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Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach
Abstract and Figures
Objective:
Some claim that treatment for dissociative identity disorder (DID) is harmful. Others maintain that the available data support the view that psychotherapy is helpful.
Method:
We review the empirical support for both arguments.
Results:
Current evidence supports the conclusion that phasic treatment consistent with expert consensus guidelines is associated with improvements in a wide range of DID patients' symptoms and functioning, decreased rates of hospitalization, and reduced costs of treatment. Research indicates that poor outcome is associated with treatment that does not specifically involve direct engagement with DID self-states to repair identity fragmentation and to decrease dissociative amnesia.
Conclusions:
The evidence demonstrates that carefully staged trauma-focused psychotherapy for DID results in improvement, whereas dissociative symptoms persist when not specifically targeted in treatment. The claims that DID treatment is harmful are based on anecdotal cases, opinion pieces, reports of damage that are not substantiated in the scientific literature, misrepresentations of the data, and misunderstandings about DID treatment and the phenomenology of DID. Given the severe symptomatology and disability associated with DID, iatrogenic harm is far more likely to come from depriving DID patients of treatment that is consistent with expert consensus, treatment guidelines, and current research.
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... While substantial evidence supports a trauma-related etiology for dissociative disorders, some argue that dissociation is linked to imaginative processes, where individuals generate trauma-related fantasies without actual trauma exposure (Giesbrecht et al., 2008;Loewenstein, 2018). In contrast, other researchers emphasize the risk of iatrogenic dissociation-conditions potentially arising from therapeutic influence and characterized by confabulated trauma memories (Brand et al., 2014). ...
... Importantly, these models may not be mutually exclusive and may offer complementary insights into how cognitive and sociocultural factors interact with trauma to shape dissociative manifestations. That said, substantial empirical evidence continues to support the trauma model's relevance, particularly in trauma-focused therapies that prioritize stabilization and symptom management over direct memory recovery (Brand et al., 2014). The trauma model's foundations remain deeply rooted in early psychiatric research and historical observations linking trauma to dissociative symptoms (Hustvedt, 2012;Loewenstein, 2018). ...
This paper introduces the hypothesis of Psychedelic Iatrogenic Structural Dissociation (PISD), proposing that psychedelics may reactivate dissociated traumatic material, increasing the risk of psychological destabilization in trauma-exposed individuals. Grounded in structural dissociation theory, this framework suggests that psychedelics can disrupt the balance between daily functioning (the Apparently Normal Personality, ANP) and trauma-related responses (the Emotional Personality, EP), leading to the resurfacing of unintegrated memories. A review of recent studies highlights persistent adverse effects associated with psychedelic use, including emotional dysregulation, identity fragmentation, derealization, and perceptual disturbances, particularly among individuals with early trauma histories. To mitigate these risks and facilitate trauma processing, integration practices, body-focused therapies, and structured social support systems are proposed as key interventions. Additionally, emerging neurophysiological models suggest that psychedelics may reconfigure dissociative processes through the modulation of entrenched patterns, potentially facilitating trauma integration or increasing vulnerability to destabilization, depending on individual and contextual factors. These findings underscore the necessity of trauma-informed screening, preparation, and integration protocols to enhance the safety and efficacy of psychedelic therapies, particularly for vulnerable populations.
... In an event of childhood sexual trauma, like in our patient, victims may experience dissociation, an immature coping mechanism where a person unconsciously disconnects from reality due to stressors that result in impairment of memory, perception, and sense of self. 18 ...
... Patients seeking treatment for DID have historically been misdiagnosed or received inaccurate treatment and spend years seeking treatment before being correctly diagnosed due to social stigma and the complex nature of the disorder. 17,18 Because DID has been historically misdiagnosed, patients reporting multiple identities must be evaluated thoroughly and accurately. DA is often experienced in patients with DID. ...
Background
Childhood trauma increases the risk for psychiatric disorders such as Dissociative Identity Disorder (DID), Other Specified Dissociative Disorder (OSDD), Depersonalisation/Derealisation disorder (DDD), Post-Traumatic Stress Disorder Dissociative Type (D-PTSD), and Borderline Personality Disorder (BPD). Children who experience prolonged stress, trauma, or abuse during developmental years of growth and change have a wide range of outcomes.
Case Presentation
We report a case of a 22-year-old female with a significant history of physical abuse and sexual assault who initially presented to the hospital for suicidal ideation with a stated plan. During the patient’s stay at the hospital, we encountered two of the six alternate identities of the patient. The patient revealed she experiences all 7 identities (her true self plus 6 alters) in parallel, recalls the events of each alter, and can intermittently switch between identities; all rare features of dissociative disorders.
