Dissociative Disorders are thought to develop in the context of disturbed early inter-personal and traumatic experiences. Treatment can be complex and difficult. Dissociative Identity Disorder (DID) could be considered the most severe form of Dissociative Disorder. Social support is considered a positive contributing factor to outcomes in a range of psychiatric disorders. Social support then is conjectured to play an important role in the outcomes of individuals with Dissociative Disorders. However, many individuals with Dissociative Disorders are thought to experience problems with inter-personal functioning (and particularly, functioning in romantic relationships) which may hinder the potential benefits of social support in contributing to positive outcomes.
The current study aimed to explore the romantic relationships of women with Dissociative Disorders. A number of hypotheses were generated relating to psychological and relationship functioning, attachment styles, inter-relations between patient and partner functioning, the effects of treatment on psychological functioning and the couple relationship, and the effects of couple relationships on treatment outcomes for female patients.
The psychiatric profiles, abuse histories and romantic relationship experiences of 30 female participants diagnosed with a Dissociative Disorder (18with a diagnosis of DID), were examined. Eleven of their male partners were also examined. Female participants were recruited from an inpatient trauma treatment program. The initial assessment (Assessment) was conducted following which they had a combination of inpatient and outpatient treatment which varied from four to six months. A follow up assessment (Follow up) was then performed. Male participants were contacted through their partners and also assessed at both times.
The study employed a mixed-methods approach, utilising both quantitative and qualitative measures. Psychological functioning was assessed using the Dissociative Disorders Interview Schedule (DDIS), the Depression Anxiety and Stress Scale (DASS21) and the Dissociative Experiences Scale (DES). Aspects of relationship functioning were measured using the Dyadic Adjustment Scale (DAS) and the Brief Index of Sexual Functioning for Women (BISF-W). Attachment styles and behaviours were measured using the Experiences in Close Relationships Scale (ECR) and self-reported attachment style prototypes. Participants were also interviewed and questioned through qualitative methods regarding specific relationship issues such as self-reported relationship needs, positive and negative relationship experiences and abuse within romantic relationships.
Results indicated, for female participants, psychopathology was elevated and there was evidence of sexual functioning lower than norms. For both males and females, relationship satisfaction was low and there was evidence that male psychopathology was elevated. All female participants self reported insecure attachment styles with the majority nominating fearful avoidant attachment. At Assessment there were positive associations between attachment avoidance and dissociation, and between attachment anxiety and general anxiety and depression. At Follow up, results revealed a positive association between attachment avoidance and stress and general anxiety for female participants.
Correlations revealed some of the expected links between male and female functioning: at Follow-up, there was a negative association between female relationship satisfaction and male anxiety. Furthermore, there was a positive association between female attachment anxiety, stress and general anxiety at Assessment and male attachment avoidance at Follow up. There was also a positive association between female attachment anxiety and male attachment anxiety over time.
For both males and females, there were no significant changes in psychopathology or relationship functioning post treatment, however the sexual functioning of partnered female participants had declined significantly at Follow up. Finally, there was some evidence to suggest that romantic relationship support may be beneficial to treatment outcomes, in that after treatment, partnered females were less stressed than females without partners.
Notable findings of qualitative results included female participants’ high rates of self-reported abuse within past and current romantic relationships. Female participants and male partners emphasised the negative impact of the patients’ symptoms on relationship functioning, communication problems and sexual problems. Female participants also frequently reported that fears of intimacy and abandonment had impacted upon their relationship functioning. Similar to what might be expected within a normative sample, couples within this sample valued factors such as friendship, support and emotional closeness within romantic relationships. Partner psychopathology and relationship experiences were considered with regard to Benjamin and Benjamin’s (1994) work with partners of individuals with Dissociative Disorders.
The limitations of the study included the small sample size and lack of a control group. The heterogeneous nature of Dissociative Disorders and the variability of the treatment the participants received are also weaknesses. This also reflects the poor understanding of this group of disorders and the small number diagnosed or seeking treatment.