Dissociative Identity Disorder and Partial Dissociative Identity Disorder

Background: The diagnosis dissociative identity disorder (DID) replaces multiple personality disorder in the ICD-11. It is characterized by the presence of two or more distinct personality states (dissociative identities) and, typically, by amnesia from one state to another. The personality states are associated with marked discontinuities in the experience of self and in the ability to take charge of one’s own actions. In partial DID, the discontinuities are less marked. In this review, we summarize and discuss empirical studies on DID and partial DID and derive potential approaches to this problem in clinical practice.

Methods: This narrative review is based on pertinent publications retrieved by a PubMed search.

Results: Only a small number of empirical studies on DID are available, and most suffer from major methodological limitations. Robust data for partial DIS are entirely lacking. The extant findings reveal a marked overlap between DID and other trauma-associated disorders, especially complex post-traumatic stress disorder (cPTSD) and borderline personality disorder (BPD). The available data tend not to support central constructs of DID; in particular, they do not support the postulated amnesia between the personality states. There is no robust evidence for the efficacy of any specific treatment.

Conclusion: DID and partial DID are insufficiently validated diagnoses for which there is no evidence-based treatment. Dissociative symptoms are already covered by better-researched entities, including cPTSD and BPD, for which validated treatment options are available. The diagnoses of DID and partial DID should only be assigned if alternative explanations of the patient’s clinical manifestations have been excluded.

Cite this as: Roepke S, Priebe K, Schmahl C, Kleim B, Rosner R, Ehring T: Dissociative identity disorder and partial dissociative identity disorder. Dtsch Arztebl Int 2026; 123: 220–25. DOI: 10.3238/arztebl.m2026.0005

According to the ICD-11, dissociative identity disorder (DID) is characterized by the presence of two or more distinct personality states—so-called dissociative identities—within an individual (1). These personality states differ in their patterns of experiencing, perceiving, thinking, and relating to self, the body, and the environment, and they recurrently take executive control over consciousness and functioning (Box 1, eBox 1). The ICD-11 does not cite any examples in this context, but the DSM-5 describes that attitudes, views, and personal preferences (for example, for food or clothing) can change abruptly and then revert again. Furthermore, body awareness can vary, for example affected individuals may experience themselves as a child or belonging to the opposite sex (2). Amnesia can exist between the personality states, but is not required. The disorder has been associated with severe and repeated childhood trauma (3). In partial DID, other personality states take executive control only temporarily, partially, or rarely, and the discontinuities are less pronounced (Box 2, eBox 2). The difference between DID and partial DID is primarily gradual at the symptom level. The ICD-10 listed the disorder as multiple personality disorder along with the comment that the diagnosis is rare and its etiology—as regards iatrogenic or culture-specific factors—is the subject of controversy. It was considered that symptoms were induced or intensified by clinicians´ beliefs, therapies that were not conducted in accordance with professional standards, or due to media influences. This note is no longer included in the ICD-11, which more closely follows the US conceptualization according to the DSM-5 (eBox 3). This review article summarizes the few existing studies of etiology, prevalence, diagnostic evaluation, and treatment of DID and partial DID and discusses them critically.

Box 1

Essential diagnostic features of dissociative identity disorder according to ICD-11*

Box 2

Essential diagnostic requirements of partial dissociative identity disorder*

eBox 3

Dissociative identity disorder according to DSM-5 (2)

Methods

A literature search was carried out in PubMed, using the search terms “dissociative identity disorder” or “multiple personality disorder” (date 8 January 2025) and the search terms “other specified dissociative disorder” or “complex dissociative disorders” or “complex dissociative disorder” or “dissociative disorder not otherwise specified” (date 14 February 2025). We included only original articles, meta-analyses, and case series of groups (sample size larger than 1) that investigated either participants with (partial) DID or clinical or healthy samples with characteristics of (partial) DID.

Results of the literature search

After duplicates were excluded, the literature search yielded a total of 878 hits. Between 1980 (the first identified study) and 2025, we identified 272 studies of “DID/multiple personality disorder” or “dissociative disorder not otherwise specified” that met the inclusion criteria, and we added one recent treatment study (4). Worldwide, this corresponds to roughly six data-based publications per year. We did not include 140 single-case reports. Studies of partial DID are completely lacking to date. In many studies, the investigated populations of patients with DID.xn showed a 100% comorbidity with post-traumatic stress disorder (PTSD) or remitted PTSD (e1, e2, e3, e4, e5, e6, e7, e8, e9) exists. Furthermore, many studies are based on the same small (N=11 or N=32) samples of participants with DID (e6, e7, e8, e9, e10) (Box 3). In the 10 years between 2011 and 2021, only 47 new cases of DID were included in the 18 publications worldwide regarding etiology (5).

