Dissociative identity disorder (DID) is among the most challenging of mental disorders to diagnose and treat. It has also been the subject of many controversies in the field. The author first discusses how the disorder is defined and reviews the DSM-IV criteria for DID as well as concepts of identities, personalities, and personality states. A number of controversial areas are then discussed, including the epidemiology and etiology of DID, dealing with allegations of abuse, and whether to assess for DID and whether to deal with alters and trauma history in treatment. A variety of diagnostic approaches are described, including clinical interviews, mental status examinations, and screening and diagnostic instruments such as the Dissociative Experiences Scale (DES). The differential diagnosis of DID is reviewed. The disorders that it is most important to consider in the differential diagnosis of DID are other dissociative disorders, psychotic disorders, affective disorders, borderline personality disorder, partial complex seizures, factitious disorders, and malingering. The second half of the article deals with treatment issues. The author reviews the various stances toward the treatment of DID (e.g., strategical integrationalist, tactical integrationalist) and then discusses the stages of DID treatment as described by a variety of authors. Treatment issues related to different subgroups of DID patients are described. The author also presents a method for monitoring the flow of DID treatment. The article concludes with special discussions of selected topics such as working with alters, trauma and abreaction, hypnosis, and the use of medication.
© 1999 by Lippincott Williams & Wilkins, Inc.