Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Seizure disorders Several symptoms associated with DID may be observed in patients with sei zure disorders (eg, depersonalization/derealization, out-of-body experiences, disruptions in consciousness, amnesia), but patients with seizure disorders tend to achieve very low on dissociation scores while patients with DID score very high. Personality disorders Patients with DID may present identities with severe personality disorders, espe cially borderline personality disorder. Conversely, patients with borderline per sonality disorder may exhibit erratic mood and behaviors, as well as an inability to form stable interpersonal relationships. The key distinction is that patients with borderline personality disorder do not experience disruptions in conscious ness, memory, or identity narrative. Conversion disorder Although dissociative amnesia may occur with conversion disorder (also known as functional neurologic symptom disorder), the amnesia is limited in scope (eg, amnesia during a nonepileptic seizure). Additionally, patients with DID have dis ruptions in consciousness, memory, and identity narrative, whereas patients with conversion disorder will not. Facetious disorder and malingering Individuals who feign DID often stand to gain or to avoid legal or financial difficulties. Additionally, they oftentimes have no history of trauma, seem to almost enjoy “having” the disorder, and create superficial personalities that may be entirely innocent or entirely sadistic. Conversely, patients with DID typically are ashamed of the condition, have no ulterior motive, and report a history of trauma. CLINICAL HINT Do not confuse imaginary companions which begin in childhood and may persist through adulthood with an alter. The companion is recognized as a separate being that may or may not communicate with the patient; the companion is always known and never takes over the patient’s personality. Course and prognosis The earlier the onset of DID, the worse is the prognosis. It is chronic and the most severe of the dissociative disorders. Levels of impairment range from mod erate to severe, depending on the number, type, and chronicity of the various alters. Individual personalities may have their own separate mood disorders and personality disorders, with other dissociative disorders being the most common. Recovery is generally incomplete and unfortunately as many as two-thirds of patients with DID attempt suicide.

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