Utility Analysis of Gold-standard Assessment Tools for Trauma-related Dissociation

Abstract
The ability to accurately assess and diagnose PTSD and dissociative disorders including DID is essential for the successful treatment of these disorders and also for advancing our understanding through research. With advances in neurobiological and genetic evidence identifying mechanisms of trauma-related dissociation, a growing body of literature supporting the effectiveness of evidence-based treatments, as well as controversy and concern about current diagnostic classification (e.g., co-occurrence, diagnostic validity, self-diagnosis), it is critical to consider the accuracy and clinical utility of the gold standard assessments for trauma-spectrum and dissociative disorders. Fifty-five treatment-seeking women with self-reported histories of childhood abuse completed commonly used trauma and dissociation self-report measures including the Multidimensional Inventory of Dissociation (MID) as well as diagnostic assessments including the Clinician Administered PTSD Scale (CAPS-5) and Structured Clinical Interview for DSM-IV—Dissociative Disorders, Revised (SCID-D). All 55 participants met full criteria for PTSD on the CAPS-5 (a requirement for inclusion in the study). An additional 42 participants met criteria for the dissociative subtype of PTSD on the CAPS-5. Thirty-five participants were diagnosed with a co-occurring dissociative disorder using the SCID-D, including 26 with DID and 16 with another dissociative disorder. A majority of participants (n = 44) had consistent results across measures such that the final clinical diagnosis matched findings on the SCID-D-R and MID and the CAPS-5 accurately identified the presence or absence of derealization and/or depersonalization. The remaining participants (n = 11) had discrepant results across measures underscoring the need for nuanced assessment of complex dissociative phenomenology.