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Dissociative disorders: pathways to diagnosis, clinician attitudes and their impact
Article first published online: 1 SEP 2005
Australian and New Zealand Journal of Psychiatry
Volume 39, Issue 10, pages 940–946, October 2005
How to Cite
Leonard, D., Brann, S. and Tiller, J. (2005), Dissociative disorders: pathways to diagnosis, clinician attitudes and their impact. Australian and New Zealand Journal of Psychiatry, 39: 940–946. doi: 10.1111/j.1440-1614.2005.01700.x
Susan Brann, Consultant Psychiatrist
Delmont Private Hospital, Glen Iris, Australia
John Tiller, Professor of Psychiatry
University of Melbourne, Albert Road Clinic, Melbourne, Australia
- Issue published online: 1 SEP 2005
- Article first published online: 1 SEP 2005
- Received 4 July 2004; revised 24 October 2004; accepted 12 December 2004.
Objectives: To study the attitudes and experiences of Australian clinicians with dissociative disorders and the paths to diagnosis and experiences of patients.
Method: The attitudes of Australian clinicians to dissociative disorders and the experiences of patients were assessed by questionnaires. The clinicians were mental health specialists and a small number of general medical practitioners. The patients had all been diagnosed with a dissociative disorder.
Results: Of the 250 clinicians, 21% reported experience with more than six cases on average of any one of the dissociative disorders, 38% with less than six, 42% with none; 55% regarded them as valid diagnoses, 35% dubiously valid and 10% invalid.
Of the 55 patients, 76% reported delays in diagnosis (57%, >3 years and 25%, >10 years) with adverse consequences in 64%; 80% had experienced sceptical or antagonistic attitudes from clinicians, rated as destructive by 48%. They were disabled (60% rated as >50% impaired) and were heavy consumers of health services (48% hospitalized, 68% >5 times). There was considerable comorbidity including moderate or severe depression (96%), self-harm (68%), suicide attempts (69%), panic disorder (53%), eating disorders (75%), substance abuse (25%), poor physical health (44%), major interpersonal (70%) and sexual problems (90%).
Patients rated individual psychotherapy as the most helpful treatment (90%) but medications, such as antidepressants, were also valued (60%).
Conclusions: Although over half of the responding Australian clinicians thought that dissociative disorders were valid, the rest were dubious about their validity with 10% believing them to be invalid. Only 21% had considerable experience with the disorders. These findings may relate to some of the difficulties perceived by patients, which included delays in diagnosis, suboptimal treatment and negative experiences with clinicians.