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Dissociative disorders: pathways to diagnosis, clinician attitudes and their impact

Authors

  • David Leonard,

  • Susan Brann,

  • John Tiller


  • Albert Road Clinic, 31 Albert Road, Melbourne, Victoria 3004, Australia. Email: leonarddp41@bigpond.com

  • Susan Brann, Consultant Psychiatrist

  • Delmont Private Hospital, Glen Iris, Australia

  • John Tiller, Professor of Psychiatry

  • University of Melbourne, Albert Road Clinic, Melbourne, Australia

David Leonard, Consultant Psychiatrist (Correspondence)

Abstract

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.

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