Negative affective responses to positive events and stimuli in patients with complex dissociative disorders: a mixed-methods pilot study.

Background: Research suggests that individuals exposed to (childhood) trauma are not only unable to experience pleasure, known as hedonic deficit (HD), but also experience 'negative affective responses to positive events', known as negative affective interference (NAI). The clinical relevance and prognostic features of NAI have increasingly been recognized. To date, no studies have focused on NAI in patients with complex dissociative disorders (CDDs) who were abused early in life. Objective: In this pilot study, we quantitatively and qualitatively investigated how NAI is related to trauma-related symptoms and how this phenomenon can be understood in a selected group of adult CDD patients. Method: CDD patients (N = 25) referred to an inpatient dissociation-focused treatment programme completed the Hedonic Deficit & Interference Scale (HDIS), and measures of trauma-related symptoms and interpersonal functioning, as well as a qualitative questionnaire addressing possible inner conflicts and phobias with respect to the experience of positive events. A convergent mixed-methods design was used to obtain different but complementary data on NAI to gain a more complete understanding of the phenomenon. Results: The quantitative analyses showed a significant relationship between NAI and trauma-related symptoms and interpersonal functioning. NAI seems to be more strongly associated with these symptoms than HD. The qualitative analysis revealed three themes - fear, shame, and aggressive 'parts' - preventing positive emotions, which provided a possible interpretation of the quantitative results. The integrated findings were discussed in light of theories of structural dissociation of the personality and attachment. Conclusions: These findings indicate that NAI is related to a spectrum of trauma-related symptoms and interpersonal functioning in patients with a CDD to a larger degree than HD and that different dissociative identities are involved. Studies of the relationship between changes in HDIS (particularly the NAI subscale) and changes in trauma-related symptoms and interpersonal functioning following treatment are warranted.

Antecedentes: Las investigaciones sugieren que los individuos expuestos a traumas (en la infancia) no sólo son incapaces de experimentar placer, lo que se conoce como déficit hedónico (HD), sino que también experimentan 'respuestas afectivas negativas a eventos positivos', lo que se conoce como interferencia afectiva negativa (NAI). Cada vez se reconoce más la importancia clínica y las características pronósticas de la NAI. Hasta la fecha, ningún estudio se ha centrado en la NAI en pacientes con trastornos disociativos complejos (TDC) que sufrieron abusos en las primeras etapas de su vida.Objetivo: En este estudio piloto, investigamos cuantitativa y cualitativamente cómo se relaciona la NAI con los síntomas relacionados con el trauma y cómo se puede entender este fenómeno en un grupo seleccionado de pacientes adultos con TDC.Método: Los pacientes con TDC (N = 25) derivados a un programa de tratamiento hospitalario centrado en la disociación completaron la Escala de Déficit e Interferencia Hedónica (HDIS en sus siglas en ingles), y medidas de síntomas relacionados con el trauma y el funcionamiento interpersonal, así como un cuestionario cualitativo que abordaba posibles conflictos internos y fobias con respecto a la experiencia de eventos positivos. Se utilizó un diseño convergente de métodos mixtos para obtener datos diferentes pero complementarios sobre la NAI y así obtener una comprensión más completa del fenómeno.Resultados: Los análisis cuantitativos mostraron una relación significativa entre la NAI y los síntomas relacionados con el trauma y el funcionamiento interpersonal. La NAI parece estar más fuertemente asociada a estos síntomas que la HD. El análisis cualitativo reveló tres temas - miedo, vergüenza y 'partes' agresivas - que impiden las emociones positivas, lo que proporcionó una posible interpretación de los resultados cuantitativos. Los resultados integrados se discutieron a la luz de las teorías de la disociación estructural de la personalidad y del apego.Conclusiones: Estos hallazgos indican que la NAI está relacionada con un espectro de síntomas relacionados con el trauma y el funcionamiento interpersonal en pacientes con un TDC en mayor grado que la HD y que están implicadas diferentes identidades disociativas. Se justifica la realización de estudios sobre la relación entre los cambios en el HDIS (particularmente la subescala NAI) y los cambios en los síntomas relacionados con el trauma y el funcionamiento interpersonal después del tratamiento.

