Schneiderian First Rank Symptoms Significantly Predict a Dissociative Disorder Diagnosis in Psychiatric In-Patients.

Previous empirical studies on the relationship between psychotic symptoms and dissociative disorders focused on auditory hallucinations only or employed limited statistical analyses. We investigated whether the frequency of Schneiderian first rank symptoms (FRS) predicts the presence or absence of a dissociative disorder (DD). Psychiatric in-patients (n = 116) completed measures of dissociation, FRS and general psychological distress (GPD). DD diagnoses were confirmed by multidisciplinary teams or administering the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R). The FRS were recorded in the Multidimensional Inventory of Dissociation (MID) and a mean score obtained for 35 relevant items: Voices arguing, voices commenting, made feelings, made impulses, made actions, influences on body, thought withdrawal, and thought insertion. A global severity index (GSI) of GPD was obtained from the Symptom Checklist-90-Revised (SCL-90-R). Logistic regression models examined whether FRS predict diagnostic classification of patients under a DD (n = 16) or not (n = 100), controlling for GSI. The overall fit of the model was significant (p = .0002). DD was correctly classified using frequency of FRS, controlling for GSI. The latter was moderately associated with FRS (r = 0.56). FRS more than doubled the odds of a DD diagnosis (odds = 2.089; 95% CI = 1.409-3.098; correct classification rate 87.1%). The study provides convincing evidence that FRS are closely related to DDs. FRS should alert clinicians to consider DDs in differential diagnosis of psychiatric in-patients. Future research should analyze whether FRS also predict a diagnosis of schizophrenia or other psychiatric disorders.

Restorative justice in a case of traumatic birth following an unperceived pregnancy.

PURPOSE: Pregnancy can be denied or better "unperceived" by women in up to 1:300 pregnancies and poses the mother and her unborn at high risk when an unassisted birth follows. The importance of recognizing unperceived pregnancy and the risk of unassisted births for both mothers and their babies are described. METHODS: Description of a case of unperceived pregnancy and traumatic unassisted birth. RESULTS: A pregnant woman was not diagnosed in a clinic despite being at the verge of giving birth. She was turned away, was on her way to another hospital, and gave birth in a toilet in a dissociative state. The baby survived, but the mother was declared guilty of attempted manslaughter and received a 6-year prison sentence. The expertise of a perinatal psychiatrist reversed the verdict and the court apologized to the mother, now living with her son. CONCLUSIONS: This case shows the severe consequences when pregnancy and labor are not recognized by health professionals. The reversal of the original sentence is considered a pioneer case of restorative justice in the context of unperceived pregnancy and obstetric violence. Health providers and courts need to be informed by perinatal mental health professionals about the impact of unperceived pregnancy and obstetric violence.

Characteristics, Methods, And Functions Of Non-Suicidal Self-Injury Among Highly Dissociative Individuals.

Upto 86% of dissociative individuals engage in non-suicidal self-injury (NSSI). Research suggests that people who dissociate utilize NSSI to regulate posttraumatic and dissociative experiences, as well asrelated emotions. Despite high rates of NSSI, no quantitative study has examined the characteristics, methods, and functions of NSSIwithin a dissociative population. The present study examined thesedimensions of NSSI among dissociative individuals, as well aspotential predictors of intrapersonal functions of NSSI. The sample included 295 participants who indicated experiencing one or more dissociative symptoms and/or having been diagnosed with a trauma- or dissociation-related disorder. Participants were recruited through online trauma- and dissociation- related forums. Approximately 92% of participants endorsed a history of NSSI. The most common methods of NSSI were interfering with wound healing (67%), hitting oneself (66%), and cutting (63%). After controlling for age and gender, dissociation was uniquely associated with cutting, burning, carving, interfering with wound healing, rubbing skin against rough surfaces, swallowing dangerous substances, and other forms of NSSI. Dissociation was correlated with affect regulation, self-punishment,anti-dissociation, anti-suicide, and self-care functions of NSSI;however, after controlling for age, gender, depressive symptoms, emotion dysregulation, and PTSD symptoms, dissociation was no longer associated with any function of NSSI. Instead, only emotion dysregulation was associated with the self-punishment function ofNSSI and only PTSD symptoms were associated with the anti-dissociation function of NSSI. Understanding the unique properties of NSSI among dissociative individuals may improve the treatment of people who dissociate and engage in NSSI.

Towards a new understanding of pregnancy denial: the misunderstood dissociative disorder.

