Global functioning and disability in dissociative disorders

Mueller‐Pfeiffer, Christoph; Rufibach, Kaspar; Perron, Noëlle Astrid Junod; Wyss, Daniela; Kuenzler, Cornelia; Prezewowsky, Cornelia; Pitman, Roger K.; Rufer, Michael

doi:10.1016/j.psychres.2012.04.028

Cited by 72 publications

(41 citation statements)

References 33 publications

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“…No study to date has found DID without multiple non-dissociative comorbid psychopathology (e.g., Boon and Draijer, 1993a;Mueller-Pfeiffer et al, 2012;Rodewald et al, 2011b). Depression and associated symptoms (lability, suicidal ideation) are among the most frequent (e.g., Ellason et al, 1996;Middleton and Butler, 1998).…”

Section: Construct Validity -Discriminant Type: Distinctiveness From mentioning

confidence: 99%

Dissociative identity disorder: An empirical overview

Dorahy

Brand

Şar

et al. 2014

Aust N Z J Psychiatry

162

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Objective: Despite its long and auspicious place in the history of psychiatry, dissociative identity disorder (DID) has been associated with controversy. This paper aims to examine the empirical data related to DID and outline the contextual challenges to its scientific investigation. Method: The overview is limited to DID-specific research in which one or more of the following conditions are met: 1) a sample of participants with DID was systematically investigated, 2) psychometrically-sound measures were utilised, 3) comparisons were made with other samples, 4) DID was differentiated from other DID: An empirical overview 2 disorders, including other Dissociative Disorders, 5) extraneous variables were controlled or 6) DID diagnosis was confirmed. Following an examination of challenges to research, data is organised around the validity and phenomenology of DID, its aetiology and epidemiology, the neurobiological and cognitive correlates of the disorder, and finally its treatment. Results: DID was found to be a complex yet valid disorder across a range of markers. It can be accurately discriminated from other disorders, especially when structured diagnostic interviews assess identity alterations and amnesia. DID is aetiologically associated with a complex combination of developmental and cultural factors, including severe childhood relational trauma. The prevalence of DID appears highest in emergency psychiatric settings and affects approximately 1% of the general population. Psychobiological studies are beginning to identify clear correlates of DID associated with diverse brain areas and cognitive functions. They are also providing an understanding of the potential metacognitive origins of amnesia. Phase-oriented empirically-guided treatments are emerging for DID. Conclusions: The empirical literature on DID is accumulating, although some areas remain under-investigated.Existing data show DID as a complex, valid, and not uncommon disorder, associated with developmental and cultural variables, that is amenable to psychotherapeutic intervention. KeywordsDissociative identity disorder, validity, phenomenology, aetiology, psychobiology, [see Taylor, 1983 ], Janet, 1907Prince, 1905). More recently DID has become the subject of considerable debate (e.g., Dalenberg et al., 2012;Gleaves, 1996;McHugh and Putnam, 1995;Merskey, 1992), especially around its validity, aetiology and prevalence. Often This overview is designed to provide a current "broad-brush" outline of the scientific foundation of DID by focusing on DID-specific research. Thus the overview excludes opinion pieces and papers without DID data and is confined to studies identified in searches of major psychological (e.g., Psycinfo) and psychiatric databases (e.g., Medline) which investigated individuals with DID where one or more of the following conditions were met: 1) a sample of participants with DID was systematically investigated, 2) psychometrically-sound measures were utilised, 3) comparisons were made with other samples, 4) DID was differentiat...

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Section: Construct Validity -Discriminant Type: Distinctiveness From mentioning

confidence: 99%

Dissociative identity disorder: An empirical overview

Dorahy

Brand

Şar

et al. 2014

Aust N Z J Psychiatry

162

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“…DDs are often comorbid conditions, occurring particularly in conjunction with anxiety, affective, and personality disorders (Dell 1998;Johnson et al 2006;Rodewald et al 2011). Clinical relevance of a comorbid DD is suggested by the findings that DDs, in particular DDNOS-I and DID, contribute to functional impairment above and beyond the presence of other non-dissociative axis I disorders (Johnson et al 2006;Mueller-Pfeiffer et al 2012). Moreover, high levels of dissociation predict a negative treatment outcome (Lima et al 2010;Michelson et al 1998;Rufer et al 2006;Spitzer et al 2007).…”

Section: The Diagnostic and Statistical Manual Of Mental Disorders (Dmentioning

confidence: 99%

“…This report presents the results of a study that was conducted to SCREENING FOR DISSOCIATIVE DISORDERS 4 determine the test performance of three well known and internationally used self-report dissociation scales, i.e., the Dissociative Experiences Scale (DES; Bernstein and Putnam 1986), Somatoform Dissociation Questionnaire (SDQ-20; Nijenhuis et al 1996), and Multidimensional Inventory of Dissociation (MID;Dell 2006aDell , 2006bDell and Lawson 2009), in screening for the presence (or absence) of a DD and more specifically, DDNOS-I or DID in clinical practice, where the aim usually is to minimize the risk of false negative cases. We decided to test the screening performance of the three dissociation scales on DD and DDNOS-I/DID separately, because DDNOS-I and DID are characterized by recurrent dissociative intrusions into every aspect of executive functioning and sense of self (Dell 2006b(Dell , 2009) and by high impact on global functioning (Mueller-Pfeiffer et al 2012), which distinguishes them from 'simpler' DDs, i.e., dissociative amnesia, dissociative fugue, and depersonalization disorder. We also combined DDNOS-I and DID into one classifier because of their strong relationship between each other.…”

