Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
What is the prognosis for dissociative identity disorder?
Research indicates that people with dissociative identity disorder have their best opportunity for living a well-adjusted life if they receive comprehensive treatment for their multiple symptoms. However, differences in how practitioners diagnose and treat this illness make it difficult to quantify outcomes.
What are complications of dissociative identity disorder?
As with other mental health conditions, the prognosis for people with DID
becomes much less optimistic if not appropriately treated. Individuals with a
history of being sexually abused, including those who go on to develop
dissociative identity disorder, are vulnerable to abusing alcohol or other substances as a negative
way of coping with their victimization. People with DID are also at risk for
attempting suicide more than once. Violent behavior has a high level of association with dissociation
as well. Other debilitating outcomes of DID, like that of
other severe chronic mental illnesses, include inability to obtain and maintain
employment, poor relationships with others, and therefore overall lower
productivity and quality of life.
How can dissociative identity disorder be prevented?
Given that the origin of dissociative identity disorder in the majority of individuals remains related to exposure to traumatic events, prevention for this disorder primarily involves minimizing the exposure to traumatic events, as well as helping survivors of trauma come to terms with what they have been through in a healthy way.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Text Revision (DSM-IV-TR); 2000, Washington, D.C.
Applegate, M. Multiphasic short-term therapy for dissociative identity disorder.
Journal of the American Psychiatric Nurses Association; 1997, 3(1): 1-9.
Becker-Blease, K., Freyd, J. Dissociation and memory for perpetration among
convicted sex offenders. Journal of Trauma and Dissociation; 2007, 8(2): 69-80.
Bernstein, Carlson E.M., Putnam, F.W. Development, reliability and validity of a
dissociation scale. Journal of Nervous and Mental Disease 1986; 174: 727-735.
Brown, R.J., Schrag, A., Trimble, M.R. Dissociation, childhood interpersonal trauma and
family functioning in patients with somatization disorder. American Journal of
Psychiatry; May 2005, 162: 899-905.
Carrion, V.G., Steiner, H. Trauma and dissociation in delinquent adolescents. Journal of the American Academy of Child and Adolescent Psychiatry; March 2000,
DeBattista, C., Solvason, H.B., Spiegel, D. ECT in dissociative identity disorder and comorbid depression.
Journal of Electroconvulsive Therapy; December 1998, 14(4):
Dell, P.F. Axis II pathology in outpatients with dissociative identity disorder.
The Journal of Nervous and Mental Disease; June 1998, 186(6): 352-356.
Escobar, J. Transcultural aspects of dissociative and somatoform disorders. Psychiatric Times; April 15, 2004, 21(5).
Fine, C.G. Treatment stabilization and crisis prevention. Pacing the therapy of
the multiple personality disorder patient. Psychiatric Clinics of North America;
September 1991, 14(3): 661-675.
Foote, B., Smolin, Y., Neft, D., Lipschitz, D. Dissociative disorders and suicidality
in psychiatric outpatients. The Journal of Nervous and Mental Disease; January
2008, 196(1): 29-36.
Friedrich, W.N., Gerber, P.N., Koplin, B., Davis, M., Giese, J., Mykelbust, C., Franckowiak, D.
Multimodal assessment of dissociation in adolescents: Inpatients and juvenile
sex offenders. Sexual Abuse: A Journal of Research and Treatment; 2001, 13(3):
Griffin, M.G., Resick, P.A., Mechanic, M.B. Objective assessment of peritraumatic
dissociation: psychophysiological indicators. American Journal of Psychiatry;
1997, 154: 1081-1088.
International Society for the Study of Trauma and Dissociation (2011): Guidelines
for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation
Klanecky, A.K., Harrington, J., McChargue, D.E. Child sexual abuse, dissociation and
alcohol: implications of chemical dissociation via blackouts among college
women. American Journal of Drug and Alcohol Abuse; 2008, 34(3): 277-284.
Lewis, D.O., Yeager, C.A., Swica, Y., Pincus, J.H., Lewis, M. Objective documentation of
child abuse and dissociation in 12 murderers with dissociative identity
disorder. American Journal of Psychiatry; June 1999, 156(6): 976.
McMinn, M.R., Wade, N.G. Beliefs about the prevalence of dissociative identity
disorder, sexual abuse, and ritual abuse among religious and nonreligious
therapists. Professional Psychology: Research and Practice; June 1995, 26(3):
Middleton, W., and J. Butler. "Dissociative Identity Disorder: An Australian Series." Australian New Zealand Journal of Psychiatry 32.6 Dec. 1998: 794-804.
Moskowitz, A. Dissociation and violence: a review of the literature. Trauma,
Violence and Abuse; 2004, 5(1): 21-46.
Piper, A., Merskey, H. The persistence of folly: a critical examination of
dissociative identity disorder: Part I. The excesses of an improbable concept.
Canadian Journal of Psychiatry; September 2004, 49(9): 592-600.
Ramsland, K., Kuter, R. Multiple personalities: crime and defense. Turner
Broadcasting System; 2008.
Ross, C.A., Keyes, B.B., Yan, H., Wang, Z., Zou, Z., Xu, Y., Chen, J., Zhang, H., Xiao, Z. A
cross-cultural test of the trauma model of dissociation. Journal of Trauma
Dissociation; 2008, 9(1): 35-49.
Sar, V., Akyuz, G., Kundakc, T., Kazaltan, E., Dogan, O. Childhood trauma, dissociation
and psychiatric comorbidity in patients with conversion disorder. American
Journal of Psychiatry; December 2004, 161: 2271-2276.
Sar, V., Kundakci, T., Kiziltan, E., Yargic, I., Tutkun, H., Bakim, B., Bozkurt, O., Ozpulat,
T., Keser, V., Ozdemir, O. The axis I dissociative disorder comorbidity of
borderline personality disorder among psychiatric outpatients. Journal of Trauma
and Dissociation; 2003, 4(1): 119-136.
Simone Reinders, A.A.T., Nijenhuis, E.R.S., Quaka, J., Korfa, J., Haaksmab, J., Paans, A.M.J.,
Willemsen, A.T.M., den Boer, J.A. Psychobiological characteristics of dissociative
identity disorder: a symptom provocation study. Biological Psychiatry; October
2006, 60(7): 730-740.
Spiegel, D. Recognizing traumatic dissociation. American Journal of Psychiatry;
April 2006, 163: 566-568.
Spitzer, C., Klauer, T., Grabe, H.J., Lucht, M., Stieglitz, R.D., Schneider, W., Freyberger,
H.J. Gender differences in dissociation: a dimensional approach. Psychopathology;
Twombly, J.H. "Incorporating EMDR and EMDR Adaptations into the Treatment of Clients with Dissociative Identity Disorder." Journal of Trauma and Dissociation 1.2 (2000): 61-81.
van der Kolk, B.A., and O. van der Hart. "Pierre Janet and the Breakdown of Adaptation in Psychological Trauma." American Journal of Psychiatry 146.12 Dec. 1989: 1530-1540.
Welburn, K.R., Fraser, G.A., Jordan, S.A., Cameron, C., Webb, L.M., Raine, D. Discriminating
dissociative identity disorder from schizophrenia and feigned dissociation on
psychological tests and structured interview. Journal of Trauma and
Dissociation; 2003, 4(2): 109-130.