Pervasive pregnancy denial is a misunderstood reproductive anomaly which compromises the health of both mother and the developing fetus. Because in extreme cases, the death of the neonate at the hands of his/her mother has criminal repercussions, research has attempted to explain the origins of this clinical phenomenon. The purpose of this review is to analyze the evolution of understanding the association between pregnancy denial and neonaticide. This paper identifies the consistent similarities in symptom presentation, particularly dissociation, when a denied pregnancy ends with the death of the newborn. The common thread across the progression of the literature over time serves as a foundation for considering the development of diagnostic criteria for future inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This paper reviews the seminal research from 1969 to current research up to 2020 addressing pregnancy denial and its connection to neonaticide. Peer reviewed and published articles related to key terms around "pregnancy denial," "pregnancy concealment," "neonaticide," and "dissociation" were retrieved from major databases such as PubMed, PsychINFO, JSTOR, ProQEST, ScienceDirect, and Google Scholar. Reference lists of relevant articles were also scanned to search for further papers pertaining to similarities in symptom presentation across demographic profiles. Papers were excluded if they were not available in English, or if they did not contribute to identifying consistencies in clinical presentation when a pregnancy is denied. There are clear repetitive markers that occur across studies which pertain not only to the frequent absence of certain expected indicators of pregnancy, (i.e. no morning sickness, weight gain, or sensations of fetal movement), but also the misattribution of pregnancy-related symptoms, and the consistent experience of a dissociative episode while giving birth that can unintentionally result in neonaticide. This paper concludes that dissociation is a consistently seen symptom in pervasive pregnancy denial. Dissociation, in addition to other commonly seen symptoms across cases, suggests specific diagnostic criteria that lend themselves to inclusion in the Diagnostic and Statistical Manual of Mental Disorders.

A systematic scoping review of dissociation in borderline personality disorder and implications for research and clinical practice: Exploring the fog.

BACKGROUND: Borderline Personality Disorder (BPD) is frequently complicated by the presence of dissociative symptoms. Pathological dissociation is linked with earlier and more severe trauma exposure, emotional dysregulation and worse treatment outcomes in Posttraumatic Stress Disorder and Dissociative Disorders, with implications for BPD. OBJECTIVE: A systematic scoping review was conducted to assess the extent of current literature regarding the impact of dissociation on BPD and to identify knowledge gaps. METHODS: Four electronic databases (MEDLINE, APA PsycINFO, EMBASE, CINAHL Plus) were searched, and English peer-reviewed studies with adults with BPD were included, following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension for scoping reviews (PRISMA-ScR) 2018 guidelines. RESULTS: Most of the 70 included studies were observational (98%) with first authors from Germany (59%). Overall, dissociation was associated with increased BPD symptom severity, self-harm and reduced psychotherapy treatment response; findings regarding suicide risk were mixed. Dissociation was associated with working memory and cognitive deficits, decreased pain perception, altered body ownership, no substance abuse or the abuse of sedative substances, increased fantasy proneness, personality fragmentation, fearful attachment, dream anxiety, perceived stress and altered stress responses, increased cumulative body mass index, decreased water consumption, several neurological correlates and changes in gene expression. CONCLUSION: BPD with significant dissociative symptoms may constitute a more severe and at-risk subgroup of BPD patients. However, there are significant research gaps and methodological issues in the area, including the possibility of unrecognized Dissociative Disorders in BPD study populations confounding results. Further studies are needed to better understand the impact of dissociation on BPD course and treatment, and to clarify the most appropriate assessment tools for clinical practice. In addition, interventional studies are needed to develop dissociation-specific BPD treatments to determine whether targeting dissociation in BPD can improve treatment outcomes.

Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat.

As recently as the late 20th century, Schizophrenia, a category of mental illness with widely varying phenotypic symptoms, was believed by psychobiologists to be a genetically based disorder in which the environment played a limited etiological role. Yet a growing body of evidence indicates a strong correlation between schizophrenia and environmental factors. This theoretical paper explores the relationship between highly elevated rates of schizophrenia in some low-income minority communities worldwide and trauma-related dissociative symptoms that often mimic schizophrenia. Elevated rates of schizophrenia in racially and ethnically isolated, inner-city Black populations are well documented. This paper contains evidence proposing that this amplification in the rate of schizophrenia is mediated by childhood trauma, disorganized attachment, and social defeat. Further, evidence demonstrating how these three variables combine in early childhood to incubate dissociative disorders will also be conveyed. The misdiagnosis of dissociative disorders as schizophrenia is theorized to partially mediate the increased rate of schizophrenia in communities that experience high levels of racial/ethnic discrimination. It is argued that this misdiagnosis is often attributable to cultural misunderstanding and/or a lack of knowledge about dissociative disorders.

