Presentations of people with Dissociative Identity Disorder are complex and associated with considerable comorbidity. They are often misdiagnosed and therefore mistreated, sometimes for many years. Further complexity results from rejection of the validity of the diagnosis by non professional sources such as a sceptical press and organisations such as the False Memory Syndrome Foundation. Some mental health professionals, including some quite influential psychiatrists, also contemptuously reject the validity of the diagnosis. As a result trainee psychiatrists, as a rule, are taught little about dissociation and learn to react to those presenting with such symptoms with suspicion and scepticism.
This is particularly destructive to people with Dissociative Identity Disorder who, understandably, given their almost universally traumatic backgrounds, have profound difficulties forming trusting relationships. Mental health professionals are often on the defensive with their own colleagues when they treat people with Dissociative Identity Disorder. This adds to the problems inherent in treating such a difficult diagnostic group. In addition, therapists may experience secondary traumatisation as a result of problems their patients bring to them. A treatment approach addressing some of these complexities is discussed.
The need for commitment, validation and safety in psychotherapy is stressed. Biological treatments frequently need to be combined with psychotherapy to address comorbid conditions as well as ameliorating some symptoms directly arising from dissociation. Approaches to providing support for mental health professionals working with these patients are also discussed.
