Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Dissociative Disorders

persons who are not experiencing abuse and who could not be subjected to abuse. The dissociated selves become a long-term, ingrained method of self-protection from perceived emotional threats.

Laboratory and psychological tests There are no laboratory tests for DID. Pathophysiology The pathophysiology of DID is poorly understood. Diagnosis, signs, and symptoms

Diagnosis requires the presence of two distinct personality states (alters). Origi nal personality is generally amnestic for and unaware of alters. The median num ber of alters ranges from 5 to 10, although data suggest an average of 8 alters for men and 15 for women. Usually, two or three alters are evident at diagnosis and others are recognized during the course of treatment (see Table 16-5 ). TABLE 16-5. Mental Status Examination Questions for Dissociative Identity Disorder Symptoms If answers are positive, ask the patient to describe the event. Make sure to specify that the symptom does not occur during an episode of intoxication. 1. Do you act so differently in one situation compared to another situation that you feel almost like you were two different people? 2. Do you feel that there is more than one of you? More than one part of you? Side of you? Do they seem to be in conflict or in a struggle? 3. Does that part (those parts) of you have its (their) own independent way(s) of thinking, perceiving, and relating to the world and the self? Have its (their) own memories, thoughts, and feelings? 4. Does more than one of these entities take control of your behavior? 5. Do you ever have thoughts or feelings, or both, that come from inside you (outside you) that you cannot explain? That do not feel like thoughts or feelings that you would have? That seem like thoughts or feelings that are not under your control (passive influence)? 6. Have you ever felt that your body was engaged in behavior that did not seem to be under your control? For example, saying things, going places, buying things, writing things, drawing or creating things, hurting yourself or others, and so forth? That your body does not seem to belong to you? 7. Do you ever feel that you have to struggle against another part of you that seems to want to do or to say something that you do not wish to do or to say? 8. Do you ever feel that there is a force (pressure, part) inside you that tries to stop you from doing or saying something? 9. Do you ever hear voices, sounds, or conversations in your mind? That seem to be discussing you? Commenting on what you do? Telling you to do or not do certain things? To hurt yourself or others? That seem to be warning you or trying to protect you? That try to comfort, support, or soothe you? That provide important information about things to you? That argue or say things that have nothing to do with you? That have names? Men? Women? Children? 10. I would like to talk with that part (side, aspect, facet) of you (of the mind) that is called the “angry one” (the Little Girl, Janie, who went to Atlantic City last weekend and spend lots of money, etc). Can that part come forward now, please? 11. Do you frequently have the experience of feeling like you are outside yourself? Inside yourself? Beside yourself, watching yourself as if you were another person? 12. Do you ever feel disconnected from yourself or your body as if you (your body) were not real? 13. Do you frequently experience the world around you as unreal? As if you are in a fog or daze? As if it were painted? Two-dimensional? 14. Do you ever while looking in the mirror not recognize who you see? See someone else there? Adapted from Loewenstein RJ. An office mental status examination for complex chronic dissociative symptoms and multiple personality disorder. Psychiatr Clin North Am . 1991;14(3):567-604. Copyright © 1991 Elsevier. With permission.

Dissociative Disorders

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