Zaburzenia dysocjacyjne
Rokowania, prognozy i postęp choroby

Rokowanie w zaburzeniach dysocjacyjnych jest zróżnicowane i zależy od rodzaju zaburzenia, momentu rozpoczęcia leczenia oraz zastosowanych metod terapeutycznych. Krótkoterminowo obserwuje się stosunkowo korzystne wyniki, jednak w długim okresie (średnio 12,4 lat) około 26,1% pacjentów nadal doświadcza zaburzeń dysocjacyjnych, a 82,6% spełnia kryteria innych zaburzeń psychicznych. Czynniki negatywnie wpływające na rokowanie to m.in. większa liczba objawów w dzieciństwie, leczenie szpitalne w młodym wieku oraz wysoki początkowy poziom dysocjacji. Wczesne rozpoczęcie terapii, szczególnie u dzieci i młodzieży, zwiększa szanse na pełne wyzdrowienie. Zmniejszenie nasilenia dysocjacji koreluje z poprawą objawów PTSD, depresji i redukcją myśli samobójczych, co potwierdza możliwość skutecznej interwencji nawet w ciężkich przypadkach.

  1. Prognozy w zaburzeniach dysocjacyjnych
    1. Krótkoterminowe vs długoterminowe rokowanie
    2. Czynniki prognostyczne
    3. Dynamika zmian w przebiegu leczenia
  2. Specyfika rokowania w różnych typach zaburzeń dysocjacyjnych
    1. Dysocjacyjne zaburzenie tożsamości (DID)
    2. Ciężkie zaburzenia dysocjacyjne w ogólnych warunkach psychiatrycznych
  3. Efektywność leczenia i jego wpływ na prognozę
    1. Specjalistyczne podejście terapeutyczne
    2. Znaczenie wczesnej diagnozy i interwencji
    3. Elastyczny program terapeutyczny
  4. Specjalne uwagi dotyczące prognozowania u dzieci i młodzieży
    1. Kolejne rozdziały

Prognozy w zaburzeniach dysocjacyjnych

Rokowanie w zaburzeniach dysocjacyjnych jest zróżnicowane i zależy od wielu czynników, w tym rodzaju zaburzenia, momentu rozpoczęcia leczenia oraz zastosowanych metod terapeutycznych. Obserwacje kliniczne wskazują na istotne różnice między krótko- i długoterminowymi wynikami leczenia, co ma znaczące implikacje dla planowania terapii i opieki nad pacjentami.12

Krótkoterminowe vs długoterminowe rokowanie

Badania wykazują interesujący kontrast między krótko- i długoterminowymi wynikami leczenia zaburzeń dysocjacyjnych u dzieci i młodzieży. W większości przypadków krótkoterminowe wyniki leczenia są stosunkowo korzystne. Jednak długoterminowy przebieg choroby okazuje się mniej pozytywny. W badaniach follow-up po średnim okresie 12,4 lat od rozpoczęcia leczenia, około 26,1% pacjentów nadal cierpiało na zaburzenia dysocjacyjne, a aż 82,6% spełniało kryteria jakiejś formy zaburzenia psychicznego. Dane te wskazują, że u znacznej części pacjentów początkowa poprawa podczas leczenia nie jest stabilna w dłuższej perspektywie czasowej.34

Czynniki prognostyczne

Zidentyfikowano kilka czynników, które mają istotny wpływ na rokowanie w zaburzeniach dysocjacyjnych:

  • Większa liczba objawów dysocjacyjnych w okresie dzieciństwa lub dojrzewania jest znacząco związana z niższym poziomem przystosowania psychospołecznego w dorosłości5
  • Leczenie szpitalne w dzieciństwie lub okresie dojrzewania wiąże się z gorszym rokowaniem w dorosłości6
  • Początkowy poziom dysocjacji jest istotnie związany z ogólną ciężkością objawów psychopatologicznych7
  • Wczesne rozpoczęcie leczenia oferuje największą możliwość pełnego wyzdrowienia, szczególnie u dzieci i młodzieży8
  • Odpowiednie rozpoznanie zaburzenia dysocjacyjnego ma kluczowe znaczenie, ponieważ brak właściwej diagnozy może prowadzić do błędnego oznaczenia współwystępujących chorób psychicznych jako opornych na leczenie9

