Psychotherapy for dissociative disorders has a long-term benefit - Assessment over a six-year period provides clearly positive results

By: Tom Cloyd - 5 minute read

(Published: 2025-06-28; reviewed: 2025-06-28:2147 Pacific Time (USA))

Page contents…

• Essential background to this study ^
• Six-year follow-up study procedure ^
• Six-year follow-up study results ^
• Cautions as to the meaning of these results ^
• References ^
• Notes ^

SUMMARY OF: Myrick, A. C., Webermann, A. R., Loewenstein, R. J., Lanius, R., Putnam, F. W., & Brand, B. L. (2017). Six-year follow-up of the treatment of patients with dissociative disorders study. European Journal of Psychotraumatology, 8(1), 1344080. https://doi.org/10.1080/20008198.2017.1344080

Access the full article online.

We offer here a summary of this methodologically complex follow-up study to assist non-professionals in understanding its important findings. (Quotes not otherwise cited, below, are from the article above.)

Essential background to this study ^{^}

Dissociative disorders present a significant, but mostly hidden mental health problem, worldwide. Large population studies have historically omitted consideration of these disorders, but studies that do consider them generally produce a lifetime prevalence rate of about 10%.¹ Affected individuals live with “…severe psychiatric symptoms, complex emotional, social, and physical health difficulties, and high levels of functional impairment related to chronic, severe childhood trauma.”

Trauma-focused treatment, both outpatient and inpatient, has been found to be useful and effective, with patients generally showing “…improvement in social, psychological, and occupational functioning.” The Treatment of Patients with Dissociative Disorders (TOP DD) study, a prospective, longitudinal study that is the largest of its kind ever attempted, reported in 2013² that phased outpatient treatment of individuals diagnosed with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDN DDOS) produced a broad range of positive results (see note³ for details).

The purpose of the present study is to revisit the question of treatment outcomes six years after the beginning of the TOP DD study.

Six-year follow-up study procedure ^{^}

Therapists originally participating in the TOP DD study, as well as others who joined as the study progressed, were invited to complete an online brief survey about treatment outcome. Patients were not contacted, both due to lack of contact information and due to concerns that being approached about current status might be distressing to some of them.

The study design was particularly complex due to both therapists and patients entering and leaving the study over the six years, and the patients themselves being at varying stages of their treatment at the time that data were gathered. (Stages of treatment are discussed below.)

Therapists were asked to report on:

• patient treatment stage⁴ (beginning with stage 1 - “stabilization and establishing safety”, working through trauma memories, and ending with stage 5 - “integration and reconnection within self and with others”).
• patient stressors in the previous 6 months (factors like sexual, physical, or emotional revictimization, family-related changes, therapy-related stresses, support-resource-related stresses).
• quality of life - romantic relationships, friendships, and employment status.
• global assessment of function - a well-known American Psychiatric Association scale that assesses psychosocial functioning, safety, and stability of symptoms.
• safety - measured by number of inpatient hospital admissions, number of days hospitalized, number of suicide attempts and self-injurious behaviors.
• intimate partner violence and sexual revictimization - considered were events of victimization, perpetration, or both combined.

Six-year follow-up study results ^{^}

Quality of life was significantly higher, and stressors significantly lower, even when the effect of treatment stage was considered.⁵ Over time, hospitalizations decreased and functioning improved. “No outcome assessed in this study worsened over time.”

Decreased hospitalizations are a critical positive outcome, as hospitalizations and the events leading to them are both costly and seriously disruptive. This reduction represents to a dramatic decrease in the broad-spectrum costs of living with a dissociative disorder.

For many, life remains challenging, although much improved. Particularly difficult are maintaining healthy relationships, which is not surprising given that the original injury was in the context of intimate relationships. But the study indicates clear improvement over time, for most individuals.

Cautions as to the meaning of these results ^{^}

The sample size for the six-year follow-up study was small, as there was considerable drop-out of patients during this period. Those who made it to this point in the study were possibly the most motivated patients and the most skilled therapists. In addition, the data reported were not directly from patients, the effect of which is likely complex.

Clearly, psychotherapy, using the staged model⁴ has distinct benefits for many patients. In the future, special focus needs to be on obtaining patient-report data, making special efforts to retain patients, and giving particular attention to the challenge of healthy relationships.

References ^{^}

Brand, B. L., McNary, S. W., Myrick, A. C., Classen, C. C., Lanius, R., Loewenstein, R. J., Pain, C., & Putnam, F. W. (2013). A longitudinal naturalistic study of patients with dissociative disorders treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 5(4), 301–308. https://doi.org/10.1037/a0027654

International Society for the Study of Trauma and Dissociation (ISSTD). (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187.

Sar, V. (2011). Epidemiology of Dissociative Disorders: An Overview. Epidemiology Research International, 2011(1), 404538. https://doi.org/10.1155/2011/404538

Notes ^{^}

 

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