Download The Dissociative Disorders

Katherine L Hilton, LPC
Mississippi College
Evidence Based Practice

 Evidence Based Practices (EBPs)
(Chambless, 1998; Gertlehner, Hasenc, & Nissman, 2006)
 Applying EBP Starts with Effective Assessment
(Byng, 2012; Caldwell, Bennett, & Mellis, 2012; Rice, 2013)
Assessment

 Difficult with complex clinical presentations
(Ellason, Ross, & Fuchs, 1996)
 Trauma
(Lamagna & Gleiser, 2007; Sprang, Craig, & Clark, 2007)
 Something May be Missing…
(International Society for the Study of Trauma and Dissociation [ISSTD], 2011)
Dissociation

 a disruption in typically integrated mental
functioning of experience, especially in regards to
consciousness, memory, identity, or perception (APA,
2000, p. 519)
 50%- 65% in a lifetime – (APA, 2013; Ross, Joshi, & Currie, 1990)
 “A normal process that is… used defensively by an
individual to handle traumatic experiences”(Putnam, 1989,
p. 9)
Types of Dissociation

 Depersonalization &
Derealization
 Identity Disruption
 DID
 “Unreality or
Detachment”
 Not delusional
 Dissociative Amnesia
 Localized
 Selective
 Generalized
(APA, 2013; Schauer & Elbert, 2010)
Maladaptive Dissociation

 Dissociative Disorder
 Characteristic of a Trauma-Related Disorder
 Co-occurring Symptom
Dissociative Disorders

 Depersonalization/
Derealization Disorder
 Dissociative Identity
Disorder
 50% - One Episode
 2% - Lifetime
prevalence
 1.5% - Lifetime
prevalence
 Dissociative Amnesia
Disorder
 1.8% in a given year
(APA, 2013)
Dissociation in Other Disorders

 Borderline Personality
Disorder
 Dissociative
experiences
 Disruption of identity
 Post-Traumatic Stress
Disorder
 Flashbacks
 Specifier
(APA, 2013)
Co-Occurring Disorders

 Somatization Disorder/ Somatic Symptom Disorder
(Brown, Schrag, & Trimble, 2005)
 OCD (Hollander & Benzaquen, 1997)
 Social Anxiety (Fontonelle et al., 2007)
 Panic Disorder (Pfaltz, Michael, Meyer, & Wilhelm, 2013)
 Bulimia Nervosa & Binge Eating (Hallings-Pott, Waller,
Watson, & Scragg, 2005)
 Depression (Hagenaars, van Minnen, & Hoogduin, 2010)
 Schizophrenia (Braehler et al., 2013)
Effect on Treatment

 “poses a serious obstacle to successful treatment”
(Schauer & Elbert, 2010, p. 109)
 OCD & Dissociation - Rufer et. al (2006)
 52 participants, CBT treatment
 Baseline DES scores positively correlated with…
 Earlier Termination
 Lack of Treatment Response
 OCD Symptoms Post-Treatment
Effect on Treatment

 Borderline personality disorder (Kleindienst et al., 2011)
 57 clients; 3 months of DBT
 Agoraphobia with panic (Michelson et al., 1998)
 89 clients; CBT treatment
 Inpatient treatment for non-psychotic disorders
(Spitzer et al., 2007)
 133 clients; short-term CBT psychotherapy
Statement of Problem

 The problem of this literature review is to identify
and describe the effects of dissociation on treatment
outcome.
 An additional concern is to identify specific
disorders and their treatments that are the most
impacted by dissociation.
Significance

 Results could improve screening and assessment
 Recommendations for improving course of treatment
and outcome for co-occurring disorders
Research Questions

1. What effects does dissociation have on treatment
outcomes?
2. Does dissociation negatively influence treatments
for certain co-occurring disorders?
3. How could screening for dissociation improve
treatment of co-occurring disorders?
Method

