Loewenstein, R. J., Frewen, P., Lanius, R., Brand, B., Schielke, H., & Spiegel, D. (2024). Advancing research on and treatment of dissociative identity disorder with people with lived experience. American Journal of Psychotherapy. https://psychiatryonline.org/doi/10.1176/appi.psychotherapy.20230024

Purpose:
This journal article reviews current evidence regarding dissociative identity disorder (DID), including its relationship to trauma, diagnostic validity, barriers to treatment, and the importance of incorporating individuals with lived experience into research and clinical care.

Methods:

• Narrative review and commentary of existing psychiatric and trauma-related literature
• Synthesizes research regarding neurobiology, trauma associations, diagnosis, stigma, and treatment approaches in DID

Results:

• DID is strongly associated with severe and chronic childhood trauma, particularly abuse and neglect
• Patients commonly present with dissociation, memory fragmentation, identity disruption, emotional dysregulation, PTSD symptoms, depression, anxiety, and suicidality
• DID remains underdiagnosed and highly stigmatized within psychiatry despite growing empirical evidence supporting the disorder
• Symptoms are frequently mistaken for psychotic disorders, personality disorders, or bipolar disorder
• Phase-oriented trauma-focused psychotherapy remains the primary evidence-supported treatment approach
• The article emphasizes the importance of patient-centered care and involving individuals with lived experience in future DID research and treatment development

Strengths:

• Recent peer-reviewed article from a major psychiatry journal
• Provides updated discussion of DID research and treatment approaches
• Addresses stigma and misconceptions surrounding DID
• Integrates both clinical and trauma-focused perspectives

Weaknesses:

• Narrative review rather than primary research study
• Limited discussion of pharmacologic management due to lack of strong evidence
• Some recommendations rely on expert consensus rather than randomized controlled trials

Impact on Patient Care:

• Helps clinicians better recognize trauma-related dissociative symptoms and differentiate DID from psychotic disorders
• Supports trauma-informed and patient-centered psychiatric care
• Encourages earlier diagnosis and referral for specialized psychotherapy
• Highlights importance of reducing stigma surrounding dissociative disorders in clinical practice