Dynamika zmian w przebiegu leczenia

Badania nad dynamiką objawów dysocjacyjnych w trakcie leczenia dostarczają istotnych informacji dla przewidywania rezultatów terapii. Zmiany w nasileniu dysocjacji są istotnie i pozytywnie związane ze zmianami w nasileniu zespołu stresu pourazowego (PTSD), depresji, myśli samobójczych i samookaleczania. Około 40% pacjentów z wysokim początkowym poziomem dysocjacji wykazuje wiarygodne zmniejszenie dysocjacji podczas leczenia, co wskazuje na możliwość skutecznej interwencji terapeutycznej nawet w poważnych przypadkach.10

Specyfika rokowania w różnych typach zaburzeń dysocjacyjnych

Dysocjacyjne zaburzenie tożsamości (DID)

Dysocjacyjne zaburzenie tożsamości (DID) jest jednym z najbardziej złożonych zaburzeń dysocjacyjnych, które może poważnie wpływać na życie pacjentów. Próby samobójcze i samookaleczenia są powszechne wśród osób z DID – ponad 70% pacjentów z tym zaburzeniem podejmuje próby samobójcze. Obecność zaburzenia dysocjacyjnego jest najsilniejszym predyktorem występowania w historii pacjenta wielokrotnych prób samobójczych.1112

Ryzyko jest dodatkowo komplikowane przez możliwość, że poszczególne stany osobowości (ANP – pozorne normalne części osobowości) mogą podejmować ekstremalne zachowania wbrew świadomej woli lub życzeniom pacjenta. W rezultacie wielu pacjentów czuje się bezradnych, poza kontrolą i doświadcza przytłaczającego poczucia wstydu. Te dysocjacyjne zachowania są często formą ataku jednego stanu osobowości na pacjenta i, biorąc pod uwagę, że dany stan często doświadcza siebie jako odrębnego od pacjenta, ataki te mogą być ekstremalne.13

Ciężkie zaburzenia dysocjacyjne w ogólnych warunkach psychiatrycznych

Ciężkie zaburzenia dysocjacyjne, takie jak dysocjacyjne zaburzenie tożsamości (DID) i zaburzenie dysocjacyjne nieokreślone inaczej (DDNOS), są złożonymi, niezbyt rzadkimi zaburzeniami związanymi z ciężkimi objawami, wysokim współwystępowaniem innych zaburzeń, wyższym wykorzystaniem usług medycznych w porównaniu z innymi zaburzeniami psychicznymi oraz wysokim ryzykiem samobójstwa. Zaburzenia te powodują wysokie obciążenia osobiste i społeczno-ekonomiczne oraz wykazują słabą odpowiedź na standardowe leczenie, z wysokim poziomem przerwania terapii i korzystania z ambulatoryjnych i stacjonarnych usług psychiatrycznych.14

Pacjenci są często błędnie diagnozowani lub określani jako nieuleczalni. Specjalistyczne leczenie, które uwzględnia objawy dysocjacyjne wraz z ich traumatycznym pochodzeniem, wykazuje obiecujące wczesne wyniki. Niestety, wiedza na temat tych zaburzeń wśród niespecjalistycznych psychiatrów i psychologów w niektórych krajach pozostaje niska, co skutkuje długimi opóźnieniami przed postawieniem diagnozy i rozpoczęciem leczenia.15

Efektywność leczenia i jego wpływ na prognozę

Specjalistyczne podejście terapeutyczne

Przy profesjonalnym leczeniu, zwykle psychoterapii, wiele osób z zaburzeniem dysocjacyjnym może złagodzić główne objawy schorzenia i poprawić swoje codzienne funkcjonowanie. Leczenie typowo trwa 7-10 lat, a interwencje środowiskowe odgrywają kluczową rolę. Wielokrotne przyjęcia do niespecjalistycznych ostrych oddziałów psychiatrycznych i programów leczenia skoncentrowanych na współwystępujących zaburzeniach bez uwzględnienia aspektów dysocjacyjnych nie są uważane za pomocne i nie są zalecane.1617

Choć dowody na skuteczność specjalistycznych metod leczenia ograniczają się do badań obserwacyjnych i opisów przypadków, wykazują one efekty po leczeniu w postaci:

  • Zmniejszenia objawów dysocjacyjnych i traumatycznych18
  • Zmniejszenia liczby przyjęć do szpitala i korzystania z usług medycznych19
  • Zmniejszenia samookaleczeń i objawów depresyjnych20
  • Poprawy funkcjonowania według Globalnej Oceny Funkcjonowania (GAF)21