Predicting outcome of patients with psychogenic nonepileptic seizures after diagnosis in an epilepsy monitoring unit.

OBJECTIVE: To identify predictors of Psychogenic NonEpileptic Seizure (PNES) improvement and anti-seizure medication (ASM) discontinuation in patients with PNES only. METHODS: This is a retrospective study of a consecutively enrolled cohort of 271 patients diagnosed with PNES by video-EEG (vEEG) telemetry in our Epilepsy Monitoring Unit (EMU) between May 2000 and February 2010. Patients with any possibility of past or present comorbid epilepsy based on clinical, EEG, and neuroimaging, or less than one year of follow-up after discharge were excluded. RESULTS: A total of 109 subjects were included. The mean age at PNES onset was 33 (range 6-89), mean age at EMU admission was 38.3 (16-89.8), 70.6% were female mean video-EEG length was 6.1 days, and the median time of final follow-up 3.3 (CI 1.6-6.4) years. 51/108 patients (47.2%) reported a PNES decrease and 29 (26.8%) experienced PNES resolution. 59/73 (81.9%) subjects on ASM at the time of EMU admission were able to discontinue them by the final visit. On univariate analysis, patients whose PNES frequency improved were significantly younger at time of admission, more likely married or cohabiting, less likely unemployed, less likely to have migraine, and had a higher frequency of PNES. On hierarchical regression analysis, younger age and employment remained significant predictors of PNES improvement and resolution. Patients who achieved ASM discontinuation had significantly more children and subsequent EMU visits, were less likely to have history of minor head trauma immediately preceding PNES onset and structural brain lesions, experienced a greater reduction of ASMs during the EMU admission, and had a greater improvement of their PNES frequency at the final visit (p ≤ 0.05). On hierarchical regression analysis, higher number of children, absence of structural brain lesions, fewer ASMs at EMU discharge, and improvement of PNES frequency remained significant predictors of ASM discontinuation. CONCLUSION: The outcome of PNES is positively correlated with earlier age of diagnosis in an EMU, especially in patients with better social resources. Furthermore, discontinuation of ASM is more likely if the process is initiated during the EMU stay and in the absence of structural brain lesions.

Dissociative Identity Disorder: Diagnostic Accuracy and DSM-5 Criteria Change Implications.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) revised the diagnostic criteria for dissociative identity disorder (DID) to more accurately reflect the symptom profile of DID patients. No study has examined how this change affects clinical diagnosis of DID. The present study examined clinician reports of patient symptoms in relation to DSM-IV-TR and DSM-5 DID diagnostic criteria. Data were analyzed from 169 clinicians who participated in the Treatment of Patients with Dissociative Disorders Network Study with a patient they assigned a DID diagnosis. Clinicians evaluated their patients with respect to DSM-IV-TR and DSM-5 DID diagnostic criteria. Researchers determined a clinician-assigned DID diagnosis as "accurate" when the patient's reported dissociative symptoms matched DSM-IV-TR and/or DSM-5 criteria for DID. Most of the clinicians (95.27%) accurately diagnosed DID. Of those accurately diagnosed, 83.85% of patients met DSM-IV-TR and DSM-5 DID criteria, 9.94% only met DSM-IV-TR DID criteria, and 6.21% only met DSM-5 DID criteria. Further examination of responses suggested that possible idiomatic responses to the negative wording of the DSM-5 exclusionary criteria might have accounted for the DSM-IV-TR appearing to fit for a greater number of cases in this study. Changes in the DSM criteria for DID did not substantially change the frequency or accuracy of assigned DID diagnoses, but the removal of the requirement in DSM-5 that self-states regularly take control of an individual's behavior slightly increased the number of individuals meeting criteria for DID.

Revisiting the concept of severe mental illness: severity indicators and healthcare spending in psychotic, depressive and dissociative disorders.

