Psych · general-adult
Dissociative identity disorder and dissociative amnesia
Also known as DID · Multiple personality disorder · Dissociative identity disorder · Dissociative amnesia · Dissociative fugue · Psychogenic amnesia · Partial DID · OSDD
Fellowship leaf on DID and dissociative amnesia (including fugue): DSM-5-TR/ICD-11 nosology, trauma vs sociocognitive debate, DES/SCID-D assessment, organic and psychiatric differentials, ISSTD phase-oriented care, TOP DD evidence caveats, suicide risk, and iatrogenic memory-recovery pitfalls. FRANZCP-primary, globally tagged.
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Red flags
- Active suicidal intent, plan, or escalating self-injury with dissociation — same-day senior review, means restriction, documented safety plan
- First-onset identity alteration or amnesia with focal neurology, seizure clues, fever, or marked confusion — medical/organic work-up before psychiatric labelling
- Fugue with wandering, inability to care for self, or inability to give history — urgent safety, capacity, and vulnerability assessment
- Aggressive memory recovery, hypnosis-for-memory, or leading interviews that risk confabulation and iatrogenic harm
- Presuming schizophrenia from internal voices alone without assessing reality testing, thought form, and amnesia pattern
- Returning a patient to ongoing interpersonal violence or coercive control while starting trauma processing
Meet the patient
Police bring in a man found sleeping at a bus station 400 kilometres from home. He knows the year, the prime minister, and how to top up a travel card. He does not know his own name, and the three days before he was found are simply not there. Bloods, CT and tox screen are clean. His wallet contains a photo of a woman he cannot identify — his wife, who reported him missing after he walked out of his own mother's funeral.[1][14]
The examiner's question: what kind of forgetting is this — and what do you absolutely not do next? This leaf teaches the forgetting half of dissociation and the identity half, together.[2][14]
References14ShowHide
- [1]Spiegel D, Lewis-Fernández R, Lanius R, Vermetten E, Simeon D Dissociative disorders in DSM-5 Annu Rev Clin Psychol, 2013.PMID 23394228
- [2]Dorahy MJ, Brand BL, Sar V, Krüger C, Stavropoulos P Dissociative identity disorder: An empirical overview Aust N Z J Psychiatry, 2014.PMID 24788904
- [3]Dalenberg CJ, Brand BL, Gleaves DH, Dorahy MJ, Loewenstein RJ Evaluation of the evidence for the trauma and fantasy models of dissociation Psychol Bull, 2012.PMID 22409505
- [4]Lynn SJ, Maxwell R, Merckelbach H, Lilienfeld SO, Kloet DVH Dissociation and its disorders: Competing models, future directions, and a way forward Clin Psychol Rev, 2019.PMID 31494349
- [5]Lyssenko L, Schmahl C, Bockhacker L, Vonderlin R, Bohus M Dissociation in Psychiatric Disorders: A Meta-Analysis of Studies Using the Dissociative Experiences Scale Am J Psychiatry, 2018.PMID 28946763
- [6]Sar V, Akyüz G, Doğan O Prevalence of dissociative disorders among women in the general population Psychiatry Res, 2007.PMID 17157389
- [7]Foote B, Smolin Y, Kaplan M, Legatt ME, Lipschitz D Prevalence of dissociative disorders in psychiatric outpatients Am J Psychiatry, 2006.PMID 16585436
- [8]Foote B, Smolin Y, Neft DI, Lipschitz D Dissociative disorders and suicidality in psychiatric outpatients J Nerv Ment Dis, 2008.PMID 18195639
- [9]Bernstein EM, Putnam FW Development, reliability, and validity of a dissociation scale J Nerv Ment Dis, 1986.PMID 3783140
- [10]Steinberg M Advances in the clinical assessment of dissociation: the SCID-D-R Bull Menninger Clin, 2000.PMID 10842445
- [11]International Society for the Study of Trauma and Dissociation Guidelines for treating dissociative identity disorder in adults, third revision J Trauma Dissociation, 2011.PMID 21391103
- [12]Myrick AC, Webermann AR, Loewenstein RJ, Lanius R, Putnam FW Six-year follow-up of the treatment of patients with dissociative disorders study Eur J Psychotraumatol, 2017.PMID 28680542
- [13]Reinders AA, Willemsen AT, Vos HP, den Boer JA, Nijenhuis ER Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states PLoS One, 2012.PMID 22768068
- [14]Staniloiu A, Markowitsch HJ Dissociative amnesia Lancet Psychiatry, 2014.PMID 26360734