FOUR SELVES OF A STUDENT – A CASE REPORT OF DISSOCIATIVE IDENTITY DISORDER

Abstract

Dissociative identity disorder’s origin is often traced back to early traumatization. This disorder is difficult to diagnose within a short appointment, and the patient may appear psychotic. We describe a patient case in which a threat of suicidal behaviour led to a further assessment in adolescent psychiatric services. A diagnosis of psychotic depression with traumatic experiences was suspected initially. The functioning of the patient remained relatively intact without treatment of psychosis. A thorough differential diagnostic study was performed due to unusual symptom presentation. The symptoms appearing psychotic were driven by communication between distinct personality states and by concerning memory gaps. Consequently, a diagnosis of dissociative identity disorder was made. The primary treatment recommendation for dissociative disorders that cause unexpected memory gaps or amnesia by expert consensus is psychotherapy. Amnesia can be frightening, and internal dialogue is difficult to explain to others. The goal of psychotherapeutic treatment is to integrate the distinct personality states or modes, to restore continuity in sense of self without memory gaps and to maintain functioning.

Keywords

• dissociative identity disorder
• early traumatization
• differential diagnostics