Cutting Edge Update About Assessing Dissociative Clients and Implications for Treatment and Forensic Assessment

Highly dissociative patients often present with an overwhelming array of severe clinical problems. Few clinicians have received systematic training in assessing and treating dissociation, despite prevalence rates of 4% of the U.S. population. Dissociation is often overlooked or misdiagnosed, contributing to prolonged suffering and poor response to treatment. Bethany Brand, PhD, provides an overview of the controversy about dissociative disorders and dispel myths about dissociative identity disorder (DID). She reviews evidence-based methods for assessing trauma-related dissociation including self-reported experiences, behavioral observations, screening questionnaires, and semi-structured interviews. The rise of social media portrayals of DID have increased clinicians’ uncertainty about differentiating trauma-based DID from self-diagnosed DID in individuals who do not have the full range of classic DID symptoms. Brand discusses this challenging differential using case vignettes. Brand reviews cutting edge methods for distinguishing trauma-related dissociation from psychotic and characterological presentations, as well as malingered and factitious dissociative disorders. Finally, using case materials, Brand outlines treatment and forensic implications for dissociative individuals.

• Identify the prevalence of pathological dissociation in the general population.
• Describe three types of dissociative symptoms.
• Identify three validated measures to aid in the assessment of dissociation.
• Discuss how to differentiate feigned from genuine trauma-related dissociation.

Bethany Brand, PhD