Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Transition from one original personality to the alter or from one alter to an other tends to be abrupt. During a specific personality state/alter, patients are amnestic about other states and events that took place when another personality was dominant. Some personalities may be aware of aspects of other personali ties; each personality may have its own set of memories and associations, and each generally has its own name or description. Different personalities may have different physiologic characteristics (eg, different eyeglass prescriptions) and different responses to psychometric testing (eg, different IQ scores). Alters may be of different sexes, ages, or races than the original personality. One or more of the alters may exhibit signs of a coexisting psychiatric disorder (eg, mood disor der, personality disorder). Signs of DID are listed in Table 16-6 . The diagnostic criteria for DID require a discontinuity in agency and sense of self, as well as alters’ ability to assume control over patients’ executive function ing. Criterion A also notes that each alter possesses unique characteristics with respect to things like memory, behavior, and perception. Criterion B requires the existence of multiple episodes of amnesia, while Criterion C requires these disruptions lead to distress or impairment. Disturbances should not be part of a normal cultural or religious tradition (Criterion D) or better explained by another condition or due to the use of a substance (Criterion E). Differential diagnosis For a list of differential diagnosis, see Table 16-7 . Psychotic disorders DID may be mistaken for hallucinations associated with psychotic disorders like schizophrenia, particularly if the patient is capable of communicating with an alternate personality, in which case the clinician may assume the alter is merely a voice the patient hears instead of a separate identity. A key distinction between psychotic hallucinations and dissociative experiences is that the former do not TABLE 16-6. Signs and Symptoms of Dissociative Identity Disorder 1. Reports of time distortions, lapses, and discontinuities 2. At least two distinct personality states (can be described/experienced as “being possessed by” another) 3. Discontinuous identity (eg, dichotomies in memory, behavior, or consciousness) 4. Persistent gaps in memory and personal information 5. Fantasy play in children is excluded. 6. Being recognized by others or called by another name by people whom the patient does not recognize 7. Notable changes in the patient’s behavior reported by a reliable observer: The patient may call themselves by a different name or refer to themselves in the third person. 8. Other personalities are elicited under hypnosis or during amobarbital sodium interviews. 9. Use of the word “we” in the course of an interview 10. Discovery of writings, drawings, or other productions or objects (eg, identification cards, clothing) among the patient’s personal belongings that are not recognized or cannot be accounted for 11. Headaches 12. Hearing voices originating from within and not identified as separate 13. History of severe emotional or physical trauma as a child (usually before the age of 5 y) Used with permission of Elsevier Science &Technology Journals from Cummings JL. Dissociative states, depersonalization, multiple personality, episodic memory lapses. In: Cummings JL, ed. Clinical Neuropsychiatry . Grune & Stratton; 1985:122; permission conveyed through Copyright Clearance Center, Inc.

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