Faculty Q&A

MENDING SHATTERED LIVES

We asked Bethany Brand about trauma-related disorders and her international researchproject, TOP DD studies.

What are dissociative disorders (DD)? |
Dissociation is an escape mechanism, a responses to a traumatic event such as abuse, combat or being a witness or victim of violence. The DSM (Diagnostic and Statistical Manual of Mental Disorders) classifies several dissociative disorders including Dissociative Amnesia, Depersonalization Disorder and Dissociative Identity Disorder (DID). DID was once called multiple personality disorder; it develops from severe and prolonged abuse in early childhood. Because children cannot escape their abusers—a parent or other trusted adult—they flee instead by disconnecting from their minds, emotions and memories.

Most people know of DID from movies such as “Sybil” and “Split,” but these movies get it wrong. While patients exhibit different states and may have amnesia when doing so, they do not look so flagrantly different as the movies portray. If they did, it would be much easier to diagnose the condition. But genuine DID behaviors are more subtle, more like a change of mood.

Patients with DD also tend to have a lot of other problems such as PTSD (posttraumatic stress disorder), depression, drug and alcohol addiction, eating disorders, anxieties and high suicidal tendencies.

What led you TO specialize in this field? |
While I was conducting psychological assessments at Hopkins, I asked how patients’ answers would differ for those who had been abused versus those who had not. Even experienced mental health clinicians had no answers…so I was “off to the races.”

What was surprising as you began to focus on dissociative disorders? |
Two things—some people in the mental health field refuted the existence of DID. And there was very little research about the disorders and how to effectively treat them.

Is there still a controversy surrounding the existence of DID? |
For years a prominent psychiatrist at Johns Hopkins denied the validity of these disorders, and there are some people who persist in these beliefs.

But we have science behind us with neurobiological evidence to support its existence.

Patients’ heart rates and EEGs—their brain waves— and other biological patterns change when shifting from one state to another. Actors cannot imitate that. In fact, students and therapists trained in psychological testing and DID could not fake the disorder.

How did you get started in researching DD? |
I headed up a 2009 review of the literature; we found only eight studies looking at DID and those were short-term—eight to 12 weeks—not nearly long enough to evaluate effectiveness in a disorder that can take years of psychotherapy. So there was a profound need for research. What’s more, insurance is reluctant to pay for therapy if treatments have not been proven effective.

I was in the right place at the right time. With the proliferation of the internet and the help of Frank Putnam, a legend in the field, we launched an online study so we didn’t need millions to fund it. The first TOP DD study recruited nearly 300 therapists and their patients in 19 countries. It not only showed psychotherapy can help patients with DD, it also identified the best treatment modalities for each stage of treatment.

How did the Top DD study evolve? |
In the next phase, the TOP DD Network study, we developed 45 videos to teach patients and their therapists about symptoms and how to stabilize them. Patients can watch these 10- to 12-minute videos whenever they want for free. We all need repetitions to learn but especially these folks who may have memory problems. What’s more, in Norway, for example, the videos can reach patients in remote areas who cannot find DD experts available within a reasonable distance.

Our goal in this randomized, controlled study is to determine whether the videos, along with keeping a journal and individual psychotherapy, would minimize self-destructive behaviors and improve treatment more than psychotherapy alone.

Though we are still finalizing the analyses, evidence so far shows patients become more stable. They are having fewer nightmares and flashbacks. They are less fragmented and less at war with themselves. They feel more self-compassion and that seems to help them be less self-destructive.

What is the most effective treatment for patients with DD? |
Patents must be stabilized first. They need carefully paced, trauma-informed treatment to stop self-destructive behaviors and manage their PSTD symptoms so they can sleep. They blame themselves for not preventing the abuse, and these beliefs must be changed so they can stop harming themselves or self-medicating with drugs or alcohol.

We do not have them talk about the trauma early on in treatment—this tends to make them more suicidal. Once patients are stable, only then can we can begin to deal with actual abuse.

What do YOU want judges and juries to take away from your testimony as an expert witness during trials? |
I want them to understand these disorders are inaccurately portrayed. These are people who are not all that different who found an amazing way to survive trauma. They are not typically violent. They need treatment, understanding and support, just like people with any other disorder.

What’s next for you professionally? |
Last fall I gave a presentation as a master clinician, an honor I never expected in my career. This talk became an article that I will submit with my colleagues to a top trauma journal about how to treat DD based on our study.

I’ll also be giving presentations on the TOP DD Network study in Norway and Amsterdam this year. And I am writing a book on DD for Oxford University Press.

Visit www.isst-d.org for more information on DD or to support The TOP DD Studies.

The painting held by Brand, the work of a patient with DID, shows the emptiness of the dissociated self and the shame and pain of the traumatized self left behind.

Bethany Brand, Ph.D., professor of psychology, is the principal investigator of the Treatment of Patients with Dissociative Disorders (TOP DD) studies. She heads this international project aimed at determining whether an online educational tool program for patients with dissociative disorders and their therapists improves their response to treatment. The initial results show that patients are showing less, leading to fewer suicides and self-destructive harmful behaviors and fewer symptoms. An earlier study showed treatment was associated
with decreased healthcare costs.

Brand has over 25 years of clinical experience, treating and assessing trauma-related disorders, including dissociative disorders and posttraumatic stress disorders.

A professor at TU for 18 years, her graduate and undergraduate classes include diagnostic interviewing, and assessing and treating trauma. She also directs the competitive undergraduate Clinical Focus program.

In addition to teaching, Brand has conducted extensive research on effectively treating trauma-related disorders, distinguishing feigned
from genuine trauma disorders, and evaluating psychology textbooks for the accuracy and adequacy of the information they include about trauma.

Brand has received numerous research, clinical, writing and teaching awards including the Morton Prince Award, the Cornelia B. Wilbur Award and the Maryland Psychology Teacher of the Year. She also serves as a forensic expert in trauma-related cases throughout the world.