Conclusion
Given our patient’s extensive history of trauma, previous psychiatric diagnoses, and current dissociative presentation, we conclude that a diagnosis of OSDD and defence mechanisms of dissociation and regression may be appropriate. The patient was discharged with clomipramine for Obsessive-Compulsive Disorder and mood, lurasidone for mood, mirtazapine for mood, insomnia, and appetite stimulation, clonidine for nightmares and Postural Orthostatic Tachycardia Syndrome (POTS), fludrocortisone for POTS, gabapentin for Generalized Anxiety and fibromyalgia, and levothyroxine for hypothyroidism, and counselled to follow up with an outpatient therapist specialising in trauma. This case highlights the impact that childhood physical, sexual, and emotional trauma can have on one’s psychiatric presentation and the complexity of diagnosing dissociative presentations in an inpatient psychiatry setting.
... The Iatrogenic Model (IM) suggests that DID may be unintentionally induced by therapists in individuals who are highly hypnotizable, imaginative, and easily influenced-traits often associated with patients diagnosed with Borderline Personality Disorder (BPD). According to this model, clinicians who endorse the concepts of repressed memories and multiple personalities may inadvertently encourage false memories through techniques such as hypnosis and recovered memory therapy, which are considered by some as potentially harmful [3,10]. The term 'fantasy-prone' originates from cognitive and hypnosis research and refers to individuals, typically not diagnosed with mental illness, who have an exceptionally vivid inner fantasy life and often struggle to distinguish between internal and external reality 7 [26]. ...
Dissociative Identity Disorder (DID) is a complex and often misunderstood psychiatric condition characterized by the presence of two or more distinct identity states, memory disruptions, and episodes of dissociation. This review presents an overview of DID, focusing on its definition, symptoms, etiology, neurobiological underpinnings, diagnosis, treatment, and ongoing controversies. Current research highlights early childhood trauma as a key etiological factor, with emerging neuroimaging studies supporting the disorder’s distinct biological profile. Despite its prevalence, DID remains underdiagnosed and frequently misidentified as other psychiatric conditions, particularly borderline personality disorder or schizophrenia. The review also explores sociocultural influences, including the impact of social media on public awareness and self-diagnosis. Diagnostic challenges persist, though structured clinical interviews such as SCID-D-R offer reliable tools. Treatment is primarily based on long-term, phase-oriented psychotherapy, supported by adjunctive pharmacological strategies targeting comorbid symptoms. While debates surrounding the validity and origin of DID continue—particularly regarding the trauma model—empirical findings increasingly affirm the disorder’s legitimacy. Simulation of DID remains a concern, especially in forensic contexts, yet validated psychological and physiological assessments can aid in differential diagnosis. This review underscores the importance of continued research and clinical awareness to improve diagnosis, treatment outcomes, and public understanding of DID.
... 16,17 Effective treatment for DID involves triphased trauma therapy focused on safety and stabilization, trauma reprocessing, and integration, a method that has demonstrated improved clinical outcomes across a number of domains. 18 While the available evidence does not support the proposition that DID is a sociogenic or iatrogenic disorder, clinical and research literature on DID has long acknowledged the potential for malingered, factitious, or imitative presentations. Malingering is intentionally reporting symptoms for personal gain, such as money or reduced legal sanctions. ...
Recent global popularity of social media content about dissociative identity disorder (DID) has coincided with increased self-diagnosis among children and young people who have formed large online communities and presented in clinical settings seeking to affirm their self-diagnoses. We situate this phenomenon within a broader trend toward self-diagnosis due to the widespread visibility and accessibility of mental health content on social media. Social media propelled self-diagnosis raises particular questions for the study and treatment of DID due to long-standing debates over whether the condition is traumagenic, sociogenic, or iatrogenic. This paper draws from the current state of knowledge about psychiatric self-diagnosis, the influence of social media on youth mental health, and the authors’ clinical experience to present preliminary conceptualizations of DID self-diagnosis and its significance for clinical practice. Established etiological models for DID acknowledge the role of sociocultural and contextual factors in shaping and reinforcing the elaboration of DID self-states. We hypothesize that multiple forms of online sociality and interaction encourage such elaborations. Social media content regarding DID, however, is routinely unreliable and low quality, often mischaracterizing the condition’s symptoms and minimizing associated suffering and disability. This paper considers the likelihood that the self-diagnosing DID cohort includes genuine, genuine but exaggerated, imitative, and malingering cases, and underscores the importance of careful and personalized assessment and diagnosis.
This is the first book to analyze empirically supported treatments by using the newest criteria from the American Psychological Association's Society of Clinical Psychology, Division 12. Clinicians, scholars, and students all need to stay updated on the treatment research, and this book goes beyond providing updated treatment information by pointing readers to other useful treatment manuals and websites for continuing to stay up-to-date. The chapters, all written by prominent experts, highlight the best available evidence for specific disorders by breaking treatments down into credible components. With an emphasis on treatments for adults, chapters also share information about treatments for youth. Other variables that influence treatment are discussed, including assessment, comorbidity, demographics, and medication. Each chapter also corresponds with a chapter in the companion book, Pseudoscience in Therapy, presenting a full picture of the evidence base for common treatments.
