Dissociative Identity Disorder

Dissociative identity disorder (DID) is disruption of identity with two or more distinct personality states, with recurrent gaps in recall beyond ordinary forgetting.

• Prevalence about 1 to 1.5%; strongly linked to severe, repeated childhood trauma.
• High comorbidity: PTSD, depression, borderline personality disorder, substance misuse, eating disorders, self harm.
• High suicide attempt rate (70%).
• Controversial historically, but recognised clinically and in structured studies.

• Experience of distinct identities or "parts" taking control, amnesia for daily events and personal information, finding unfamiliar items, hearing internal voices, depersonalisation, derealisation, flashbacks.
• Fluctuating function, self harm, somatic symptoms, nonepileptic seizures.
• Usually covert presentation; patients conceal symptoms.

• Structured interview (SCID-D, DDIS); Dissociative Experiences Scale (DES-II) screening.
• Exclude epilepsy (temporal lobe), psychosis, substance related states, bipolar disorder, factitious disorder, malingering, traumatic brain injury.
• Full trauma, suicide risk and comorbidity assessment.

• Phased trauma informed psychotherapy: stabilisation and safety, trauma processing, integration and rehabilitation; usually over years.
• Therapies: DBT skills, schema therapy, EMDR (later phase), hypnosis in experienced hands; avoid suggestive memory recovery.
• No drug treats dissociation directly; treat comorbid depression (SSRI), PTSD, anxiety and sleep; prazosin for nightmares; limit benzodiazepines; naltrexone 50 mg trials for dissociation or self injury.
• Safety planning for suicide and self harm, crisis planning.
• Consistent therapeutic relationship and coordinated care.