How Do Psychiatric Residents View Dissociative Identity Disorder?

Abstract
Dissociative Identity Disorder (DID) is a uniquely challenging disorder to learn about and treat during residency in part because many psychiatrists, including those who educate residents, do not believe it exists (1). Thus, trainees in psychiatry are often caught in the middle of disparate views about the disorder, which includes being subject to misinformation such as the 6 common myths about DID identified by Bethany Brand and her colleagues (2). It is our hypothesis that the transfer of misinformation and stigmatized views about DID within the field of psychiatry, especially during formative training years, contributes to the perpetuation of a longstanding misunderstanding about DID within mental health services (3) despite advances in neuroscientific understandings of dissociative disorders (4). Education changes could prevent adverse consequences that ensue in the current system, such as prolonged hospitalizations, exposure to ineffective or harmful medication, delayed or absent treatment, stigmatization, and inadvertent contribution to patient morbidity (5).

In this study, we surveyed psychiatry residents across U.S. psychiatry residency programs to sample their experience with clinical education about DID. In the late spring of the academic year, we e-mailed a link to an anonymous 21-item RedCAP survey to 327 general program directors whose e-mail addresses were listed in FRIEDA. We requested they forward the survey link to their residents. A total of 64 residents returned the survey across a one month period in which the original e-mail and one reminder was sent. A response rate cannot be calculated as we do not know how many residents received the survey. The sample was fairly evenly distributed across 6 AADPRT geographical regions and across all four post-graduate years of residency.

Results showed that of the 64 residents who responded, 31% had encountered at least one patient with DID to date in their program. In alignment with our hypothesis, 36% did not feel they had adequate clinical supervision about dissociative disorders (DD) and 38% did not (and/or did not think they would) receive didactic education about DID. 45% were not encouraged to screen for DD or include them in their differential diagnosis. Only 30% of the residents believed that DID has validity, whereas 37% did not. We also assessed belief in the myths about DID. Particularly concerning, 29% thought work with alters caused more harm than good and 10% thought any treatment was harmful. Of note, we received some interesting open response comments at the end of the survey which we will group by themes and present on the poster.

In summary, formative clinical learning and didactic education about DID in psychiatric residencies is significantly biased by misinformation and unwarranted skepticism/disbelief amongst psychiatry faculty. This most likely contributes to adverse clinical outcomes in mental health settings in which psychiatrists hold leadership roles. The limitations of this study include a small sample size and the use of an e-mail survey rather than direct interviews. Future directions are to develop “best practices” in resident-specific pedagogy about dissociative disorders designed to combat misperceptions and stigma.