Znaczenie wczesnej diagnozy i interwencji

Rozpoznanie zostało ułatwione dzięki narzędziom przesiewowym, takim jak Skala Doświadczeń Dysocjacyjnych II (DES-II), która daje wiarygodne punkty odcięcia do dalszego badania, oraz ustrukturyzowanym wywiadom klinicznym, takim jak Ustrukturyzowany Wywiad Kliniczny dla Zaburzeń Dysocjacyjnych DSM-IV (SCID-D-R). Identyfikacja współchorobowości jest ważna ze względu na jej wpływ na wyniki leczenia.22

Wiele badań wykazało wyższe wskaźniki przerwania leczenia, gorsze wyniki i niższą odpowiedź przy standardowych terapiach psychologicznych dla PTSD, zaburzeń lękowych, uzależnień, zaburzenia osobowości typu borderline, zaburzenia obsesyjno-kompulsywnego i zaburzeń odżywiania wśród osób ze współwystępującymi zaburzeniami dysocjacyjnymi.23

Elastyczny program terapeutyczny

Płynność programu terapeutycznego oznacza, że terapia może poruszać się w przód i w tył między trzema różnymi fazami, w zależności od aktualnej prezentacji objawów i potrzeb pacjenta. Ważne jest, aby psychiatrzy zapewnili, że będą kontynuować rozwój swojego zrozumienia i praktycznej wiedzy o wszystkich zaburzeniach i pozostaną otwarci na nowe interpretacje i rozwój w tych obszarach, tak aby w ocenie pacjentów zachowali otwartość w zrozumieniu i formułowaniu ich prezentowanych trudności.24

Specjalne uwagi dotyczące prognozowania u dzieci i młodzieży

Rokowanie u dzieci i młodzieży może się znacznie różnić między pacjentami oraz w zależności od konkretnego typu zaburzenia dysocjacyjnego. Wczesne leczenie daje największą możliwość pełnego wyzdrowienia. Wyzdrowienie wymaga specjalnie przeszkolonych, wykwalifikowanych psychiatrów, którzy dokładnie rozumieją stan pacjenta.25

Strategie leczenia muszą uwzględniać, że u znacznej części młodych pacjentów początkowe wyzdrowienie może nie być stabilne w czasie. Badania wskazują, że w przeciwieństwie do raczej korzystnego początkowego wyniku leczenia, długoterminowy przebieg młodzieńczego zaburzenia dysocjacyjnego okazuje się poważniejszy w odniesieniu do chorobowości psychiatrycznej w dorosłości.2627

Istnieje potrzeba dalszych badań nad długoterminowym przebiegiem zaburzenia z wykorzystaniem bardziej dokładnego projektu badawczego (duża liczba uczestników, badania prospektywne, quasi-eksperymentalne).28

Kolejne rozdziały

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Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

