How to Assess Adherence Risk in Dissociative Disorders
How should clinicians assess which patients with dissociative disorders are at higher risk of treatment nonadherence?
Patients with dissociative disorders often have substantial impairment and complex comorbidity, and treatment adherence is a major determinant of recovery. This study indicates that adherence is better understood through treatment beliefs and current treatment engagement than through demographic profiling.
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Ask about current treatment engagement
Determine whether the patient is currently in therapy and whether the patient is currently taking medication. In this study, both were strongly associated with higher adherence: 55 of 83 patients currently in therapy were in the high-adherence group, and 61 of 106 patients taking medication showed higher adherence, with P < .001 for both.
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Assess perceived benefit of treatment
Ask directly whether the patient believes therapy or medication will meaningfully improve dissociative symptoms. Perceived benefit was significantly associated with compliance (P = .003) and remained a significant positive predictor in multivariable analysis (beta = 0.295, P = .001), making it the most clinically useful health belief model domain to probe.
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Screen for perceived barriers to adherence
Identify obstacles the patient believes interfere with following treatment, including concerns related to stigma, cost, side effects, access to specialized care, and other psychosocial or logistical problems described in the article. High perceived barriers were significantly associated with noncompliance (P = .007) and showed a negative association in regression analysis (beta = -1.633, P = .015).
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Do not rely on demographic risk profiling
Avoid using age, sex, marital status, education, occupation, employment type, or duration of diagnosis as the main basis for estimating adherence risk in this population. None of these variables showed a statistically significant association with treatment adherence in this study.
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De-emphasize severity- and susceptibility-based adherence judgments
Do not assume that patients who acknowledge illness seriousness or personal vulnerability will necessarily be more adherent. In this sample, perceived severity and perceived susceptibility were not significantly associated with compliance, and cues to action were also not significant.
Clinical Considerations
- The study was cross-sectional, so these factors identify associations with adherence rather than proving causation.
- Adherence was self-reported, which may have been affected by recall bias or fluctuating insight in dissociative disorders.
- The study did not directly assess culturally specific barriers such as stigma, family beliefs, or reliance on alternative healing practices.
- Because the study was conducted in a single center, generalizability to other settings may be limited.
Bottom Line
When estimating adherence risk in dissociative disorders, focus on perceived benefits, perceived barriers, and whether the patient is actively engaged in therapy or medication, not on demographics or illness-severity messaging alone.
