DID and dissociative amnesia — assessment, differential and phase-oriented management (MEQ)

(i) Differential and discriminators (≈5 marks)

Acute presentation: dissociative amnesia with fugue features pending organic exclusion; chronic picture raises DID or partial DID/OSDD with comorbid depression and self-injury.[1][4]

• Dissociative amnesia/fugue: autobiographical gap with travel/wandering; often relatively preserved new learning once settled; still exclude seizure/TBI/substance/encephalitis.[4]
• DID: identity disruption with distinct states + recurrent amnesia inconsistent with ordinary forgetting; internal self-state voices; reality testing generally intact outside switches.[1]
• Primary psychosis: thought disorder, external hallucinations, persistent delusions — not suggested by stem but must be considered.[1]
• BPD: chronic emptiness, abandonment fears, affective instability; discrete autonomous self-states with extensive amnesia less central (comorbidity possible).[1]
• PTSD with dissociative symptoms: trauma clusters may co-occur; do not collapse labels.[1]

State trauma associations with method caution; sociocognitive/iatrogenic risks remain clinically relevant.[5][7]

(ii) Assessment (≈4 marks)

Safety first: suicide/self-injury, vulnerability while amnestic, capacity, child protection if relevant.[3] Trauma-informed, non-leading history; MSE for identity continuity and amnesia pattern; collateral; diary/time-loss inquiry. DES screens/tracks; SCID-D structures diagnosis when expertise available.[6] Organic work-up when first-onset/atypical neurological clues.[4]

(iii) Acute fugue/amnestic management (≈3 marks)

Protect from exploitation; re-orient gently; calm environment; medical exclusion as indicated; temporary practical supports for identity and housing; avoid forced memory recovery or hypnosis-for-all-memories in crisis.[4][2] Safety plan and least-restrictive care setting.

(iv) Phase-oriented longer-term care (≈4 marks)

ISSTD-style: Phase 1 safety/stabilisation/skills/comorbidity; Phase 2 carefully paced trauma processing when stable; Phase 3 integration/rehabilitation (fusion not the only goal). Evidence stronger for consensus and naturalistic cohorts (e.g. TOP DD long-term gains) than large DID-specific RCTs — say so explicitly.[2][1]

(v) Pharmacotherapy and pitfalls (≈4 marks)

Medications treat comorbidity (e.g. antidepressant pathway for major depression with standard dosing/monitoring) — do not fuse identities.[2] Pitfalls: aggressive leading memory recovery/hypnosis-for-memory; mislabelling as schizophrenia with unnecessary chronic antipsychotics for non-psychotic internal voices.[2][7]