  1. 09.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Dissociative Disorders: Causes, Symptoms, Types & Treatment
    https://my.clevelandclinic.org/health/diseases/17749-dissociative-disorders
    The prognosis (outlook) for dissociative disorders varies. […] With professional treatment (usually psychotherapy), many people with a dissociative disorder can address the major symptoms of the condition and improve their daily functioning. […] For some people, the dissociative disorder, especially dissociative identity disorder (DID), severely impacts their life. […] Suicide attempts and self-harm are common in people with DID. More than 70% of people with DID attempt suicide.
  • #2 Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence | Child and Adolescent Psychiatry and Mental Health | Full Text
    https://capmh.biomedcentral.com/articles/10.1186/1753-2000-2-19
    In the majority of cases short-term treatment outcome of juvenile dissociative disorder is rather favourable. […] In contrast, the long-term course seems to be less positive, but meaningful results are still fragmentary. […] At the time of follow-up investigation 82.6% of the patients met the criteria for some form of psychiatric disorder, while 26.1% were still suffering from dissociative disorder. […] More dissociative symptoms and inpatient treatment in childhood or adolescence were significantly related to a lower level of psychosocial adjustment in adulthood. […] Treatment strategies have to consider that in a significant portion of young patients initial recovery may not be stable over time. […] After a mean follow-up period of 12.4 years 26% of our patients still suffered from dissociative disorder.
  • #3 Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence | Child and Adolescent Psychiatry and Mental Health | Full Text
    https://capmh.biomedcentral.com/articles/10.1186/1753-2000-2-19
    In the majority of cases short-term treatment outcome of juvenile dissociative disorder is rather favourable. […] In contrast, the long-term course seems to be less positive, but meaningful results are still fragmentary. […] At the time of follow-up investigation 82.6% of the patients met the criteria for some form of psychiatric disorder, while 26.1% were still suffering from dissociative disorder. […] More dissociative symptoms and inpatient treatment in childhood or adolescence were significantly related to a lower level of psychosocial adjustment in adulthood. […] Treatment strategies have to consider that in a significant portion of young patients initial recovery may not be stable over time. […] After a mean follow-up period of 12.4 years 26% of our patients still suffered from dissociative disorder.
  • #4 Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence | Child and Adolescent Psychiatry and Mental Health | Full Text
    https://capmh.biomedcentral.com/articles/10.1186/1753-2000-2-19
    In summary, our results also point to the fact that in a significant proportion of patients improvement during initial treatment is not stable over time. […] In contrast to a rather favourable initial treatment outcome long-term course of juvenile dissociative disorder proves to be more serious with respect to psychiatric morbidity in adulthood. […] There is a need for further studies on the long-term course of the disorder using a more thorough design (large N, prospective, quasi-experimental).
  • #5 Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence | Child and Adolescent Psychiatry and Mental Health | Full Text
    https://capmh.biomedcentral.com/articles/10.1186/1753-2000-2-19
    In the majority of cases short-term treatment outcome of juvenile dissociative disorder is rather favourable. […] In contrast, the long-term course seems to be less positive, but meaningful results are still fragmentary. […] At the time of follow-up investigation 82.6% of the patients met the criteria for some form of psychiatric disorder, while 26.1% were still suffering from dissociative disorder. […] More dissociative symptoms and inpatient treatment in childhood or adolescence were significantly related to a lower level of psychosocial adjustment in adulthood. […] Treatment strategies have to consider that in a significant portion of young patients initial recovery may not be stable over time. […] After a mean follow-up period of 12.4 years 26% of our patients still suffered from dissociative disorder.
  • #6 Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence | Child and Adolescent Psychiatry and Mental Health | Full Text
    https://capmh.biomedcentral.com/articles/10.1186/1753-2000-2-19
    In the majority of cases short-term treatment outcome of juvenile dissociative disorder is rather favourable. […] In contrast, the long-term course seems to be less positive, but meaningful results are still fragmentary. […] At the time of follow-up investigation 82.6% of the patients met the criteria for some form of psychiatric disorder, while 26.1% were still suffering from dissociative disorder. […] More dissociative symptoms and inpatient treatment in childhood or adolescence were significantly related to a lower level of psychosocial adjustment in adulthood. […] Treatment strategies have to consider that in a significant portion of young patients initial recovery may not be stable over time. […] After a mean follow-up period of 12.4 years 26% of our patients still suffered from dissociative disorder.
  • #7 Attending to dissociation: assessing change in dissociation and predicting treatment outcome – PubMed
    https://pubmed.ncbi.nlm.nih.gov/19042780/
    High dissociation has been linked to severe psychopathology. However, relatively little is known about the impact of dissociation on treatment outcome. We sought to examine (a) whether initial levels of dissociation predicted treatment outcome, (b) whether changes in dissociation were associated with changes in other forms of psychopathology, and (c) to what extent individuals with high initial dissociation reported meaningful symptom improvement. […] Initial dissociation was significantly associated with general symptom severity. Change in dissociation was significantly and positively associated with change in posttraumatic stress disorder, depression, suicidal ideation, and self-harm. Approximately 40% of high dissociators demonstrated reliable decreases in dissociation during treatment.
