title: Global functioning and disability in dissociative disorders.
abstract: Dissociative disorders are frequent comorbid conditions of other mental disorders. Yet, there is controversy about their clinical relevance, and little systematic research has been done on how they influence global functioning. Outpatients and day care patients (N=160) of several psychiatric units in Switzerland were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV Axis I Disorders, Structured Clinical Interview for DSM-IV Dissociative Disorders, Global Assessment of Functioning Scale, and World Health Organization Disability Assessment Schedule-II. The association between subjects with a dissociative disorder (N=30) and functional impairment after accounting for non-dissociative axis I disorders was evaluated by linear regression models. We found a proportion of 18.8% dissociative disorders (dissociative amnesia=0%, dissociative fugue=0.6%, depersonalization disorder=4.4%, dissociative identity disorder=7.5%, dissociative disorder-not-otherwise-specified=6.3%) across treatment settings. Adjusted for other axis I disorders, subjects with a comorbid dissociative identity disorder or dissociative disorder-not-otherwise-specified had a median global assessment of functioning score that was 0.86 and 0.88 times, respectively, the score of subjects without a comorbid dissociative disorder. These findings support the hypothesis that complex dissociative disorders, i.e., dissociative identity disorder and dissociative disorder-not-otherwise-specified, contribute to functional impairment above and beyond the impact of co-existing non-dissociative axis I disorders, and that they qualify as "serious mental illness".
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital of Zurich, Culmannstrasse 8, 8091 Zurich, Switzerland. christoph.mueller-pfeiffer@access.uzh.ch
authors.forename: Christoph
authors.initials: C
authors.lastname: Mueller-Pfeiffer
authors.forename: Kaspar
authors.initials: K
authors.lastname: Rufibach
authors.forename: Noelle
authors.initials: N
authors.lastname: Perron
authors.forename: Daniela
authors.initials: D
authors.lastname: Wyss
authors.forename: Cornelia
authors.initials: C
authors.lastname: Kuenzler
authors.forename: Cornelia
authors.initials: C
authors.lastname: Prezewowsky
authors.forename: Roger K
authors.initials: RK
authors.lastname: Pitman
authors.forename: Michael
authors.initials: M
authors.lastname: Rufer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003861:Depersonalization / Q000523:psychology*; D004185:Disability Evaluation; D004213:Dissociative Disorders / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D019989:Persons with Intellectual Disabilities / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires