I'm Terrified of the Stigma: The Impact of Stigma on the Experiences of People Who Dissociate

Abstracts
"Faking it:" Stigma as a Barrier to Accessing and Continuing Mental Health Treatment among People who Dissociate
Only 28-48% of people with dissociative disorders receive mental health treatment despite a high need and desire for care. Individuals that do pursue treatment are often misdiagnosed, repeatedly hospitalized, and experience disbelief from providers about their trauma history and dissociative experiences. Stigma is believed to influence people's ability to access and continue mental health treatment. Given the relatively infrequent utilization of treatment, the current study explored barriers to accessing and continuing mental health treatment among individuals with dissociative symptoms and DDs. A total of 276 participants with self-reported dissociative symptoms were recruited via online social media platforms. The majority of participants reported barriers to accessing (97%) and continuing (92%) mental health treatment. More specifically, stigma prevented 32% of people from accessing treatment and caused 18% of people to discontinue care. Qualitative descriptions of barriers to care highlighted unique ways stigma perpetuated these barriers, such as instances where individuals were told they were faking their symptoms, were "crazy" or hypersensitive, or unable to be helped. We will discuss the ways barriers to accessing and continuing mental health treatment can be addressed in order to facilitate destigmatizing, understanding, and compassionate treatment opportunities for people who dissociate.
 
This 'Prison' Where I Cannot Heal: Interactions of Culture, Dissociation, and Treatment Among Individuals Who Dissociate
Dissociation is influenced by cultural factors such as identity and community, among others. Related mental health treatment is also surrounded by socioculturally contextual layers, including stigma and treatment barriers. However, multicultural factors and their relationship with dissociation and treatment experiences among those who dissociate have received little attention in the research literature, despite many specialized clinicians working toward and requesting more training regarding cultural competence. In an online survey study, individuals who dissociate indicated how they understood their culture to affect their dissociative and treatment-related experiences. In this presentation, we will review our reflexive thematic analysis in which five themes were generated: (1) identification of cultural dimensions, (2) culture as a dissociation-catalyst, (3) culture as dissociation-resistance, (4) negation of culture’s impact on dissociation or treatment experiences and (5) uncertainty regarding cultural impact on dissociation or treatment experiences. Participants’ responses told a story of understanding dissociation and treatment experiences in the context of sociocultural systems and processes, including aspects such as stigma, intergenerational trauma, and systemic oppression. We will share participant quotes and discuss the implications of these findings as they apply to clinical practice and working toward cultural competence with individuals who dissociate.
 
It's Not Just a Movie: The Damaging Impact of Misportrayals of Dissociative Identity Disorder in the Media
Hollywood has demonstrated an incessant fixation on dissociative identity disorder (DID). Countless films and television series have depicted DID in the interest of creating a captivating storyline or plot twist at the expense of individuals living with the condition. However, film-based media representations of DID are often stigmatizing, stereotypical, and inaccurate. We conducted a qualitative research study with 377 individuals diagnosed with DID to explore the potential impact of media portrayals on patients’ views of themselves and their treatment. Of the 151 participants who reported that media portrayals of DID had an impact on their mental health treatment, 85.4% (n=129) reported negative or detrimental experiences when asked to describe the impact, and 7.3% (n=11) reported positive or facilitating experiences. Five themes to summarize the data were created using reflexive thematic analysis: 1) portrayals are inaccurate and perpetuate myths among clinicians, 2) portrayals impact patients’ experience of themselves and access to treatment, 3) lack of clinical training leads to negative outcomes, 4) portrayals lead to inadequate or even harmful treatment by clinicians, and 5) importance of specialty treatment. In this presentation, these themes and subthemes within each category will be discussed. Implications for clinical practice and community advocacy will be discussed.
 
This session was originally presented as a live conference session in April 2023.

Target Audience

Beginning/Introductory

Learning Objectives

At the conclusion of this presentation, participants will be able to:

  • Describe two ways cultural competence can be applied to the treatment of individuals who dissociate
  • List four dimensions of culture that individuals who dissociate understand as affecting their dissociative experiences
  • Explain two ways stigma can cause individuals who dissociate to discontinue mental health treatment
  • Describe five ways in which film or media representations of DID impact patients and their treatment
  • Identify two implications for clinical practice when working with patients with DID who have viewed film or media portrayals of this disorder

Course summary

Available credit: 
  • 1.50 APA
    The International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
  • 1.50 ASWB ACE
    The International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/20/2024 – 08/20/2027. Social workers completing this course receive 1.50 continuing education credits.
  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program. No certificate of completion is generated for this type of credit.
Course opens: 
11/01/2023
Course expires: 
12/31/2050
ISSTD Member cost:
$35.00
Your Price:
$55.00
Part of: 
Against the Grain: Shifting the Societal Denial of Dissociation (2023 Annual Conference) - Day Three
Rating: 
0

Presenter: Jennifer Caplan, PsyD
Presenter Bio: Jennifer Caplan, PsyD (she/her) is a postdoctoral fellow at Survivors of Abuse in Recovery (SOAR), Inc., where she specializes in treating complex trauma and dissociation in children, adolescents, and adults. Dr. Caplan also serves on the psychological testing team at SOAR, offering trauma-focused psychological assessments for individuals of all ages. She earned a Bachelor of Arts in Psychology and a Bachelor of Science in Communication Studies, Human Relations from the University of Texas at Austin. Dr. Caplan earned her doctorate in Clinical Psychology at Widener University’s Institute for Graduate Clinical Psychology in 2022 with concentrations in psychodynamic psychotherapy as well as work with children, adolescents, and families. She was the 2021 recipient of the Shirley Fink Scholarship Award. Dr. Caplan’s dissertation focused on addressing trauma-related dissociation in clinical practice with young children. She has co-authored a manuscript on dissociative disorders published in the Delaware Journal of Public Health. Dr. Caplan has provided psychotherapy and psychological assessment services in a variety of settings, including community mental health, private practice, college counseling centers, and hospital inpatient and outpatient settings. She is currently continuing additional clinical training at the Institute of Relational Psychoanalysis of Philadelphia.

Presenter: Stacey Boyer, PsyD
Presenter Bio: Stacey Boyer, PsyD (she/her) is a licensed clinical psychologist and the Associate Director of Clinical Services at the University of Delaware. Dr. Boyer earned her doctorate at Widener University's Institute for Graduate Clinical Psychology in 2014, after which she completed the prestigious Sheppard Pratt Trauma Disorders Fellowship. She served as the Director of Psychology Services for ChristianaCare Health System until March 2023, where she oversaw all adult and child outpatient services, integrated behavioral health, and embedded healthy psychology. In addition to her work at the University of Delaware, Dr. Boyer maintains a private practice in which she provides outpatient psychotherapy to trauma survivors, psychological assessment, and supervision/consultation in Delaware, Pennsylvania, and New Jersey. Dr. Boyer is an Adjunct Professor of Psychology at Widener University. She has held several local and national leadership positions for organizations such as the Society for Personality Assessment and the Philadelphia Society for Psychoanalytic Psychology. Most recently, she served on the US Surgeon General’s roundtable for clinician wellbeing in 2021. Dr. Boyer is a 2021 recipient of Governor Carney’s Compassionate Champion Award for her leadership in Trauma-Informed Care in the state of Delaware. Dr. Boyer has published and presented on topics of trauma, dissociation, assessment, and clinician wellbeing. In 2022, her toolkit on organizational response to collective trauma was published by the American Medical Association and she released a grant-funded and APA-accredited CE module on developing cultural competency in treating healthcare workers. She is currently co-authoring an article on a new Trauma Experience Variable for the Rorschach Performance Assessment System and guidelines for the assessment of trauma in adults for the American Psychological Association (APA).
 
