Simulated Presentations of Dissociative Identity Disorder in Adolescence: A Case Report and Clinical Reflections

Handbook of Dissociation: Theoretical, Empirical, and Clinical Perspectives

Dissociation, development, and the psychobiology of trauma.

The authors assessed the opinions of American psychiatrists regarding the diagnostic status and scientific validity of the DSM-IV categories of dissociative amnesia and dissociative identity disorder. A one-page questionnaire was mailed to a random national sample of 367 board-certified American psychiatrists. Three hundred one responses were received-a rate of 82%. Only about one-third of respondents replied that dissociative amnesia and dissociative identity disorder should be included without reservations in DSM-IV; a larger proportion replied that these categories should be included only as proposed diagnoses. Only about one-quarter of respondents felt that diagnoses of dissociative amnesia and dissociative identity disorder were supported by strong evidence of scientific validity. Among board-certified American psychiatrists, there currently appears to be little consensus regarding the diagnostic status or scientific validity of dissociative amnesia and dissociative identity disorder.

Multilayered

Background: A category of disorders frequently associated with a history of trauma are the dissociative disorders, of which Dissociative Identity Disorder (DID) is the most severe and chronic form. DID is associated with high levels of impairment, treatment utilization, and treatment costs, yet systematic research into treatment effects is scarce. Practice-based clinical guidelines advise a phase-based approach which is lengthy and has rather high reported dropout rates. Therefore, in the current proposal the efficacy of an alternative treatment for DID (i.e. schema therapy) is tested. Objective: The aim of this study is to critically test the effectiveness of schema therapy for DID patients, for whom at present no evidence-based treatment is available. Method: In light of the low prevalence of DID, and the proposed treatment length of three years, a case series experimental approach is used (non-concurrent multiple baseline design). Ten outpatients are included, who are diagnosed with DID by an independent rater using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R), which is double-checked by another independent expert. Primary outcomes are a (bi)weekly assessed state measure of dissociative symptoms, a pre-, post- and follow-up measure of the presence of the DID diagnosis, and drop-out rate. Secondary outcomes include various measures of trait dissociative symptoms, comorbid symptomatology, and global symptomatic distress. Trial registration: Netherlands Trial Register (NTR): NTR4496

The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. A total of 116 consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the 1st time were evaluated using the Adolescent Dissociative Experiences Scale, adolescent version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by 2 senior psychiatrists in a blind fashion. There was excellent interrater reliability between the 2 clinicians on SCID-D diagnoses and scores. Among 73 participants, 33 (45.2%) had a dissociative disorder: 12 (16.4%) had DID, and 21 (28.8%) had dissociative disorder not otherwise specified. There was no difference in gender distribution, childhood trauma, or family dysfunction scores between the dissociative and nondissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of the dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than in controls. Although originally designed for adults, the SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rated dissociation and lack of relationship between diagnosis and childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults must be replicated. The introduction of diagnostic criteria for adolescent DID in revised versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would refine the assessment of dissociative disorders in this age group.

To identify the most relevant clinical and video-polysomnographic characteristics of patients with sleep-related dissociative disorders (SRDDs) and to propose a framework for new diagnostic criteria. We searched potential SRDD cases from the scientific literature and from a database of patients referred for clinical and video-polysomnographic assessment in a single sleep disorders center for disruptive nocturnal behaviors (n = 731). The most relevant clinical and neurophysiological characteristics of the cases were extracted and a descriptive analysis was performed. Twenty-six SRDD cases (8 new and 18 previously published cases) were reviewed. Almost all cases of SRDDs occurred in a context of past traumatic events or abuse and were associated with at least 1 comorbid psychiatric disorder. We highlighted 4 relevant clinical characteristics of SRDD useful for the differential diagnosis with parasomnias: episodes of long duration of more than 1 hour (90.9%), self-inflicted injuries (83.3%), occurrence while awake close to bedtime (35.7%), and the presence of daytime dissociative symptoms (72.7%). The video-polysomnography documented typical episodes of SRDD with prolonged wakefulness before, during, and after the event in 11/26 cases. New diagnostic criteria for SRDD were proposed, with 3 levels of certainty for the diagnosis based on clinical, video-polysomnographic, and homemade video findings. More than 30 years after its formal identification, SRDD is not currently recognized as an official diagnostic entity. We better delineate the clinical and neurophysiological features of SRDD and propose a framework for its reinstatement in the next revisions of the sleep and psychiatric disorders classifications. Lopez R, Lefevre L, Barateau L, Micoulaud-Franchi J-A, Dauvilliers Y, Schenck CH. A series of 8 cases of sleep-related psychogenic dissociative disorders and proposed updated diagnostic criteria. J Clin Sleep Med. 2022;18(2):563-573.

College counseling professionals address a wide range of complex student mental health concerns. Among these, accurately identifying client presentations of dissociative identity disorder (DID) can be especially challenging because students with DID sometimes present as if they are experiencing another problem, such as a mood, anxiety, or psychotic disorder. This article reviews DID diagnostic criteria, introduces assessment strategies for use during intake and subsequent counseling sessions, and presents case illustrations.