Although frequently conceptualized as a controversial issue in forensic psychology, research demonstrates that dissociation and dissociative disorders are common throughout the world. Many who are involved in civil litigation will have one or more previous trauma experiences that may lead to the reliance on dissociation as a neurologically driven mechanism to mediate distress. When dissociation becomes entrenched, the likelihood of psychological injury and related distress increases. The authors will discuss factors, such as inadequate training, that interfere with the identification and assessment of dissociative symptoms. They will also provide a brief overview of the neurobiological basis and the prevalence rates of dissociative symptoms and disorders. Potential problems with using common malingering (e.g., SIRS-2, SIMS, M-FAST) and multi-symptom self-report measures (e.g., MMPI, PAI) when evaluating individuals with a history of complex trauma are discussed and evidence-based assessment tools are described. The overall goal of this chapter is to highlight the complexities of evaluating individuals who experience dissociation and emphasize the importance of utilizing the most up-to-date tools, research, and interpretation when completing forensic evaluations where severe and/or repeated trauma is present.
Zusammenfassung
Im Rahmen psychiatrischer und psychotherapeutischer Arbeit ist es nicht selten, dass sich Symptome und die sich davon ableitenden Diagnosen im Behandlungsverlauf ändern. Ein besonderer Stellenwert kommt hierbei den dissoziativen Störungen zu, welche sich oft erst im Verlauf neben anderen Symptomen zeigen können oder auch als einziges Störungsbild vorliegen können. Im Folgenden wollen wir einen Fallbericht einer Patientin mit dem Verdacht auf eine partielle dissoziative Identitätsstörung darstellen.
The diagnosis of dissociative identity disorder (DID) has been associated with controversy and remains an area of dispute among clinicians to this day. This review explores the evolution of the diagnosis and how it is currently described and understood in the International Classification of Diseases (ICD‐11) and Diagnostic and Statistical Manual of Mental Disorders (DSM‐5). Also considered, are recent implications for clinical practice, treatment recommendations and the potential for any medicolegal issues to emerge.
Introduction:
Dissociative identity disorder (DID) is a treatable mental health condition that is associated with a range of psychobiological manifestations. However, historical controversy, modern day misunderstanding, and lack of professional education have prevented accurate treatment information from reaching most clinicians and patients. These obstacles also have slowed empirical efforts to improve treatment outcomes for people with DID. Emerging neurobiological findings in DID provide essential information that can be used to improve treatment outcomes.
Areas covered:
In this narrative review, the authors discuss symptom characteristics of DID, including dissociative self-states. Current treatment approaches are described, focusing on empirically supported psychotherapeutic interventions for DID and pharmacological agents targeting dissociative symptoms in other conditions. Neurobiological correlates of DID are reviewed, including recent research aimed at identifying a neural signature of DID.
Expert opinion:
Now is the time to move beyond historical controversy and focus on improving DID treatment availability and efficacy. Neurobiological findings could optimize treatment by reducing shame, aiding assessment, providing novel interventional brain targets and guiding novel pharmacologic and psychotherapeutic interventions. The inclusion of those with lived experience in the design, planning and interpretation of research investigations is another powerful way to improve health outcomes for those with DID.
In the Netherlands, the diagnosis of dissociative identity disorder (DID) is widely accepted, although skeptics also have made their opinions known. Dutch clinicians treating DID patients generally follow the common three phase model for treatment of post-traumatic stress. Given the fact that they usually deal with complicated cases and enmeshed patients (cf. Horevitz & Loewenstein, 1994), most often treatment is restricted to Phase 1: stabilization and symptom reduction. Treatment of higher functioning patients, on the other hand, usually aims at processing of traumatic memories and complete personality integration as well. In this article, two Dutch cases are described in detail, with a special emphasis on the clinical deliberations which, in the first case, led to the decision to proceed to trauma treatment, and which led in the second case to the decision to refrain from it. The current standard of care with regard to the treatment of trauma-induced disorders, including post-traumatic stress disorder and many dissociative disorders, entails, among other things, the application of a phase-oriented treatment model (. Phase-oriented trauma treatment has its origins in the pioneering work of Pierre Janet (1898, 1919/25), who described three phases in the overall treatment: 1) stabilization and symptom reduction; 2) treatment of traumatic memories; and 3) personality reintegration and rehabilitation (van der Hart, Brown, & van der Kolk, 1989). In the Netherlands, clinicians usually follow Janet's terminology, while mentioning the following treatment goals for each separate phase: 1) overcoming the phobia of dissociative identities; 2) overcoming the phobia of traumatic memories; and 3) overcoming the phobia of normal life and attachment (Nijenhuis, 1994; Nijenhuis & van der Hart, in press; van der Hart & Boon, 1998). In actual clinical practice the model is not applied in a strict linear model, but rather takes the
The article gives a short review of how knowledge and competence on dissociative disorders have developed in Stavanger, Norway. The main part of the article describes two patients with dissociative disorders. The first of these cases describes a middle-aged female patient with a long psychiatric history with different psychiatric diagnoses. She was the first among our patients to get the MPD diagnosis in 1992. The other case presents a young man diagnosed with DDNOS during his first stay in the psychiatric department in 1993. The diagnosis later on was changed to MPD. Their treatments within the Norwegian mental health system are illustrated.