predicted recent criminal behavior.ConclusionsIn a representative sample of individuals with DDs, recent criminal justice involvement was low, and symptomatology did not predict criminality. We discuss the implications of these findings and future directions for research.

Objective: 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 (X 2(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.