Background: The concept of severe mental illness (SMI) has been related to bipolar or psychotic diagnosis, or to some cases of depressive disorders. Other mental health problems such as personality disorders or posttraumatic dissociative conditions, which can sometimes lead to relevant functional impairments, remain separate from the SMI construct.Aims: This study aimed to evaluate the clinical severity as well as healthcare spending on dissociative disorders (DDs). This diagnostic group was compared with two other groups usually considered as causing severe impairment and high healthcare spending: bipolar and psychotic disorders, and unipolar depression.Methods: From a random sample of 200 psychiatric outpatients, 108 with unipolar depression (N = 45), psychotic/bipolar (N = 31) or DDs (N = 32) were selected for this study. The three groups were compared by the severity of their disorder and healthcare indicators.Results: Of the three groups, those with a DD were more prone to and showed higher indices of suicide, self-injury, emergency consultations, as well as psychotropic drug use. This group ranked just below psychotic/bipolar patients in the amount of psychiatric hospitalisations.Conclusions: Despite a certain intra-professional stigma regarding DDs, these data supported the severity of these posttraumatic conditions, and their inclusion in the construct of SMI.

Fibromyalgia and dissociative symptoms.

BACKGROUND: Fibromyalgia (FM) is a chronic pain syndrome with a controversial etiopathogenesis. Patients with FM usually complain of cognitive symptoms, which are described as "fibrofog." These cognitive complaints might be caused partially by dissociative disorders (DD). The aim of this research is to determine the association between FM and DD. METHODS: The authors conducted a case-control study for this purpose, integrated by 3 groups: control (C), patients with rheumatic disorders (R), and patients with FM (FM), who were compared through the Dissociative Experiences Scale (DES).The findings are as follows: 42% were taking medications in the FM group, and their differences in scores with those who were not under medications were then considered. In terms of the results, the FM group showed higher scores than both C and R groups (p < 0.05). Patients with FM who were taking antidepressants had lower scores than those who were not (Z-score -8.03; p < 0.05); and finally, 5.71% had a score over 30 (χ2 = 3.73, p = 0.15). CONCLUSION: Patients with FM had higher scores, which might be related to the association of dissociative experiences, lifetime trauma, and victimization. Antidepressants might have some role on dissociative symptoms as well.

Towards a Multi-Level Phenomenology of Delusional Disorder: The Dissociative Thought-Script.

Delusional disorder (DD) is still considered a diagnosis of exclusion for a difficult-to-treat condition characterised by the presence of delusional beliefs in the absence of other psychiatric symptoms. Attempts to contextualise psychological processes recognised since the earliest observations of this disorder have had very limited impact on improving some fixed beliefs. In the Cambridge Early Intervention in Psychosis Service we have observed a particular phenomenon, often categorised as a delusional idea in the context of DD, which manifests through highly repetitive belief expression that fails to respond to pharmacological and psychological treatments. Key aspects of this phenomenon are similar to those observed in dissociative (functional neurological) presentations. Drawing on the Integrative Cognitive Model of functional neurological disorders, we developed a successful psychological intervention that places less emphasis on challenging delusional content and focuses more on dismantling dissociation and underlying affective factors associated with the activation of the fixed belief. Our initial findings reinforce the need to continue developing a multi-level phenomenological approach to define a variety of symptoms traditionally grouped under the concept of "delusion."

Is there a complex relation between social anxiety disorder, childhood traumatic experiences and dissociation?

BACKGROUND: A possible relationship has been suggested between social anxiety and dissociation. Traumatic experiences, especially childhood abuse, play an important role in the aetiology of dissociation. AIM: This study assesses childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with social anxiety disorder (SAD). METHOD: The 94 psychotropic drug-naive patients participating in the study had to meet DSM-IV criteria for SAD. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), the Dissociation Questionnaire (DIS-Q), the Liebowitz Social Anxiety Scale (LSAS), and the Childhood Trauma Questionnaire (CTQ). Patients were divided into two groups using the DIS-Q, and the two groups were compared. RESULTS: The evaluation found evidence of at least one dissociative disorder in 31.91% of participating patients. The most prevalent disorders were dissociative disorder not otherwise specified (DDNOS), dissociative amnesia, and depersonalization disorders. Average scores on LSAS and fear and avoidance sub-scale averages were significantly higher among the high DIS-Q group (p < .05). In a logistic regression taking average LSAS scores as the dependent variable, the five independent variables DIS-Q, CTQ-53 total score, emotional abuse, sexual abuse, and emotional neglect were associated with average LSAS scores among patients with SAD (p < .05). CONCLUSIONS: It is concluded that, on detecting SAD symptoms during hospitalization, the clinician should not neglect underlying dissociative processes and traumatic experiences among these patients.

[Factitious disorders]. / Artifizielle Störungen.

