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.

To date, most of the inpatient outcome studies among early traumatized individuals lack data on dissociative disorders. More research is needed to evaluate whether severely dissociative patients can improve following specialized inpatient treatment for chronic childhood abuse. The objectives of this study were to investigate symptomatic change in patients attending a 3-month specialized inpatient treatment program for adults with a history of childhood sexual abuse (CSA) and mixed trauma-related disorders. In particular, symptomatic changes in those with and without a complex dissociative disorder I + II (CDD) were contrasted. Fifty-six patients with CSA and trauma-related disorders (including 23 patients with CDD) completed the treatment program and a test battery at precare evaluation, admission, discharge, and at 1-year follow-up. There was an overall symptom reduction in dimensional measures maintained at the 1-year follow-up. Patients with CDD consistently had significantly higher symptom levels than the patients without these disorders. Both patient subgroups showed parallel improvement from admission to follow-up, although those high in dissociation (CDD patients) needed more time to show improvement and were still clinically worse at the end of treatment and at follow-up. The findings were matched by clinically significant changes. The results suggest that adults with reported childhood sexual abuse and mixed trauma-related disorders can improve in symptom severity following a trauma-based 3-month inpatient program regardless of CDD status. The high distress level in CDD patients indicates that patients with CDD need treatment that is in part different from the more general treatment of polysymptomatic CSA survivors, addressing the pathological aspects of dissociation more vigorously.

The objective of this study was to examine the changes in psychiatric symptoms and interpersonal problems in 34 adults with a history of childhood sexual abuse and posttraumatic stress disorder who attended a 3-month inpatient treatment program. Levels of posttraumatic, depressive, and general psychiatric symptoms and interpersonal problems were assessed at pre-care evaluation, admission, discharge, and 1-year follow-up using the Impact of Event Scale, the Beck Depression Inventory, the Symptom Check List 90 Revised, and the Inventory of Interpersonal Problems. Work status was assessed at admission and at follow-up. Significant improvements were seen during treatment on the global scores of all instruments except the Beck Depression Inventory. At follow-up, patients had kept their gains on symptom measures and experienced further progress regarding interpersonal problems. At discharge, 3 of the previously 32 unemployed patients were able to return to work. Patients with comorbid somatization disorder tended to have higher levels of distress and less favorable treatment response. Future studies should include pre- and posttreatment assessment of dissociation to evaluate its association with outcome.

BackgroundLittle is known about the possible predictors of treatment outcome in early chronically sexually abused adults. The current study aimed to investigate what impact initial levels of dissociation and pre-treatment negative change in interpersonal functioning have on treatment response after 3 months of first-phase trauma inpatient treatment as well as after a period of 1 year the patients returned to their usual lives.MethodsThe sample comprised 48 inpatients with childhood sexual abuse histories and mixed trauma-related disorders who were examined at discharge and prospectively followed up for a period of 1 year under naturalistic conditions. Outcome variables were general psychiatric symptoms and interpersonal problems as measured with the Symptom Check List-Revised (SCL-R) and the Inventory of Interpersonal Problems (IIP) Circumplex.ResultsThe central findings were that pathological dissociation and deterioration in interpersonal functioning prior to admittance predicted general psychiatric symptom levels and interpersonal problems at the end of treatment and at 1-year follow-up. Pathological dissociation, involving memory and identity problems, alone predicted negative outcome at the end of treatment. The findings at 1-year follow-up indicate that it is not pathological dissociation in isolation that affects outcomes, but rather the interaction between dissociation and change in interpersonal functioning prior to treatment.ConclusionThese findings indicate the need of addressing dissociation and interpersonal problems in treatment planning and favor an integrated treatment approach for complex trauma patients. Future research should investigate whether and how this leads to better outcome, including long-term maintenance of gains after the end of treatment.

Objective: 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. Method: We searched six databases and the reference lists of articles. We also approached researchers to identify unpublished studies. No language restrictions were imposed. Results: A total of 1002 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 under-represented. Due to the heterogeneity among studies, we could not perform a meta-analysis. Conclusions: 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.Running head: SYSTEMATIC REVIEW COSTS OF DISSOCIATIVE DISORDERS 3 Clinical Impact StatementThis review suggests that dissociative disorders (DDs) are associated with substantial costs to the society, although conclusions are tentative due to few studies and methodological limitations. There was agreement in the studies about DDs having substantial direct mental health care costs. Considering that these disorders might often be undetected or misdiagnosed, clinicians and health care authorities should be aware of potential economic gains from earlier recognition and treatment. Appropriate diagnostic and treatment practice may result in financial savings as well as improved life quality for patients and their families.