Psychiatric Health Care Costs of Multiple Personality Disorder

Ross, Colin A.; Dua, Vikram

doi:10.1176/appi.psychotherapy.1993.47.1.103

Cited by 44 publications

(30 citation statements)

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“…(Canadian) in the three years after treatment for DID (Ross and Dua, 1993). This and other studies document considerable cost savings even for those who had been chronically ill before being appropriately treated for DID (Lloyd, 2011).…”

Section: Treatment Of Didsupporting

confidence: 53%

Dissociative identity disorder: An empirical overview

Dorahy

Brand

Şar

et al. 2014

Aust N Z J Psychiatry

162

118

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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: Treatment Of Didsupporting

confidence: 53%

Dissociative identity disorder: An empirical overview

Dorahy

Brand

Şar

et al. 2014

Aust N Z J Psychiatry

162

118

View full text Add to dashboard Cite

show abstract

“…These patients’ severe and chronic trauma histories are well documented, as are the many years they spend in the mental health system receiving inpatient and outpatient services (Boon & Draijer, 1993; Fraser & Raine, 1992; Hornstein & Putnam, 1992; Lloyd, 2011; Putnam, Guroff, Silberman, Barban, & Post, 1986; Ross & Dua, 1993; Ross, Joshi, & Currie, 1990). Mansfield and colleagues (2010) reported that DD patients who were spouses of active-duty U.S. military personnel utilized mental health services at a higher rate than individuals diagnosed with any of the other 16 psychiatric disorders they studied.…”

Section: Highlightsmentioning

confidence: 99%

“…Each individual suicide attempt among general psychiatric patients costs an estimated 2000–68,000 USD when direct costs such as ambulatory care, medical tests, surgeries, and psychiatric treatment are considered (reviewed in Yang & Lester, 2007). Some preliminary studies have calculated that swift and accurate diagnosis of DDs, followed by appropriate trauma- and dissociation-focused treatment, would substantially decrease the cost of DD patients’ treatments, even in cases where patients are severely impaired (Fraser & Raine, 1992; Lloyd, 2011; Ross & Dua, 1993). …”

Section: Highlightsmentioning

confidence: 99%

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

Myrick

Webermann

Langeland

et al. 2017

European Journal of Psychotraumatology

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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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“…These studies' systematic data show that DID treatment consistent with the expert guidelines is associated with decreased dissociation, depression, anxiety, posttraumatic stress, general psychiatric distress, and self-destructiveness, among others (Brand, Classon, McNary, & Zaveri, 2009). In addition, cost-efficacy studies of DID treatment have shown a robust decrease in costs over years of followup, once phasic DID treatment was initiated, even in the most chronically ill DID patients (Fraser & Raine, 1992;Lloyd, 2011;Loewenstein, 1994;Ross & Dua, 1993).…”

Section: Expert Treatment Guidelines and Evidence About Did Treatmentmentioning

confidence: 99%

Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach

Brand¹,

Loewenstein²,

Spiegel³

2014

Psychiatry: Interpersonal and Biological Processes

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The evidence demonstrates that carefully staged trauma-focused psychotherapy for DID results in improvement, whereas dissociative symptoms persist when not specifically targeted in treatment. The claims that DID treatment is harmful are based on anecdotal cases, opinion pieces, reports of damage that are not substantiated in the scientific literature, misrepresentations of the data, and misunderstandings about DID treatment and the phenomenology of DID. Given the severe symptomatology and disability associated with DID, iatrogenic harm is far more likely to come from depriving DID patients of treatment that is consistent with expert consensus, treatment guidelines, and current research.

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Psychiatric Health Care Costs of Multiple Personality Disorder

Cited by 44 publications

References 0 publications

Dissociative identity disorder: An empirical overview

Dissociative identity disorder: An empirical overview

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach

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