Master Dissociative Identity Disorder with Picmonic for Medicine

This condition is characterized by the presence of 2 or more distinct identities or personality states that recurrently take control of behavior.

These identities may have distinct patterns of perception, affect, cognition, and behavior. The alteration in identity is often observed by others or reported by the patient. Transitions may be sudden and triggered by stress.

Although this disorder is one of the rarer psychiatric diseases, it is much more common in women than in men. Women often present with more dissociative symptoms, while men may present more frequently with violent or criminal behavior under different identities (less often diagnosed).

DID usually begins in childhood, but symptoms may not be recognized until later. It is often linked to severe childhood trauma, particularly repetitive sexual or physical abuse before age 9. Often occurs in individuals who lacked a supportive caregiver during or after the trauma.

DID is associated with a history of sexual abuse. Sexual abuse is abusive sexual behavior by one person upon another. It is often perpetrated using force.

DID may be a psychological response to interpersonal and environmental stresses, particularly during early childhood years, when emotional neglect may interfere with personality development. Posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and borderline personality disorder are all closely linked with DID.

Depersonalization is characterized by feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions. Derealization is characterized by feelings of detachment from one’s environment. Intact reality testing helps clinicians differentiate depersonalization and derealization from psychosis. Patients with dissociative identity disorder frequently experience depersonalization and derealization. DID is distinct from depersonalization/derealization disorder, which involves these symptoms without identity fragmentation.

Lapses in personal information are a common manifestation of dissociative identity disorder. Patients may develop an inability to recall important personal information (e.g., personal identity, memories), usually following severe emotional stress or trauma; this is known as dissociative amnesia. Dissociative amnesia may be accompanied by dissociative fugue, which is characterized by unexpected travel to unfamiliar environments.

These amnesic episodes often relate to trauma and may result in dissociative fugue (sudden travel + identity confusion). This is classified under dissociative amnesia, a specifier of DID or a separate diagnosis.

Cognitive behavioral therapy is a type of psychotherapy based on analyzing and reforming maladaptive thoughts that are contributing to emotional and behavioral distress. It is indicated in a wide variety of behavioral health disorders and has demonstrated benefit in patients with dissociative identity disorder.

Selective Serotonin Reuptake Inhibitors are antidepressants that work by selectively inhibiting serotonin reuptake into presynaptic cells, increasing the neurotransmitter's availability in the synaptic cleft. Selective serotonin reuptake inhibitors are frequently used in patients with dissociative identity disorder, usually in combination with cognitive behavioral therapy.

Long-term psychotherapy is the cornerstone of treatment for dissociative identity disorder. It focuses on integrating fragmented identities, processing past trauma, and improving emotional regulation and functioning. Therapy often spans several years and may include trauma-focused modalities such as dialectical behavior therapy (DBT), psychodynamic therapy, or cognitive behavioral therapy (CBT). Establishing a strong therapeutic alliance and ensuring patient safety are essential goals.

Unfortunately, patients with dissociative identity disorder tend to have a poor prognosis due to high morbidity and mortality associated with comorbid conditions (e.g., PTSD, depression) and high rates of suicide.