The economic burden of dissociative disorders: A qualitative systematic review of empirical studies.

OBJECTIVE: Dissociative disorders (DDs) are associated with intensive, long-term treatment, suicidality, recurrent hospitalizations, and high rates of disability. However, little is known about the specifics of the economic burden associated with DDs. This worldwide, systematic review examines the results of studies in adults on direct and indirect costs associated with DDs. METHOD: We searched 6 databases and the reference lists of articles. We also approached researchers to identify unpublished studies. No language restrictions were imposed. RESULTS: A total of 1,002 records met the search criteria, of which 29 papers were selected for full-text inspection. Ultimately, of these, we reviewed four empirical studies. We provide a narrative discussion of study findings. Our findings suggest that DDs are costly to society, and that there is a reduction in service utilization and associated costs over time with diagnosing of and specialized treatment for DDs. However, the overall quality of the economic evaluations was low; several types of DDs, comorbid conditions, and costs were not included; and men were underrepresented. Due to the heterogeneity among studies, we could not perform a meta-analysis. CONCLUSIONS: Due to the heterogeneity and low quality of the identified economic evaluations, no firm conclusions about the economic burden of DDs alone can be drawn. Higher quality research, including a detailed description of the study design, population, and primary outcome measures used, utilizing appropriate clinical alternatives and including major comorbidities, is urgently needed to more rigorously assess the economic impact of DDs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

An Online Educational Program for Individuals With Dissociative Disorders and Their Clinicians: 1-Year and 2-Year Follow-Up.

Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and posttraumatic stress disorder (PTSD) symptoms with significant disability. Patients with DD have high rates of nonsuicidal self-injury (NSSI) and suicide attempts. Despite this, there is a dearth of training about DDs. We report the outcome of a web-based psychoeducational intervention for an international sample of 111 patients diagnosed with dissociative identity disorder (DID) or other complex DDs. The Treatment of Patients with Dissociative Disorders Network (TOP DD Network) program was designed to investigate whether, over the course of a web-based psychoeducational program, DD patients would exhibit improved functioning and decreased symptoms, including among patients typically excluded from treatment studies for safety reasons. Using video, written, and behavioral practice exercises, the TOP DD Network program provided therapists and patients with education about DDs as well as skills for improving emotion regulation, managing safety issues, and decreasing symptoms. Participation was associated with reductions in dissociation and PTSD symptoms, improved emotion regulation, and higher adaptive capacities, with overall sample |d|s = 0.44-0.90, as well as reduced NSSI. The improvements in NSSI among the most self-injurious patients were particularly striking. Although all patient groups showed significant improvements, individuals with higher levels of dissociation demonstrated greater and faster improvement compared to those lower in dissociation |d|s = 0.54-1.04 vs. |d|s  = 0.24-0.75, respectively. These findings support dissemination of DD treatment training and initiation of treatment studies with randomized controlled designs.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Un programa educativo online para personas con trastornos disociativos y sus médicos: Seguimiento de uno y dos años INTERVENCIÓN ONLINE PARA TRASTORNOS DISOCIATIVOS Las personas con trastornos disociativos (TDs) se encuentran sub-reconocidas, con pocos servicios y, a menudo, con enfermedades psiquiátricas graves, caracterizadas por marcados síntomas disociativos y de trastorno de estrés postraumático (TEPT) con discapacidad significativa. Los pacientes con TD tienen altas tasas de autolesión no suicida (ALNS) e intentos de suicidio. A pesar de esto, hay una escasez de entrenamiento sobre los TDs. Reportamos el resultado de una intervención psicoeducativa basado en la web para una muestra internacional de 111 pacientes diagnosticados con trastorno de identidad disociativa (TID) u otros TDs complejos. El programa de la Red de Tratamiento de Pacientes con Trastornos Disociativos (TOP DD Network, en su denominación en inglés) se diseñó para investigar si, en el transcurso de un programa psicoeducativo basado en la web, los pacientes con TD exhibirían un mejor funcionamiento y reducción de síntomas, incluso en los pacientes que generalmente han sido excluidos de los estudios de tratamiento por razones de seguridad. Mediante el uso de videos, ejercicios de escritura y prácticas conductuales, el programa TOP DD Network brindó a los terapeutas y los pacientes educación sobre los TDs y las habilidades para mejorar la regulación de las emociones, manejar los problemas de seguridad, y disminuir los síntomas. La participación se asoció con reducciones en los síntomas de disociación y de TEPT, mejor regulación de las emociones y mayores capacidades de adaptación, muestra total ds = .44-.90, así como reducción de ALNS. Las mejoras en ALNS entre los pacientes más auto-agresivos fueron particularmente sorprendentes. Aunque todos los grupos de pacientes mostraron mejoras significativas, los individuos con niveles más altos de disociación demostraron una mejoría mayor y más rápida en comparación con los más bajos en disociación |d|s = .54-1.04 vs. |d|s = .24-.75, respectivamente. Estos hallazgos apoyan la diseminación de la capacitación en el tratamiento del TD y el inicio de estudios de tratamiento con diseños controlados aleatorios.