  • #8 Dissociative Identity Disorder: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/916186-overview
    The prognosis in children and adolescents can vary widely among patients and between the specific types of dissociation disorder; however early treatment offers the greatest possibility of full recovery. […] Recovery requires specially trained skilled psychiatrists who thoroughly understand the condition.
  • #9 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    Diagnosis has been facilitated by screening tools such as the Dissociative Experiences Scale II (DES-II), which gives reliable cut-offs for further investigation, and diagnostic structured clinical interviews such as the Structured Clinical Interview for DSM-IV Dissociative Disorders Revised (SCID-D-R). […] Identifying comorbidity is important because of its impact on treatment outcomes. […] Many studies have shown higher treatment drop-out rates, poor outcomes and lower response with standard psychological treatments for PTSD, anxiety disorders, addictions, borderline personality disorder, obsessive-compulsive disorder and eating disorders among people with comorbid dissociative disorders. […] If dissociative disorders are not correctly identified, comorbid psychiatric illness may be incorrectly labelled treatment resistant.
  • #10 Attending to dissociation: assessing change in dissociation and predicting treatment outcome – PubMed
    https://pubmed.ncbi.nlm.nih.gov/19042780/
    High dissociation has been linked to severe psychopathology. However, relatively little is known about the impact of dissociation on treatment outcome. We sought to examine (a) whether initial levels of dissociation predicted treatment outcome, (b) whether changes in dissociation were associated with changes in other forms of psychopathology, and (c) to what extent individuals with high initial dissociation reported meaningful symptom improvement. […] Initial dissociation was significantly associated with general symptom severity. Change in dissociation was significantly and positively associated with change in posttraumatic stress disorder, depression, suicidal ideation, and self-harm. Approximately 40% of high dissociators demonstrated reliable decreases in dissociation during treatment.
  • #11 Dissociative Disorders: Causes, Symptoms, Types & Treatment
    https://my.clevelandclinic.org/health/diseases/17749-dissociative-disorders
    The prognosis (outlook) for dissociative disorders varies. […] With professional treatment (usually psychotherapy), many people with a dissociative disorder can address the major symptoms of the condition and improve their daily functioning. […] For some people, the dissociative disorder, especially dissociative identity disorder (DID), severely impacts their life. […] Suicide attempts and self-harm are common in people with DID. More than 70% of people with DID attempt suicide.
  • #12 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    Understanding its impact allows the appropriate planning and phasing of treatment. […] Treatment typically lasts 7-10 years and community-based interventions are key. […] Repeated admissions to non-specialist acute psychiatric settings and treatment programmes addressing comorbidities with no focus or interventions for dissociative aspects are not felt to be helpful and not recommended. […] The presence of a dissociative disorder was the strongest predictor of a history of multiple suicide attempts. […] Risk is further complicated by the possibility that self-states (ANPs) will carry out extreme behaviours that would be against the conscious will or wishes of the patient. […] Many patients therefore feel out of control, helpless and a sense of overwhelming shame. […] These dissociative behaviours are often a self-state’s attack on the patient and, given that self-state commonly experiences itself as separate from the patient, these attacks can be extreme.
  • #13 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    Understanding its impact allows the appropriate planning and phasing of treatment. […] Treatment typically lasts 7-10 years and community-based interventions are key. […] Repeated admissions to non-specialist acute psychiatric settings and treatment programmes addressing comorbidities with no focus or interventions for dissociative aspects are not felt to be helpful and not recommended. […] The presence of a dissociative disorder was the strongest predictor of a history of multiple suicide attempts. […] Risk is further complicated by the possibility that self-states (ANPs) will carry out extreme behaviours that would be against the conscious will or wishes of the patient. […] Many patients therefore feel out of control, helpless and a sense of overwhelming shame. […] These dissociative behaviours are often a self-state’s attack on the patient and, given that self-state commonly experiences itself as separate from the patient, these attacks can be extreme.
  • #14 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    The severe dissociative disorders of dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) are complex, not uncommon presentations associated with severe symptoms, high rates of comorbidity, high service use compared with other psychiatric disorders, and high suicidality. […] They exact high personal and socioeconomic burdens and show poor response to standard treatments, with high levels of treatment attrition and revolving-door out-patient and in-patient service use; patients are often misdiagnosed or labelled untreatable. […] Specialist treatment that addresses the dissociative symptoms alongside their trauma origins shows promise in early evidence. […] Working knowledge of these disorders among non-specialist psychiatrists and psychologists in the UK remains poor, resulting in long delays before diagnosis and treatment.
