The treatment of traumatic memories in DID: indications and contra-indications

p. 065-079A treatment model with a focus on trauma treatment and subsequent integration is widely accepted as the most successful among therapists treating DID. However, this model may not be the best option for all DID patients. Lower functioning patients often do not have the strength or therapeutic potential and/or opportunity to endure this kind of treatment. This article discusses indications and contra-indications for entering into the second phase in the treatment of DID patients: the treatment of traumatic memories. A checklist was developed to evaluate the treatment process and make a well-founded decision about the transition from phase I, stabilization and symptom reduction, to phase II, treatment of traumatic memories. Criteria that influence a decision to focus on phase I only, without proceeding to phase II, will be discussed. Clinical examples will demonstrate the use of the checklist

Treatment strategies for complex dissociative disorders: two dutch case examples

p. 157-165In the Netherlands, the diagnosis of dissociative identity disorder (DID) is widely accepted, although skeptics also have made their opinions known. Dutch clinicians treating DID patients generally follow the common three-phase model for treatment of post-traumatic stress. Given the fact that they usually deal with complicated cases and enmeshed patients (cf. Horevitz E. Loewenstein, 1994), most often treatment is restricted to Phase 1: stabilization and symptom reduction. Treatment of higher functioning patients, on the other hand, usually aims at processing of traumatic memories and complete personality integration as well. In this article, two Dutch cases are described in detail, with a special emphasis on the clinical deliberations which, in the first case, led to the decision to proceed to trauma treatment, and which led in the second case to the decision to refrain from it

Article titleThe differentiation of patients with MPD of DDNOS from patients with a cluster B personality disorder

p. 126-135Because of similarities in presentation, multiple personality disorder (MPD) and dissociative disorder not otherwise specified (DDNOS) can be misdiagnosed as borderline personality disorder (BPD) or another cluster B personality disorder. In order to find distinguishing symptoms, four groups of patients are compared: DDNOS patients (N=24); MPD patients (N=49); patients with BPD or histrionic personality disorder, referred for evaluation of dissociative pathology (N=21); control patients with a cluster B personality disorder (N=19). All patients were interviewed with the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D) and the Structured Trauma Interview (STI). Although there are many areas of overlap in the phenomenology of patients with MPD or DDNOS and patients with a "cluster B" personality disorder, we clearly found that these groups can be differentiated by the severity and cluster of dissociative symptoms, the prevalence of some Schneiderian symptoms, and the severity of childhood trauma

The validation of the Dissociative Experiences Scale against the criterion of the SCID-D, using Receiver Operating Characteristics (ROC) analysis

p. 028-037Objective and method: The aim of this study is to analyze the utility of the Dissociative Experience Scale (DES) as a screener for dissociative disorders. The Structured Clinical Interview for DSM-IIIR Dissociative Disorders (SCID-D) was used as standard of comparison. Forty-three patients with a dissociative disorder and 36 control patients with a range of psychiatric diagnoses participated in the study. Results: The DES distinguishes dissociative disorder patients from non-dissociative disorder patients very well (p<.0001); diagnostic utility of the DES based on Receiver Operating Characteristic (ROC) analysis is excellent (AUC=.96). The optimal cut-off score of 25 yields good to excellent sensitivity (93 %) and specificity (86%). The positive predictive value of the DES (≥25) in random clinical samples is limited (.26 - .54) due to the relatively low estimated prevalence rate of dissociative disorders (5 - 15% respectively); the negative predictive value is high (.99). The use of a confirmatory interview such as the SCID-D is required to eliminate false positives

Contemporary Interest in Multiple Personality Disorder and Child Abuse in the Netherlands

p. 034-037Interest in multiple personality disorder (MPD) as well as sexual child abuse is rapidly growing in the Netherlands, perhaps more so than in other European countries. Clinical, theoretical, and research developments in these respects are outlined, and it is mentioned that patients stating that they have been victims of satanic cult abuse are also encountered in the Netherlands. The need for more international cooperation is expressed

Group treatment for Complex Dissociative Disorders: A randomized controlled trial

This manuscript was published in BMC Psychiatry 16th of May 2022: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-03970-8 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 group – treatment, 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, &amp; 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

Group treatment for complex dissociative disorders: a randomized clinical trial

Background Patients with complex dissociative disorders (CDD) 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. The current study evaluates a structured protocolled group treatment delivered in a naturalistic clinical setting to patients with CDD, as an add-on to individual treatment. Methods Fifty nine patients with CDD were randomized to 20 sessions of stabilizing group–treatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment was based on the manual Coping with Trauma-Related Dissociation. The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, and interpersonal difficulties. Results Mixed effect models showed no condition x time interaction during the delayed treatment period, indicating no immediate differences between conditions in the primary outcome. Similar results were observed for secondary outcomes. Within-group effects were non-significant in both conditions from baseline to end of treatment, but significant improvements in psychosocial function, PTSD symptoms, and general psychopathology were observed over a 6-months follow-up period. Conclusion In the first randomized controlled trial for the treatment of complex dissociative disorders, stabilizing group treatment did not produce immediate superior outcomes. Treatment was shown to be associated with improvements in psychological functioning. Trial registration Clinical Trials ( NCT02450617 )

The treatment of traumatic memories: synthesis, realization, and integration

p. 162-180This paper is based on Pierre Janet's dissociation theory and his concept of the non-realization of a traumatic event. A model of treatment that integrates Janet's dissociation-integration theory with contemporary trauma-based models of therapy is delineated. The nature of traumatic memories is described, and a stage-oriented model for their treatment in patients with multiple personality disorder (MPD) is presented. Ideally a discrete phase in the overall treatment of MPD, this phase can itself be subdivided into the following stages: (1) preparation; (2) synthesis; and (3) realization/integration. Although a number of treatment recommendations are offered, the emphasis here is more on clarifying concepts than on the description of techniques