Barriers to accessing and continuing mental health treatment among individuals with dissociative symptoms
Open accessAbstract
Background: Dissociative disorders (DDs) are characterized by interruptions of identity, thought, memory, emotion, perception, and consciousness. Patients with DDs are at high risk for engaging in dangerous behaviours, such as self-harm and suicidal acts; yet, only between 28% and 48% of individuals with DDs receive mental health treatment. Patients that do pursue treatment are often misdiagnosed, repeatedly hospitalized, and experience disbelief from providers about their trauma history and dissociative symptoms. Lack of dissociation-specific treatment can result in poor quality of life, severe symptoms requiring utilization of hospitalization and intensive outpatient treatment, and high rates of disability. Objective: Given the extensive and debilitating symptoms experienced by individuals with DDs and the infrequent utilization of treatment, the current study explored barriers to accessing and continuing mental health treatment for individuals with dissociative symptoms and DDs. Method: A total of 276 participants with self-reported dissociative symptoms were recruited via online social media platforms. Participants completed a survey which featured 35 possible barriers to accessing treatment and 45 possible reasons for discontinuing treatment, along with open text boxes for adding barriers/reasons that were not listed. Results: = 7 barriers). Conclusions: The most frequently endorsed barriers were structural barriers, such as those related to finances, insurance, and lack of provider availability. It is imperative more service providers are trained to treat dissociation and that insurers and health care systems recognize the need for specialized, dissociation-focused treatment.
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Historical controversies have resulted in concrete harms and prolonged suffering for people with DID, including underdiagnosis, years-long delays in accessing care, stigmatizing responses from some clinicians, treatment barriers, and a stunted body of research into empirically based treatments.
“Historical controversies echo into the present and have resulted in concrete harms and prolonged suffering for people with DID: underdiagnosis, years-long delays in accessing care, stigmatizing responses from some clinicians, treatment barriers, and a stunted body of research into empirically based treatments [64,65,69].”
From Treatment of dissociative identity disorder: leveraging neurobiology to optimize success (2024) · cites this paper as [69]
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- Authors
- Nester, M. S., Hawkins, S. L., & Brand, B. L.
- Affiliations
- Towson University (US)
- Corresponding author
- Brand, Bethany L.
- Venue
- European Journal of Psychotraumatology
- Publisher
- Informa UK Limited
- Published
- 2022-02-17
- Volume
- 13
- Issue
- 1
- Pages
- 2031594-2031594
- ISSN
- 2000-8066 (ISSN-L)
- PMC
- PMC8856065
- OpenAlex
- W4212900765
- Cited by
- 39
- References
- 39
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 9 · 2023: 11 · 2022: 1
- FWCI
- 5.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Journal of Psychotraumatology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- International Society for the Study of Trauma and Dissociation David Caul Grant, Towson University Graduate Research Grant, and Sheppard Pratt Health System’s Trauma Disorders Program
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- dissociative disorders, dissociative symptoms, barriers to mental health care, treatment access, treatment discontinuation, structural barriers, financial barriers, insurance coverage, provider availability, misdiagnosis, trauma history
- MeSH terms
- Adult, Aged, Dissociative Disorders, Female, Health Services Accessibility, Humans, Male, Mental Health Services, Middle Aged, Patient Acceptance of Health Care, Surveys and Questionnaires, Qualitative Research
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