What factor best predicts poorer clinical outcomes in patients with dissociative disorders who do not receive specialized treatment?

Years of Unproductive Treatment and Hospitalizations Best Predicts Poor Outcomes

The correct answer is A: Years of unproductive treatment and hospitalizations is the factor that best predicts poorer clinical outcomes in patients with dissociative disorders who do not receive specialized treatment. This is directly supported by longitudinal research demonstrating that patients who receive specialized dissociation-focused treatment show significantly fewer psychiatric hospitalizations and improved functioning over time 1.

Evidence Supporting This Answer

The six-year follow-up of the Treatment of Patients with Dissociative Disorders (TOP DD) study provides the most direct evidence for this question 1. This longitudinal research demonstrated that:

• Patients receiving specialized treatment had significantly fewer psychiatric hospitalizations (t(54) = 2.57, p < .05, Cohen's d = .43) over the six-year period 1
• Higher global functioning was achieved with specialized treatment (Χ2 (2) = 59.27, p < .001, canonical r = .65) 1
• Fewer stressors and instances of revictimization occurred with appropriate treatment 1

The implication is clear: without specialized treatment, patients accumulate years of unproductive treatment attempts and repeated hospitalizations, which becomes the hallmark predictor of poor outcomes 1.

Why Other Options Are Less Predictive

Elevated Dissociation (Option E)

While elevated dissociation does predict poorer treatment outcomes in general psychiatric populations 2, the research specifically examining dissociative disorders shows that:

• Dissociation predicts poor response to non-specialized treatments (such as brief psychodynamic therapy or cognitive-behavioral therapy for other conditions) 2
• However, specialized dissociation-focused treatment effectively addresses dissociative symptoms, with medium to large effect sizes 3
• The key distinction is that dissociation severity matters most when treatment is not appropriately targeted 2, 4

History of Suicide Attempts (Option B)

Suicide attempts are associated with dissociative disorders, but the evidence shows:

• Specialized treatment reduces suicidality along with other symptoms 3
• The relationship between dissociation and suicide risk in borderline personality disorder (which frequently co-occurs) shows mixed findings 4
• This is more of a treatment target than a predictor of poor outcome when appropriate care is provided 1

Limited Social Supports (Option D)

While social factors matter, the research emphasizes that:

• Treatment type and specialization are more critical than baseline social support in determining outcomes 1
• Patients with marked initial difficulties still benefit substantially from specialized treatment 1

Increased Healthcare Costs (Option C)

This is a consequence rather than a predictor—the accumulated costs reflect the years of unproductive treatment and hospitalizations 1.

Clinical Implications

The critical pitfall is failing to refer patients with dissociative disorders to specialized treatment early in their course of illness. The evidence demonstrates that:

• Specialized phasic, dissociation-focused treatment produces significant symptom reduction across multiple domains 3
• Integration of dissociated self-states is associated with better outcomes compared to non-integration 3
• Long-term specialized treatment is necessary for stabilization and functionality 1

Without this specialized approach, patients enter a cycle of repeated hospitalizations and ineffective treatments that becomes the strongest predictor of continued poor outcomes 1.