Treatment of dissociative identity disorder: leveraging neurobiology to optimize success

ABSTRACT

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.

KEYWORDS:

• Dissociative identity disorder (DID)
• dissociation
• lived experience
• neurobiology
• neuroimaging
• psychotherapy
• pharmacology
• treatment outcomes

Article highlights

• Dissociative identity disorder (DID) is a trauma-related psychiatric condition that is associated with a range of psychobiological manifestations

• A rich literature of case histories, clinical examples, and empirical work affirm that DID is treatable

• Medications are frequently used to manage co-occurring symptoms (e.g. posttraumatic stress disorder, depression, anxiety), but few agents are supported by research to target dissociative symptoms specifically

• Recent advances in the neurobiological understanding of dissociation and DID can inform the development of novel psychotherapeutic and pharmacological interventions

• Prioritizing the voices of those with lived experience in the development, implementation, and interpretation of research is essential in optimizing treatment outcomes

Abbreviations

CEN	=	central executive network
DID	=	dissociative identity disorder
DMN	=	default mode network
OSDD	=	other specified dissociative disorders
PTSD	=	posttraumatic stress disorder
RCT	=	randomized controlled trial
SSRI	=	selective serotonin reuptake inhibitor
TOP DD	=	treatment of patients with dissociative disorders
vmPFC	=	ventromedial prefrontal cortex

Acknowledgments

The authors acknowledge the insightful contributions from the Lived Experience Advisory Panel (LEAP) members toward the editing of this publication and their reflections on the importance of neurobiological research on dissociative identity disorder.

Declaration of interest

LAM Lebois has an unpaid membership on the Scientific Committee for the International Society for the Study of Trauma and Dissociation (ISSTD). They also report spousal IP payments from Vanderbilt University for technology licensed to Acadia Pharmaceuticals and spousal equity/ownership interest in Violet Therapeutics unrelated to the present work. ML Kaufman, CA Palermo and M Robinson reports unpaid membership on the Scientific Committee for the ISSTD. Neither ISSTD nor any funding sources were involved in the analysis or preparation of the paper. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors are funded by the Julia Kasparian Fund for Neuroscience Research and by the National Institute of Mental Health, the United States via grants K01 MH118467 and R01 MH119227.