Impact of dissociation on treatment of depressive and anxiety spectrum disorders with and without personality disorders

Abstract

ObjectiveThe central goal of the study was to analyze the impact of dissociation on the treatment effectiveness in patients with anxiety/neurotic spectrum and depressive disorders with or without comorbid personality disorders.MethodsThe research sample consisted of inpatients who were hospitalized in the psychiatric department and met the ICD-10 criteria for diagnosis of depressive disorder, panic disorder, generalized anxiety disorder, mixed anxiety–depressive disorder, agoraphobia, social phobia, obsessive compulsive disorder, posttraumatic stress disorder, adjustment disorders, dissociative/conversion disorders, somatoform disorder, or other anxiety/neurotic spectrum disorder. The participants completed these measures at the start and end of the therapeutic program – Beck Depression Inventory, Beck Anxiety Inventory, a subjective version of Clinical Global Impression-Severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale.ResultsA total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment on an outpatient basis and were referred for hospitalization for the 6-week complex therapeutic program, were enrolled in this study. Of them, 606 were statistically analyzed. Data from the remaining 234 (27.86%) patients were not used because of various reasons (103 prematurely finished the program, 131 did not fill in most of the questionnaires). The patients’ mean ratings on all measurements were significantly reduced during the treatment. Also, 67.5% reached at least minimal improvement (42.4% showed moderate and more improvement, 35.3% of the patients reached remission). The patients without comorbid personality disorder improved more significantly in the reduction of depressive symptoms than those with comorbid personality disorder. However, there were no significant differences in change in anxiety levels and severity of the mental issues between the patients with and without personality disorders. Higher degree of dissociation at the beginning of the treatment predicted minor improvement, and also, higher therapeutic change was connected to greater reduction of the dissociation level.ConclusionDissociation is an important factor that influences the treatment effectiveness in anxiety/depression patients with or without personality disorders resistant to previous treatment. Targeting dissociation in the treatment of these disorders may be beneficial.

Self-stigma and treatment effectiveness in patients with anxiety disorders – a mediation analysis

“…The correlation coefficients between the relative objCGI and the initial anxiety, depressive, and dissociation levels were negligible, and the mediation model did not prove their role in the process. Based on previous research, 9 , 10 we found that the relative change of the objCGI was influenced by a number of quite small predictors (ranging from clinical, such as initial disorder severity, to psychological, like dissociation) which together mildly predicted the therapeutic outcome. This study concluded with same results as well.…”

“…The CBT program included therapeutic activities such as psychoeducation, case conceptualization, work with automatic thoughts and schemas, exposures, and problem-solving. 10 Short psychodynamic therapy concentrated on relational problems in a patient’s life and group interactions, which were both related to a person’s development. The program for both groups was supplemented with assertive training, mental imagery, relaxation, sport, and ergotherapy.…”

“…Patients with high rates of self-stigma express high dissociation levels. 9 , 10 Both factors are associated with worse treatment outcomes. 7 , 11 It is possible that they are the result of aversive childhood experiences.…”

“… 12 Excessive use of dissociation also develops in childhood, when the child is exposed to traumatic experiences that they cannot handle other than by the splitting of integrative mental functions, such as memory, emotions, cognition, and physical perceptions. 10 …”

“…Some present psychosocial variables which prevent the patients from reaching remission. Rigidly held cognitive errors, maladaptive schemas, and avoidant behavior, 25 early life experiences, 26 dissociations, 10 and self-stigma 16 negatively influence the treatment response. Biological factors, such as genetics 27 and temperament, 26 also play a role.…”