Background A dissociative identity disorder (DID) complicates care for trans people seeking gender affirming medical and surgical treatments (GAMST). Monash Health Gender Clinic (MHGC) clinicians noted an increase in clients reporting dissociative symptoms suggesting DID. Aim To evaluate implications of a DID diagnosis for assessment and clinical care for clients seeking GAMST. Methods 1. A literature review identified and systematically summarized relevant cases. 2. Clinicians identified relevant MHGC clients (2016-2023); file reviews of constructed case summaries and a matrix. Results 1. Analysis of 32 relevant articles identified themes: high trauma rates; reluctance to discuss DID symptoms complicated diagnosis; psychotherapy improving dissociation occasionally changed desire for GAMST; and integrating alter personalities. Prevalence studies found varying DID rates in trans people (0-1.5%), with DID and dissociative symptoms at higher rates compared to controls. Dissociative symptoms reduced with GAMST and increased with abuse and transphobia. 2. At MHGC, four clients were identified with a formal clinician DID diagnosis, one with Other Specified Dissociative Disorder - Type 1B, and four with a suspected or self diagnosis and relevant symptoms. Clients with a formal diagnosis reported earlier and more severe childhood trauma. All nine clients required an extended assessment, including: consulting external specialists (n = 4), seeking secondary opinions (n = 5), and clinical review meeting discussion (n = 9). Clinicians determined that all identified alters (n = 7) or main fronters (n = 2) favored GAMST. Conclusions Awareness of DID is needed in complex trauma history cases, as is reaching consensus among alters, through a supportive approach without restricting access to GAMST. Clinicians took a slower, more cautious approach to assessing clients with DID. Mapping and obtaining consent from all identified alters were key steps before providing GAMST.

BackgroundWorld Professional Association for Transgender Health guidelines support the importance of a mental health assessment before providing medical treatment for Gender Dysphoria (GD). During this assessment, patients without GD but with mental health disorder and who request treatment for GD should be excluded. Dissociative Identity Disorder (DID) is a poorly known mental disorder which can be confused for GD.AimTo provide a case report of a patient suffering for DID but asking for treatment for GD and to provide a review of the literature on GD and DID.MethodA case report assessment and follow-up was described and a systematic review of the literature was performed in Pubmed, PsychInfo, and Embase databases.OutcomeTo provide all cases with assessment and follow-up of DID and GD.ResultsThe case report describes a man suffering from DID and asking for hormonal treatment for GD. After assessment the patient was able to let go of his wish for treatment for GD and begin psychotherapy for DID. During the literature review 11 articles were included. 3 articles showed a prevalence of DID of 0%, 0.8% and 1,5% in GD samples. 5 articles were case reports of patients with both diagnoses of GD and DID which showed the complexity of the care of these patients. 2 articles were case reports, where a GD diagnosis was done first, and then counseling for GD was proposed. After a second session, the diagnosis was changed for DID. In 1 other case report and our case report there was a description of 2 persons suffering from DID and asking for treatment for GD.Clinical implicationsOur review shows the complexity of providing care to patients with a comorbidity of GD and DID, as well as the complexity of making the differential diagnosis between GD and DID.Strengths and LimitationsA systematic review was performed on these rare cases. Our study presents the results for a small group of patients.ConclusionsThis article provides the first systematic review on GD and DID and shows that DID in a GD sample does not seem to be higher than in the general population. In addition, it allow clinicians to gain better knowledge about patients suffering from both DID and GD and patients suffering from DID who ask for GD treatment.Soldati L, Hasler R, Recordon N, et al. Gender Dysphoria and Dissociative Identity Disorder: A Case Report and Review of Literature. Sex Med 2022;10:100553.

Frontal and occipital perfusion changes in dissociative identity disorder

Recognizing Traumatic Dissociation

A cross-sectional survey on French psychiatrists’ knowledge and perceptions of dissociative identity disorder

L’adolescent aux diagnostics multiples ou le trouble dissociatif de l’identité à l’adolescence

Dissociative identity disorder is the most complex, severe, and chronic condition within the category of dissociative disorders. The core issue in dissociative identity disorder involves significant divisions and discontinuities in an individual's memory, behavior, emotions, consciousness, and identity, which typically function as a cohesive whole. These dissociative experiences lead to impairments in various psychological functions and are often accompanied by other psychological disorders. Compared to other mental health conditions, environmental factors play a more prominent role in the development of dissociative identity disorder. This is primarily because the etiology of dissociative disorders is closely linked to repeated, systematic, and traumatic experiences, particularly during childhood. Historically, dissociative identity disorder has been diagnosed late, and its association with trauma has often been overlooked. The presence of alter identities and the challenges in recognizing dissociative identity disorder have contributed to this oversight, resulting in a delay in exploring the connections between dissociative identity disorder and other diagnoses. This study aims to investigate the history, diagnostic criteria, treatment approaches, and dissociative aspects of dissociative identity disorder, as well as its relationships with other mental health disorders. Notably, dissociative identity disorder has strong associations with conditions such as post-traumatic stress disorder, schizophrenia, borderline personality disorder, somatization, eating disorders, and attention deficit hyperactivity disorder. The interplay between these diagnoses and dissociative identity disorder is examined through the lens of shared symptoms, comorbidity, etiology, and epidemiology. The delayed recognition of the diagnostic and therapeutic protocols for dissociative identity disorder and the consequent neglect of its relationship with other disorders in the literature underscore the significance of this study. By highlighting these connections, we can enhance our understanding and improve the treatment of individuals affected by dissociative identity disorder and its comorbid conditions.