Patients with complex dissociative disorders report high levels of childhood-abuse experiences, c... more Patients with complex dissociative disorders report high levels of childhood-abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. In the current study, 59 patients with Dissociative Identity Disorder (DID) or Other Specified Dissociative Disorders (OSDD) were randomized to 20 sessions of stabilizing grouptreatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment is based on the manual Coping with Trauma-Related Dissociation (Boon, Steele, & Hart, 2011). The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, interpersonal difficulties, and self-destructive behavior. Results indicate medium to large effects on psychosocial functioning and small to insignificant effects on reduction of symptoms and self-destructive behavior. Mixed effect models showed no condition x time interaction, indicating no immediate differences in treatment outcome, but some indication of positive effects in the six months follow-up period.
ICD-10 and DSM-5 do not provide clear diagnosing guidelines for DID, making it difficult to disti... more ICD-10 and DSM-5 do not provide clear diagnosing guidelines for DID, making it difficult to distinguish 'genuine' DID from imitated or false-positive cases. This study explores meaning which patients with false-positive or imitated DID attributed to their diagnosis. 85 people who reported elevated levels of dissociative symptoms in SDQ-20 participated in clinical assessment using the Trauma and Dissociation Symptoms Interview, followed by a psychiatric interview. The recordings of six women, whose earlier DID diagnosis was disconfirmed, were transcribed and subjected to interpretative phenomenological analysis. Five main themes were identified: (1) endorsement and identification with the diagnosis. (2) The notion of dissociative parts justifies identity confusion and conflicting ego-states. (3) Gaining knowledge about DID affects the clinical presentation. (4) Fragmented personality becomes an important discussion topic with others. (5) Ruling out DID leads to disappointment or anger. To avoid misdiagnoses, clinicians should receive more systematic training in the assessment of dissociative disorders, enabling them to better understand subtle differences in the quality of symptoms and how dissociative and non-dissociative patients report them. This would lead to a better understanding of how patients with and without a dissociative disorder report core dissociative symptoms. Some guidelines for a differential diagnosis are provided.
Patients with complex dissociative disorders report high levels of childhood-abuse experiences, c... more Patients with complex dissociative disorders report high levels of childhood-abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. In the current study, 59 patients with Dissociative Identity Disorder (DID) or Other Specified Dissociative Disorders (OSDD) were randomized to 20 sessions of stabilizing grouptreatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment is based on the manual Coping with Trauma-Related Dissociation (Boon, Steele, & Hart, 2011). The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, interpersonal difficulties, and self-destructive behavior. Results indicate medium to large effects on psychosocial functioning and small to insignificant effects on reduction of symptoms and self-destructive behavior. Mixed effect models showed no condition x time interaction, indicating no immediate differences in treatment outcome, but some indication of positive effects in the six months follow-up period.
ICD-10 and DSM-5 do not provide clear diagnosing guidelines for DID, making it difficult to disti... more ICD-10 and DSM-5 do not provide clear diagnosing guidelines for DID, making it difficult to distinguish 'genuine' DID from imitated or false-positive cases. This study explores meaning which patients with false-positive or imitated DID attributed to their diagnosis. 85 people who reported elevated levels of dissociative symptoms in SDQ-20 participated in clinical assessment using the Trauma and Dissociation Symptoms Interview, followed by a psychiatric interview. The recordings of six women, whose earlier DID diagnosis was disconfirmed, were transcribed and subjected to interpretative phenomenological analysis. Five main themes were identified: (1) endorsement and identification with the diagnosis. (2) The notion of dissociative parts justifies identity confusion and conflicting ego-states. (3) Gaining knowledge about DID affects the clinical presentation. (4) Fragmented personality becomes an important discussion topic with others. (5) Ruling out DID leads to disappointment or anger. To avoid misdiagnoses, clinicians should receive more systematic training in the assessment of dissociative disorders, enabling them to better understand subtle differences in the quality of symptoms and how dissociative and non-dissociative patients report them. This would lead to a better understanding of how patients with and without a dissociative disorder report core dissociative symptoms. Some guidelines for a differential diagnosis are provided.
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Papers by Suzette Boon