Treatment of Patients with Dissociative Disorders Study

There have been few studies assessing how patients with dissociative disorders (DD) respond to treatment. The paucity of research contributes to the limited awareness of DD and the lack of training for treatment providers. The goal of the Treatment of Patients with Dissociative Disorders studies is to assess treatment outcome among people with DD, and, ultimately, to learn how to provide the most effective treatment to them. So far, the TOP DD research team has conducted two studies, one a prospective, naturalistic study of treatment outcome among DD patients from around the world (hence forward called the “TOP DD study”), and another which surveyed DD experts for their recommendations of specific treatment interventions that are effective at various stages in DD treatment.

Thanks to the generous sharing of time and treatment experiences by our TOP DD participants, the TOP DD naturalistic treatment study was very successful. We were able to recruit approximately 290 therapists and their patients from 19 countries around the world. This makes the TOP DD study the largest and only international study of dissociative disorders (DD). The TOP DD study collected data at four points across 30 months of treatment. The patients showed less depression, dissociation, PTSD, and general distress over 30 months of treatment, as well as decreases in suicide attempts, self-injurious behaviors, and hospitalizations. Additionally, therapists rated patients as having higher adaptive functioning over time. The consistent reports of both the patients and the therapists in the TOP DD study demonstrated that DD treatment is associated with decreased symptoms and improved functioning. The study has important implications for the mental health field because DD are prevalent and associated with severe symptoms and dysfunction, as well as high treatment costs.

The TOP DD study is providing fascinating insights into how DD patients respond to treatment and the variables that are associated with different treatment outcomes such as age, revictimization, and stressors. Although data collection for the first TOP DD study is complete, we will continue to analyze the data to learn more about DD treatment. We anticipate that in addition to the seven papers already published or in press based on the TOP DD data, we will have additional papers about the impact of therapeutic alliance on treatment outcome and the costs of treatment. See a listing of the TOP DD publications.  

The TOP DD study received IRB approval through Towson University and Sheppard Pratt Health System.


The Next Phase

The great success of the TOP DD study highlights the need for further inquiry into the treatment outcomes of DD patients. The research team has launched a follow-up study to the TOP DD study entitled TOP DD Network.

While the first study was a naturalistic study that did not alter the treatment that patients were receiving, the new study allows patients to participate in a web-based educational program that has been specifically developed to target the enhancement of safety for DD patients. All patients participating in the TOP DD Network study will need to be in individual therapy; in addition, both the patient and his or her therapist must also participate in the study in order to be eligible. This requirement insures that DD patients have clinical help in case of a crisis. The TOP DD Network study cannot provide clinical advice or consultation.

Using the original TOP DD study participants as a control group, patients in the new study will be statistically matched to those in the original TOP DD study. The TOP DD Network participants will view a series of 5 minute educational video discussions created by the TOP DD research team. These short video segments will discuss educational topics related to safety including reasons why DD patients are unsafe and how to begin to get control over unsafe behaviors. The TOP DD team includes expert clinicians who have decades of experience in specifically treating DD patients. They have selected the topics, as well as the written reflection assignments and practical exercises that they have found to be the most effective in their clinical work. The video scripts have also been reviewed by a focus group of individuals diagnosed with DID who have worked closely with the TOP DD team and provided useful feedback that has improved the material presented in the study. The focus of the TOP DD Network intervention will be on establishing and maintaining safety, as well as related skills such as safely managing emotions, maintaining an awareness of the present moment, and grounding skills to increase control over dissociation.

The goal of the TOP DD Network study is to determine whether a web-based intervention, in combination with individual psychotherapy, is more effective for DD patients than individual psychotherapy alone. This is an exciting study because it will be the first systematic, controlled study of treatment for outpatients with DD. As a web-based intervention for DD patients, it has the potential to benefit DD patients around the world by providing a free intervention that may reduce their symptoms and improve their functioning. It will also provide training to therapists about how to help stabilize DD patients’ safety. Finding the most beneficial and cost effective interventions for DD patients is crucial because DD are associated with severe symptoms, considerable suffering for DD individuals, serious impairment in functioning, and high treatment costs.

TOP DD Network Book

The results of the TOP DD Network study are so promising that we are busy writing a book based on the TOP DD Network study that will serve as the treatment manual for the next TOP DD study. The book will be published by Oxford University Press. Updates about the book publication will be posted here and on our Facebook page.

If you would like to be informed about the publication of the book, please contact us via email at .

Thank you for your interest!

Participation in TOP DD Studies

We have completed the TOP DD Network study. Thank you to all participants!

If you are interested in participating in future studies, please contact us via email at

Thank you for your interest!

Contact Information

Principal Investigator

Psychology Department
Bethany Brand