 Systematic Literature Review
 Preferred Reporting Items for Systematic reviews
and Meta-Analyses (PRISMA) statement
 PRISMA Checklist
 PRISMA Flowchart
Method

 1980 – 2014
 Databases:





PscyhINFO
PscyhARTICLES
Sage Premier
SocINDEX
Wiley Online Library
 Reference Lists
 Specific Journals
 e.g. Journal of Trauma
and Dissociation
Dissociation
Search Terms

Treatment
Co-occurring Disorders
Dissociation
Treatment
Comorbidity
Dissociative
Outcome
Co-occurring Disorders
Dissociate
Efficacy
Post-traumatic Stress Disorder
Depersonalization
Effectiveness
Borderline Personality Disorder
Derealization
Course of Treatment
Obsessive-Compulsive Disorder
Identity disruption
Drop-Out
Anxiety Disorder
Premature Termination
Panic Disorder
Treatment Response
Eating Disorder
Post-Treatment Symptoms
Bulimia Nervosa
Depression
Schizophrenia
Inclusion Criteria

 Psychometric
assessment(s) that have
proven validity and
reliability
 Subscales or items from
other assessments (e.g.,
Briere, 1995)
 Structured Clinical
Interview for DSM–IV
Dissociative Disorders–
Revised (SCID-D-R; Steinberg, 1994)
 Multidimensional
Inventory of Dissociation
(MID; Dell, 2006)
 Dissociative Experiences
Scale (DES; Bernstein & Putnam,
1993)
 Dissociative Disorders
Interview Schedule (DDIS;
Ross et al., 1989)
Exclusion Criteria

 Non-English
 Non-peer reviewed
 Focus of Treatment is a Dissociative Disorder
Definition of Terms

 Dissociation - “a
disruption of and/or
discontinuity in the
normal integration of
consciousness,
memory, identity,
emotion, perception,
motor control, and
behavior” (APA, 2013, p. 519)
 Dissociation - Not
inherently pathological
Definition of Terms

 Depersonalization –”the
experience of unreality
or detachment from
one’s mind, self, or
body”(APA, 2013, p. 291)
 Derealization – “the
experience of unreality
or detachment from ”
(APA, 2013, p. 291) the
environment
 Dissociative amnesia –the
“inability to recall
autobiographical
information that is
inconsistent with
normal forgetting” (APA,
2013, p. 291)
Definition of Terms

 Treatment - any number
of interventions in the
counseling and
psychotherapy field
 Treatment Outcome changes made and/or
maintained throughout
treatment that can be
reasonably attributed to
the treatment
Remainder of Study

 Chapter 2
1. Theories of
development
2. Current views on
how dissociation
operates
3. Common cooccurring disorders
4. Available assessment
procedures and
treatments
 Chapter 3
 Methodology
 Procedures
 Chapter 4
 Literature Review
 Chapter 5
 Implications
References

American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed., text rev.). Washington, DC:
Author.
American Psychiatric Association. (2013). Diagnostic and statistical
manual of mental disorders (5th ed.). Washington, DC: Author.
Barlow, M. R., & Freyd, J. F. (2009). Adaptive dissociation:
Information processing and response to betrayal. In P. F. Dell &
J. A. O’Neil (Eds.). The Dissociative Disorders: DSM-V and Beyond
(pp. 93-106). New York, NY: Routledge.
Bernstein, E. M., & Putnam, F. W. (1993). An update on the
Dissociative Experiences Scale. Dissociation, 6, 16–27.
References

Bonanno, G. A., Keltner, D., Holen, A., & Horowitz, M. J. (1995).
When avoiding unpleasant emotions might not be such a bad
thing: Verbal-autonomic response dissociation and midlife
conjugal bereavement. Journal of Personality and Social
Psychology, 69(5), 975-989.
Braehler, C., Valiquette, L., Holowka, D., Malla, A. K., Joober, R.,
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References

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
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
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
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
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
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
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
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