Presenter: Shae Nester, MA
Presenter Bio: Shae Nester (they/them) is a first-year clinical psychology doctoral student at the University of North Carolina at Greensboro (UNCG). They are a graduate student in the Cognitive, Psychopathology, and Emotion lab and provide assessment and clinical services to the community through the UNCG Psychology Clinic. Their most recent research has examined interoception, feelings of disgust, PTSD symptoms, and dissociation using experience sampling methodology. They received their M.A. in clinical psychology from Towson University in 2021 while working with the Treatment of Patients with Dissociative Disorders (TOP DD) research team. While in the TOP DD lab, Shae produced multiple publications, which can be found in the European Journal of Psychotraumatology and the Journal of Trauma and Dissociation, among others. Shae was awarded the ISSTD David Caul Grant in 2020 and explored barriers to accessing and continuing mental health treatment among individuals who dissociate. After graduation, Shae worked as a research assistant in the Dissociative Disorders and Trauma Research Program (DDTRP) at McLean Hospital. Shae also serves as an anti-trafficking research and clinical consultant, contributing to grants, research projects, and clinical services surrounding the identification, assessment, and treatment of people who were trafficked with several organizations, including Survivor Alliance and the University of Maryland SAFE Center. Shae is a member of the ISSTD Scientific Committee and the Transgender and Nonbinary Special Interest group. Shae's is also a student clinician at the UNCG Psychology Clinic. They offer individual therapy and assessment services and specialize in treating complex trauma and dissociation in both children and adults.
 
Presenter: Nicholas A. Pierorazio, BA
Presenter Bio: Nicholas Pierorazio (he/they) is a first-year graduate student pursuing a M.A. degree in clinical psychology from Towson University. He graduated from Towson University in 2021 with a B.A. in Psychology, Clinical Area of Focus, and Foreign Languages, Spanish concentration. Nicholas continues to train clinically and in research in Towson University’s clinical psychology M.A. program. His ongoing thesis project for his M.A. program is a qualitative exploration of the lived experiences and self-care of psychotherapists who work with dissociative identity disorder. Nicholas has served as a Research Assistant in the Treatment of Patients with Dissociative Disorders (TOP DD) lab since 2020. While working in the TOP DD lab, he has contributed to several quantitative and qualitative studies, among other projects. He has particularly led projects regarding the qualitative exploration of multicultural factors related to trauma, dissociation, and mental health treatment. He is currently a Research Assistant for the TOP DD Network Randomized Controlled Trial (RCT), a novel RCT for the field of trauma and dissociation. Between 2020 and 2022, he worked clinically as a Mental Health Worker for Sheppard Pratt Health System’s Trauma Disorders Program. Nicholas also served as a member of the Trauma Disorders Program’s Diversity Work Group, contributing to diversity, equity, and inclusion initiatives. He has served as a Research Assistant for the Trauma Disorders Program’s ongoing data collection and research since 2021. Nicholas has published a manuscript in the Journal of Trauma and Dissociation, as well as a trauma-informed clinical interview guide to be included in a book regarding assessing dissociation.
 
Presenter: Briana L. Snyder, PhD, RN, PMH-BC, CNE, RYT 200
Presenter Bio: Dr. Briana Snyder (she/her/hers) has been an assistant professor in the Department of Nursing at Towson University in Towson, Maryland since 2016, where she teaches psychiatric-mental health nursing at the graduate and undergraduate level. She is the current graduate program director for the Entry-Level Master of Science in Nursing program at Towson University. She maintains clinical practice on the inpatient Trauma Disorders Unit at Sheppard Pratt Hospital in Towson, Maryland, where she has worked as a board-certified psychiatric-mental health registered nurse since 2009. She is also a registered yoga teacher and Reiki master. Dr. Snyder received a Bachelor of Arts in History from the University of North Carolina at Chapel Hill, a Bachelor of Science in Nursing from Stevenson University, and a Master of Science in Nursing Education from Towson University. Dr. Snyder obtained her PhD in Nursing from the University of Missouri-Columbia in 2017, and she received the ISSTD’s David Caul Research Grant to fund her dissertation work on the experiences of women diagnosed with dissociative identity disorder who experienced intimate partner violence in adulthood. Dr. Snyder has been awarded additional grant funding and gone on to publish additional qualitative research related to the nursing care of individuals with dissociative disorders and related to nursing education in peer-reviewed journals such as American Nurse, Journal of the American Psychiatric Nurses Association, Archives of Psychiatric Nursing, Journal of Psychosocial Nursing, Western Journal of Nursing Research, Journal of Psychiatric and Mental Health Nursing, and others. Dr. Snyder has presented her research both nationally and internationally.

 

Available Credit

  • 1.50 APA
    The International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
  • 1.50 ASWB ACE
    The International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/20/2024 – 08/20/2027. Social workers completing this course receive 1.50 continuing education credits.
  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program. No certificate of completion is generated for this type of credit.

Price

ISSTD Member cost:
$35.00
Your Price:
$55.00
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