Diagnostic difficulty in an adolescent with dissociative identity disorder

Dissociative identity disorder (DID) is a complex and controversial psychiatric condition characterised by the presence of two or more distinct identities, personality states, or identities that recurrently take control of an individual's behaviour. The identities or personality states may have distinct characteristics, memories, and behaviours, making identifying and differentiating them challenging. We describe a complex case that presented diagnostic challenges because of the fluctuations in psychiatric presentations associated with DID, and we outline a multidisciplinary and biopsychosocial intervention.

A 15-year-old transgender female presented with psychosis, suicidal ideation, a history of self-harm and aggressive behaviour, and panic attacks. She had a diary with excerpts that she could not remember writing and a history of forgetting certain parts of her day. She displayed extreme variations of psychiatric presentations, including depression, mania, panic, and aggression.

The patient's alters were individually treated based on their psychiatric presentation and theme. Management followed the phased approach of the International Society for the Study of Trauma and Dissociation (ISSTD guidelines), which included establishing safety and symptom reduction, integration of traumatic memories and identity as well as rehabilitation.

In this case report, we present an adolescent with a myriad of psychiatric presentations and describe her management. We summarise key difficulties that a clinician can encounter in diagnosing DID.

We bring awareness to the complexity of this diagnosis. Lastly, we propose an Multidisciplinary team (MDT) biopsychosocial approach that helps to manage the condition.