"I know that all this is me" Pathways of change in complex dissociative disorder.

Objectives: This qualitative study explored changes described by individuals with complex dissociative disorders (CDDs) 2 years after participating in a psychoeducative group. Few recent studies have examined the early changes from incomprehensible reactions to the integration of traumatic events.

Methods: Interviews were conducted with 25 participants with CDD 2 years after completing a 20-week psychoeducative skills training group. Transcripts were analysed using an interpretive phenomenological framework.

Results: Three pathways of change were identified: (1) the ability to be present in life, (2) ways of approaching internal conflicts and (3) the degree of ownership of the self. These pathways illustrate the initial steps towards integration, in which participants start recognizing and confronting previously avoided emotions and experiences. This allows them to better tolerate and accept more of themselves. Processes varied among the participants, with some achieving cohesive integration of challenging memories.

Conclusion: Traditionally, there has been little treatment optimism for individuals with CDD. This study highlights the potential for comprehensive change within 2 years. It contributes to the debate on whether focusing on coping strategies delays trauma memory integration, emphasizing the need for a balance between exposure and coping based on the patient's capacity.