Section: The Diagnostic and Statistical Manual Of Mental Disorders (Dmentioning

confidence: 99%

“…Data were gathered within a larger study of the relationship between DDs and functional impairment (Mueller-Pfeiffer et al 2012). As reported in this paper, consecutive subjects between 18 and 65 years with sufficient fluency in the German language, who were in treatment for three or more sessions during 1/2009 to 12/2010, were eligible.…”

Section: Subjects and Proceduresmentioning

confidence: 99%

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Screening for Dissociative Disorders in Psychiatric Out- and Day Care-Patients

Mueller‐Pfeiffer

Rufibach

Wyss

et al. 2013

J Psychopathol Behav Assess

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Dissociative disorders are frequent and clinically relevant conditions in psychiatric populations. Yet, their recognition in clinical practice is often poor. This study evaluated the performance of three well known and internationally used dissociation scales in screening for dissociative disorders. Consecutively treated out-and day care-patients (n = 160) from several psychiatric units in Switzerland completed the Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ-20), and Multidimensional Inventory for Dissociation (MID). The Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R) was then administered. Test performance of the scales was analyzed by receiver operating characteristic curves. The diagnostic accuracy, represented by the area under the curve, did not differ significantly between the three summary scales. Cut-off scores for detecting at least 80 % of any dissociative disorder and dissociative disorder-not-otherwise-specified/dissociative identity disorder, respectively, were 12 and 20 for the DES, 30 and 33 for the SDQ-20, and 28 and 28 for the MID summary scale. The diagnostic accuracy of the DES subscale 'absorption' and the MID subscale 'somatic symptoms' was equal or slightly lower than the corresponding summary scale. The DES, SDQ-20, and MID summary scales are suitable in screening for dissociative disorders in general psychiatric out-and day care-patients. Adequate cut-off scores in the German-adapted DES are lower than in non-German versions. Screening with the DES subscale 'absorption' and the MID subscale 'somatic symptoms' could be more efficient without the loss of diagnostic accuracy. and the MID subscale 'somatic symptoms' was equal or slightly lower than the corresponding summary scale. The DES, SDQ-20, and MID summary scales are suitable in screening for dissociative disorders in general psychiatric out-and day care-patients. Adequate cut-off scores in the German-adapted DES are lower than in non-German versions. Screening with the DES subscale 'absorption' and the MID subscale 'somatic symptoms' could be more efficient without the loss of diagnostic accuracy.

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“…Dissociative disorder not otherwise specified (DDNOS), the DSM-IV-TR diagnosis assigned to patients with symptoms similar to DID (Spiegel et al, 2011), is more than twice as prevalent in the U.S. (4.4%; Johnson et al, 2006). These severe dissociative disorder (DD) patients frequently present with myriad difficulties, including emotion dysregulation, intrusions of traumatic experiences and other symptoms of posttraumatic stress disorder (PTSD), dissociation, self-harm, suicidality, attachment and relationship difficulties (including mistrust of therapists), and poor quality of life (Brand, Classen, Lanius et al, 2009; Foote, Smolin, Kaplan, Legatt, & Lipschitz, 2006; Johnson et al, 2006; Liotti, 1992; Mueller-Pfeiffer et al, 2012; Pasquini, Liotti, Mazzotti, Fassone, & Picardi, 2002). Treatment research for DD patients is scarce, however (Brand, Classen, McNary, & Zaveri, 2009), and is made more difficult by the lack of a reliable, validated measure for assessing DD treatment progress.…”

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confidence: 99%

Assessing therapeutic change in patients with severe dissociative disorders: the progress in treatment questionnaire, therapist and patient measures

Schielke

Brand

Marsic³

2017

European Journal of Psychotraumatology

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Background: Treatment research for dissociative identity disorder (DID) and closely related severe dissociative disorders (DD) is rare, and has been made more difficult by the lack of a reliable, valid measure for assessing treatment progress in these populations. Objective: This paper presents psychometric data for therapist and patient report measures developed to evaluate therapeutic progress and outcomes for individuals with DID and other DD: the Progress in Treatment Questionnaire – Therapist (PITQ-t; a therapist report measure) and the Progress in Treatment Questionnaire – Patient (PITQ-p; a patient self-report measure). Method: We examined the data of 177 patient–therapist pairs (total N = 354) participating in the TOP DD Network Study, an online psychoeducation programme aimed at helping patients with DD establish safety, regulate emotions, and manage dissociative and posttraumatic symptoms. Results: The PITQ-t and PITQ-p demonstrated good internal consistency and evidence of moderate convergent validity in relation to established measures of emotional dysregulation, dissociation, posttraumatic stress disorder, and psychological quality of life, which are characteristic difficulties for DD patients. The measures also demonstrated significant relationships in the hypothesized directions with positive emotions, social relations, and self-harm and dangerous behaviours. The patient-completed PITQ-p, which may be used as an ongoing assessment measure to guide treatment planning, demonstrated evidence of stronger relationships with established symptom measures than the PITQ-t. Conclusions: The PITQ-t and PITQ-p merit use, additional research, and refinement in relation to the assessment of therapeutic progress with patients with DD.

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Global functioning and disability in dissociative disorders

Cited by 72 publications

References 33 publications

Dissociative identity disorder: An empirical overview

Dissociative identity disorder: An empirical overview

Screening for Dissociative Disorders in Psychiatric Out- and Day Care-Patients

Assessing therapeutic change in patients with severe dissociative disorders: the progress in treatment questionnaire, therapist and patient measures

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