Patients with factitious disorders intentionally fabricate, exaggerate or feign physical and/or psychiatric symptoms for various open and covert psychological reasons. There are many issues regarding the diagnostic state and classification of factitious disorders. Both the categorical differentiation of and clinical continuum ranging from somatoform/dissociative disorders to malingering are being controversially debated. Epidemiological studies on the frequency of factitious disorder meet basic methodological difficulties. Reported rates of prevalence and incidence in the professional literature most probably have to be considered underestimations. Illness deception and self-harm as core features of the abnormal illness behaviour in factitious disorder may refer to various highly adverse and traumatic experiences during early development in a subgroup of patients. Chronic courses of illness prevail; however, there are also episodic variants.

[Differential diagnosis of dissociative seizures]. / Differenzialdiagnose dissoziativer Anfälle.

Patient history taking and semiology provide seminal clues to the diagnosis of dissociative seizures. Openness and alertness of the treating physician are essential. Video-electroencephalogram(EEG)-based analyses of the events are crucial to establish the correct diagnosis, particularly in complex cases. The patient-doctor relationship is of particular importance in order to successfully motivate the patient for psychotherapeutic treatment. Coexisting psychiatric morbidity as well as other functional somatic symptoms must be actively explored. Current changes in the established diagnostic manuals, including ICD-11, reflect the ongoing vivid interest and controversial discussions in the field of dissociative disorders.

Tracking down the footprints of bad paternal relationships in dissociative disorders: A diffusion tensor imaging study.

Preclinical studies indicate that stress early in life can cause long-term alterations in brain development. Studies have shown alterations in the brain functions of patients after experiencing trauma. Our aim is to examine whether the integrity of white matter tracts might be affected in dissociative disorder (DD) patients. A total of 15 DD patients and 15 healthy controls were studied, with the groups matched by age and gender. Diffusion-weighted echoplanar brain images were obtained using a 1.5 Tesla magnetic resonance imaging scanner. Regions of interest were manually placed on directional maps based on principal anisotropy. Apparent diffusion coefficient and fractional anisotropy (FA) values of white matter were measured bilaterally in the anterior corona radiata (ACR) and by diffusion tensor imaging in the genu and splenium of the corpus callosum. Significantly lower FA values were observed in the right ACR of DD patients versus healthy individuals. We also found an association between bad paternal relationships and lower FA in the genu of the corpus callosum in female patients. Alterations in the right ACR suggest that diffusion anisotropy measurement can be used as a quantitative biomarker for DD. Paternal relationships may also affect the brain's microstructure in women with DD.

[Hysterical pseudo-coma: A case report]. / Le pseudo-coma hystérique: à propos d'un cas clinique.

Hysterical pseudo-coma corresponds to a state of clinical sleep with contrasting waking electroencephalogram. It can last several hours or even several days in the absence of an underlying organic disease. In psychiatry, this disorder is currently part of the "dissociative disorder not otherwise specified". Through this case report, we describe the evolution of a hysterical pseudo-coma that lasted four days in a 28-year-old man. The normality of biological, radiological and electroencephalographic assessments, and responsiveness of the patient during the implementation of a nasogastric tube, led us to suspect a mental origin. An adapted psychiatric care allowed the patient to recover his autonomy after three days of hospitalization. This had prevented the escalation of explorations and invasive treatments. However, the search for organic comorbidity and its management remains a priority.

Sleep-Related Dissociative Disorders.

In sleep-related dissociative disorders, phenomena of the psychiatrically defined dissociative disorders emerge during the sleep period. They occur during sustained wakefulness, either in the transition to sleep or following an awakening from sleep. Behaviors during episodes vary widely, and can result in injury to self or others. Daytime dissociative episodes and a background of trauma are almost always present; there is typically major co-existing psychopathology. Diagnosis is based on both clinical history and polysomnography; differential diagnosis primarily involves other parasomnias and nocturnal seizures. Information available about treatment is limited; in a few reported cases, psychological interventions have proven effective.

Anger regulation in patients with functional neurological disorder: A systematic review.