  • #15 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    The severe dissociative disorders of dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) are complex, not uncommon presentations associated with severe symptoms, high rates of comorbidity, high service use compared with other psychiatric disorders, and high suicidality. […] They exact high personal and socioeconomic burdens and show poor response to standard treatments, with high levels of treatment attrition and revolving-door out-patient and in-patient service use; patients are often misdiagnosed or labelled untreatable. […] Specialist treatment that addresses the dissociative symptoms alongside their trauma origins shows promise in early evidence. […] Working knowledge of these disorders among non-specialist psychiatrists and psychologists in the UK remains poor, resulting in long delays before diagnosis and treatment.
  • #16 Dissociative Disorders: Causes, Symptoms, Types & Treatment
    https://my.clevelandclinic.org/health/diseases/17749-dissociative-disorders
    The prognosis (outlook) for dissociative disorders varies. […] With professional treatment (usually psychotherapy), many people with a dissociative disorder can address the major symptoms of the condition and improve their daily functioning. […] For some people, the dissociative disorder, especially dissociative identity disorder (DID), severely impacts their life. […] Suicide attempts and self-harm are common in people with DID. More than 70% of people with DID attempt suicide.
  • #17 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    Understanding its impact allows the appropriate planning and phasing of treatment. […] Treatment typically lasts 7-10 years and community-based interventions are key. […] Repeated admissions to non-specialist acute psychiatric settings and treatment programmes addressing comorbidities with no focus or interventions for dissociative aspects are not felt to be helpful and not recommended. […] The presence of a dissociative disorder was the strongest predictor of a history of multiple suicide attempts. […] Risk is further complicated by the possibility that self-states (ANPs) will carry out extreme behaviours that would be against the conscious will or wishes of the patient. […] Many patients therefore feel out of control, helpless and a sense of overwhelming shame. […] These dissociative behaviours are often a self-state’s attack on the patient and, given that self-state commonly experiences itself as separate from the patient, these attacks can be extreme.
  • #18 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    Unfortunately, the evidence for effective specialist treatments is limited to observational studies and case reports, but these do demonstrate after-treatment effects of reduced dissociative and trauma symptoms, decreased hospital admissions and service use, reduced self-harm and depressive symptoms and improved functioning on the Global Assessment of Functioning (GAF) scale. […] The fluidity of the programme means that the therapy can move backwards and forwards across the three different phases as required, depending on the presentation and needs at the time. […] It is important for psychiatrists to ensure we continue to develop our understanding and working knowledge of all disorders and are open to new understandings and developments within these, such that in our assessment of patients we remain open in our understanding and formulation of their presenting difficulties.
  • #19 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    Unfortunately, the evidence for effective specialist treatments is limited to observational studies and case reports, but these do demonstrate after-treatment effects of reduced dissociative and trauma symptoms, decreased hospital admissions and service use, reduced self-harm and depressive symptoms and improved functioning on the Global Assessment of Functioning (GAF) scale. […] The fluidity of the programme means that the therapy can move backwards and forwards across the three different phases as required, depending on the presentation and needs at the time. […] It is important for psychiatrists to ensure we continue to develop our understanding and working knowledge of all disorders and are open to new understandings and developments within these, such that in our assessment of patients we remain open in our understanding and formulation of their presenting difficulties.
  • #20 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    Unfortunately, the evidence for effective specialist treatments is limited to observational studies and case reports, but these do demonstrate after-treatment effects of reduced dissociative and trauma symptoms, decreased hospital admissions and service use, reduced self-harm and depressive symptoms and improved functioning on the Global Assessment of Functioning (GAF) scale. […] The fluidity of the programme means that the therapy can move backwards and forwards across the three different phases as required, depending on the presentation and needs at the time. […] It is important for psychiatrists to ensure we continue to develop our understanding and working knowledge of all disorders and are open to new understandings and developments within these, such that in our assessment of patients we remain open in our understanding and formulation of their presenting difficulties.
  • #21 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    Unfortunately, the evidence for effective specialist treatments is limited to observational studies and case reports, but these do demonstrate after-treatment effects of reduced dissociative and trauma symptoms, decreased hospital admissions and service use, reduced self-harm and depressive symptoms and improved functioning on the Global Assessment of Functioning (GAF) scale. […] The fluidity of the programme means that the therapy can move backwards and forwards across the three different phases as required, depending on the presentation and needs at the time. […] It is important for psychiatrists to ensure we continue to develop our understanding and working knowledge of all disorders and are open to new understandings and developments within these, such that in our assessment of patients we remain open in our understanding and formulation of their presenting difficulties.
