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Recently I met a patient who reported a history of dissociative identity disorder. This was the first time I've met a patient who had this as an actual diagnosis. He states this diagnosis was made by another medical professional after they witnessed a dissociative episode. The patient experiences a dramatic change in behavior during these episodes, including changes in his speech and mannerisms, and he becomes very angry, evil, or grandiose; episodes may last minutes to hours, and he denies having any memory of the episode afterward. His mother was present for his first visit with me and confirmed this history.
Looking at the diagnostic criteria alone, it would seem that DID could be present. However, aside from the fact that this is a controversial diagnosis, I am hesitant to make this diagnosis myself because the patient also meets criteria for borderline personality disorder. I understand that DID and BPD can both be diagnosed in the same patient, but given that BPD can present with severe dissociative symptoms, how do you tell when a dissociative episode is part of BPD or due solely to DID?
Looking at the diagnostic criteria alone, it would seem that DID could be present. However, aside from the fact that this is a controversial diagnosis, I am hesitant to make this diagnosis myself because the patient also meets criteria for borderline personality disorder. I understand that DID and BPD can both be diagnosed in the same patient, but given that BPD can present with severe dissociative symptoms, how do you tell when a dissociative episode is part of BPD or due solely to DID?