BACKGROUND: Functional neurological disorder (FND) has been associated with predisposing psychological factors, including dysregulation of anger-related processes. This paper provides a systematic review of the literature on anger regulation in FND. We evaluated anger-related research on patient self-report, observational, and laboratory based measures in FND. The review also addresses adverse childhood experiences and their relation with anger regulation, and the effects of therapies targeting anger regulation in FND. METHODS: MEDLINE, EMBASE, and PsycINFO were searched for both quantitative and qualitative research, published in a peer-reviewed journal with a sample size of at least 5 (registered under Prospero protocol CRD42022314340). RESULTS: A total of 2200 articles were identified. After screening, 54 studies were included in this review (k = 20 questionnaire-based studies, k = 12 laboratory studies, k = 21 using other methods, and k = 1 used both questionnaires and other methods) representing data of 2502 patients with FND. Questionnaire-based studies indicated elevated levels of state anger and trait hostility in patients with FND. Laboratory studies showed a higher tendency to avoid social threat cues, attentional bias towards angry faces, difficulties reliving anger, and preoccupation with frustrating barriers among FND patients versus controls. No specific childhood experiences were identified related to anger regulation in FND, and too few small and uncontrolled studies were available (k = 2) to assess the effects of anger-related interventions in FND. The overall quality of the studies was fair (k = 31) to poor (k = 18). Five studies (k = 5) were rated as having a good quality. CONCLUSIONS: This review suggests that patients with FND have maladaptive anger regulation compared to individuals without FND. The findings also highlight the need for further research on the prevalence and consequences of anger-related processes in the development, diagnosis and treatment of FND.

Experimental evidence for a robust, transdiagnostic marker in functional disorders: Erroneous sensorimotor processing in functional dizziness and functional movement disorder.

OBJECTIVE: Recent neuroscientific models suggest that functional bodily symptoms can be attributed to perceptual dysregulation in the central nervous system. Evidence for this hypothesis comes from patients with functional dizziness, who exhibit marked sensorimotor processing deficits during eye-head movement planning and execution. Similar findings in eye-head movement planning in patients with irritable bowel syndrome confirmed that these sensorimotor processing deficits represent a shared, transdiagnostic mechanism. We now examine whether erroneous sensorimotor processing is also at play in functional movement disorder. METHODS: We measured head movements of 10 patients with functional movement disorder (F44.4, ICD-10), 10 patients with functional dizziness (F45.8, ICD-10), and (respectively) 10 healthy controls during an eye-head experiment, where participants performed large gaze shifts under normal, increased, and again normal head moment of inertia. Head oscillations at the end of the gaze shift served as a well-established marker for sensorimotor processing problems. We calculated Bayesian statistics for comparison. RESULTS: Patients with functional movement disorder (Bayes Factor (BF)10 = 5.36, BFincl = 11.16; substantial to strong evidence) as well as patients with functional dizziness (BF10 = 2.27, BFincl = 3.56; anecdotal to substantial evidence) showed increased head oscillations compared to healthy controls, indicating marked deficits in planning and executing movement. CONCLUSION: We replicate earlier experimental findings on erroneous sensorimotor processing in patients with functional dizziness, and show that patients with functional movement disorder show a similar impairment of sensorimotor processing during large gaze shifts. This provides an objectively measurable, transdiagnostic marker for functional disorders, highlighting important implications for diagnosis, treatment, and de-stigmatization.

Helpful and meaningful aspects of a psychoeducational programme to treat complex dissociative disorders: a qualitative approach.

Purpose: Complex dissociative disorders (CDDs) are prevalent among psychotherapy clients, and research suggests carefully paced treatment for CDDs is helpful. The purpose of the present study is to qualitatively explore helpful and meaningful aspects of the TOP DD Network programme, a web-based adjunctive psychoeducational programme for the psychotherapeutic treatment of clients with CDDs.Methods: TOP DD Network programme participants (88 clients and 113 therapists) identified helpful and meaningful aspects of their participation in response to two open textbox questions. Framework analysis was used to qualitatively analyze client and therapist responses.Findings: Participants found the TOP DD Network programme helpful and meaningful in nuanced ways. Three themes were created: (1) Components of the Programme (subthemes: content, structure), (2) Change-Facilitating Processes (subthemes: heightened human connection, receiving external empathy and compassion, contributing to something bigger, improved therapeutic work and relationship), and (3) Outcomes (subthemes: insight, increased hope, self-compassion, increased safety and functioning). The most emphasized theme was components of the programme, which captured its content and structure.Conclusion: Clients and therapists in the TOP DD Network programme described the programme's components and processes as helpfully facilitating positive outcomes in the treatment of CDDs. Therapists may consider integrating the components and processes in the programme into their practice with clients with CDDs.

The aim of the present study was to qualitatively explore significant aspects of the TOP DD Network programme through the experiences of complex dissociative disorder (CDD) clients and psychotherapists.Helpful and meaningful aspects of the programme included its components (i.e. content and structure), processes, and outcomes.This psychoeducational programme can be effective and result in improved therapeutic processes and outcomes for individuals with CDDs in psychotherapy.