Early traumatized inpatients high in psychoform and somatoform dissociation: characteristics and treatment response.

This study examined the clinical relevance of differences in psychoform and somatoform dissociative symptoms in 55 early traumatized inpatients. The high psychoform and somatoform dissociative group (n = 18), somatoform dissociative group (n = 22), and nondissociative group (n = 15) did not differ on abuse severity, depressive symptoms, interpersonal problems, Axis I or II comorbidity, or deterioration rates. Compared to the other 2 groups, the highly dissociative group was characterized by younger age, living alone, higher levels of posttraumatic and general distress, more frequent reports of suicidality, self-mutilation, eating problems, and less favorable treatment response. The results highlight the clinical relevance of using dissociation measures for identifying subgroups of patients with severe psychopathology who may be more treatment resistant.

Impact of dissociation and interpersonal functioning on inpatient treatment for early sexually abused adults.

BACKGROUND: Little is known about the possible predictors of treatment outcome in early chronically sexually abused adults. The current study aimed to investigate what impact initial levels of dissociation and pre-treatment negative change in interpersonal functioning have on treatment response after 3 months of first-phase trauma inpatient treatment as well as after a period of 1 year the patients returned to their usual lives. METHODS: The sample comprised 48 inpatients with childhood sexual abuse histories and mixed trauma-related disorders who were examined at discharge and prospectively followed up for a period of 1 year under naturalistic conditions. Outcome variables were general psychiatric symptoms and interpersonal problems as measured with the Symptom Check List-Revised (SCL-R) and the Inventory of Interpersonal Problems (IIP) Circumplex. RESULTS: The central findings were that pathological dissociation and deterioration in interpersonal functioning prior to admittance predicted general psychiatric symptom levels and interpersonal problems at the end of treatment and at 1-year follow-up. Pathological dissociation, involving memory and identity problems, alone predicted negative outcome at the end of treatment. The findings at 1-year follow-up indicate that it is not pathological dissociation in isolation that affects outcomes, but rather the interaction between dissociation and change in interpersonal functioning prior to treatment. CONCLUSION: These findings indicate the need of addressing dissociation and interpersonal problems in treatment planning and favor an integrated treatment approach for complex trauma patients. Future research should investigate whether and how this leads to better outcome, including long-term maintenance of gains after the end of treatment.

Inpatient treatment for adult survivors of childhood sexual abuse: a preliminary outcome study.

The objective of this study was to examine the changes in psychiatric symptoms and interpersonal problems in 34 adults with a history of childhood sexual abuse and posttraumatic stress disorder who attended a 3-month inpatient treatment program. Levels of posttraumatic, depressive, and general psychiatric symptoms and interpersonal problems were assessed at pre-care evaluation, admission, discharge, and 1-year follow-up using the Impact of Event Scale, the Beck Depression Inventory, the Symptom Check List 90 Revised, and the Inventory of Interpersonal Problems. Work status was assessed at admission and at follow-up. Significant improvements were seen during treatment on the global scores of all instruments except the Beck Depression Inventory. At follow-up, patients had kept their gains on symptom measures and experienced further progress regarding interpersonal problems. At discharge, 3 of the previously 32 unemployed patients were able to return to work. Patients with comorbid somatization disorder tended to have higher levels of distress and less favorable treatment response. Future studies should include pre- and posttreatment assessment of dissociation to evaluate its association with outcome.