  • #22 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    Diagnosis has been facilitated by screening tools such as the Dissociative Experiences Scale II (DES-II), which gives reliable cut-offs for further investigation, and diagnostic structured clinical interviews such as the Structured Clinical Interview for DSM-IV Dissociative Disorders Revised (SCID-D-R). […] Identifying comorbidity is important because of its impact on treatment outcomes. […] Many studies have shown higher treatment drop-out rates, poor outcomes and lower response with standard psychological treatments for PTSD, anxiety disorders, addictions, borderline personality disorder, obsessive-compulsive disorder and eating disorders among people with comorbid dissociative disorders. […] If dissociative disorders are not correctly identified, comorbid psychiatric illness may be incorrectly labelled treatment resistant.
  • #23 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    Diagnosis has been facilitated by screening tools such as the Dissociative Experiences Scale II (DES-II), which gives reliable cut-offs for further investigation, and diagnostic structured clinical interviews such as the Structured Clinical Interview for DSM-IV Dissociative Disorders Revised (SCID-D-R). […] Identifying comorbidity is important because of its impact on treatment outcomes. […] Many studies have shown higher treatment drop-out rates, poor outcomes and lower response with standard psychological treatments for PTSD, anxiety disorders, addictions, borderline personality disorder, obsessive-compulsive disorder and eating disorders among people with comorbid dissociative disorders. […] If dissociative disorders are not correctly identified, comorbid psychiatric illness may be incorrectly labelled treatment resistant.
  • #24 Understanding, identifying and managing severe dissociative disorders in general psychiatric settings | BJPsych Advances | Cambridge Core
    https://www.cambridge.org/core/journals/bjpsych-advances/article/understanding-identifying-and-managing-severe-dissociative-disorders-in-general-psychiatric-settings/62CC0133915C7F47CDAFADC230EE5001
    Unfortunately, the evidence for effective specialist treatments is limited to observational studies and case reports, but these do demonstrate after-treatment effects of reduced dissociative and trauma symptoms, decreased hospital admissions and service use, reduced self-harm and depressive symptoms and improved functioning on the Global Assessment of Functioning (GAF) scale. […] The fluidity of the programme means that the therapy can move backwards and forwards across the three different phases as required, depending on the presentation and needs at the time. […] It is important for psychiatrists to ensure we continue to develop our understanding and working knowledge of all disorders and are open to new understandings and developments within these, such that in our assessment of patients we remain open in our understanding and formulation of their presenting difficulties.
  • #25 Dissociative Identity Disorder: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/916186-overview
    The prognosis in children and adolescents can vary widely among patients and between the specific types of dissociation disorder; however early treatment offers the greatest possibility of full recovery. […] Recovery requires specially trained skilled psychiatrists who thoroughly understand the condition.
  • #26 Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence | Child and Adolescent Psychiatry and Mental Health | Full Text
    https://capmh.biomedcentral.com/articles/10.1186/1753-2000-2-19
    In the majority of cases short-term treatment outcome of juvenile dissociative disorder is rather favourable. […] In contrast, the long-term course seems to be less positive, but meaningful results are still fragmentary. […] At the time of follow-up investigation 82.6% of the patients met the criteria for some form of psychiatric disorder, while 26.1% were still suffering from dissociative disorder. […] More dissociative symptoms and inpatient treatment in childhood or adolescence were significantly related to a lower level of psychosocial adjustment in adulthood. […] Treatment strategies have to consider that in a significant portion of young patients initial recovery may not be stable over time. […] After a mean follow-up period of 12.4 years 26% of our patients still suffered from dissociative disorder.
  • #27 Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence | Child and Adolescent Psychiatry and Mental Health | Full Text
    https://capmh.biomedcentral.com/articles/10.1186/1753-2000-2-19
    In summary, our results also point to the fact that in a significant proportion of patients improvement during initial treatment is not stable over time. […] In contrast to a rather favourable initial treatment outcome long-term course of juvenile dissociative disorder proves to be more serious with respect to psychiatric morbidity in adulthood. […] There is a need for further studies on the long-term course of the disorder using a more thorough design (large N, prospective, quasi-experimental).
  • #28 Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence | Child and Adolescent Psychiatry and Mental Health | Full Text
    https://capmh.biomedcentral.com/articles/10.1186/1753-2000-2-19
    In summary, our results also point to the fact that in a significant proportion of patients improvement during initial treatment is not stable over time. […] In contrast to a rather favourable initial treatment outcome long-term course of juvenile dissociative disorder proves to be more serious with respect to psychiatric morbidity in adulthood. […] There is a need for further studies on the long-term course of the disorder using a more thorough design (large N, prospective, quasi-experimental).

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