Box 3

Functional and structural brain changes in dissociative identity disorder

Prevalence

The diagnosis of DID is assigned significantly more in women than in men; the literature reports ratios of up to 8 women:1 man (e11, e12). In Germany in 2023, the sex ratio for inpatient psychiatric and psychosomatic cases was about 17 women : 1 man (main diagnosis according to PEPP [the reimbursement system for psychiatric and psychosomatic services], (6)). A review and meta-analysis of point prevalence studies in Europe and the US found a prevalence of DID of 1.3% in the general population and 3.9% among students (7). For Germany, this would mean more than 1 million affected individuals. A 2009 review of point prevalence studies from psychiatric institutions in Europe and the US found a 5–21% prevalence of DID in psychiatric hospitals and 12–29% in the outpatient psychiatric setting (e13). All psychiatric and psychosomatic departments using the PEPP billing system reported in 2023 a total of 381 cases (0.045% of all cases) where DID (F44.81) was the main diagnosis and 660 cases (0.079%) where it was a secondary diagnosis (6). Surveys in the 1990s in Switzerland and the Netherlands found that 10% and 42% of participating psychiatrists had ever assigned that diagnosis (e14, e15). This discrepancy in the prevalence rates may be the result of non-representative samples, diagnostic instruments of low validity, investigator bias, or a lower validity of the DID diagnosis. No prevalence rates are available for partial DID.

Etiology

In the literature, two models regarding the etiology of DID are competing: the trauma model (8) and the sociocognitive model (9). The former model dates back to Pierre Janet and understands dissociation as a defense mechanism for processing trauma, in which stressful experiences are stored in the memory, but are split off into personality states. A further development is the model of structural dissociation, which depicts continuity from PTSD to DID and deducts therapeutic strategies (e16). The sociocognitive model posits that media influences and psychotherapeutic approaches in persons who are already affected by a mental disorder and are prone to increased suggestibility and fantasies prompt the assignation of symptoms to different personality states (9). Meta-analyses and reviews have shown associations between suggestibility and dissociative symptoms (10) as well as between trauma and dissociation (8, 11). A new integrative approach tries for a synthesis of the two models and explains the symptoms of DID with malfunctions of normally adaptive processes (9). Approaches in schema therapy interpret the personality states as schema modes (12). What is of note is the almost complete lack of empirical data in children, although the onset of DID typically occurs in childhood (5). Case numbers of all German psychiatric and psychosomatic hospitals that bill according to PEPP for 2023 did not show a single case of DID (F44.81) in those younger than 15 and only 21 cases in 15–20 year-olds as the main diagnosis and 43 cases as a secondary diagnosis (6).

Amnesia

According to ICD-11, episodes of amnesia that exceed ordinary forgetting are typical for the diagnosis of DID, but not essential. This represents a conceptual change compared with ICD-10 and DSM-5, where amnesia is an essential criterion. A detailed discussion of this change is lacking. In the literature, two types of amnesia have been described:

• (Partial) amnesia that is associated with the change between identities for the respective other identity and its memories, the so-called inter-identity amnesia, and
• Dissociative amnesia for past trauma, which is potentially reversible.

Although those affected subjectively described amnesia between identities, most experimental studies did not confirm this objectively (e17, 13, 14, 15, 16, 17, 18, 19). The therapeutic conclusion is that strategies that strengthen the subjective conviction of “separateness” and therefore the perception of “being more than one” (for example those that entail further differentiation of identities) are contraindicated and that the mistaken assumption of having no memory transfer between identities should be corrected (20).

The frequency and mechanisms of amnesia episodes that exceed normal forgetting after traumatic experiences are disputed (21). Many studies have shown that traumatic events are often well remembered (22), whereas in retrospective surveys, 15–30% reported earlier memory gaps (23, e18). Prospective studies with documented trauma found that 14–38% did not report these events at a later date (24), with the non-reporting particularly occurring when no direct questions relating to the trauma are asked. The data furthermore seem to imply alternative explanations such as normal forgetting, amnesia in early childhood, or the decision not to talk about it (22). Altogether, the available studies do not yield any robust proof for dissociative amnesia (22, 24). Furthermore, empirical research shows that in patients with proved high suggestibility, there is a greater risk of inducing pseudo-memories (false memories, (22)). On this background, suggestive techniques are considered contraindicated.

Diagnosis

For all current diagnostic instruments—the Structured Clinical Interview for Dissociative Disorders (SCID-D, (26)), in German (e27) as the gold standard, the Dissociative Disorders Interview Schedule (27), in German (e27), and the Multidimensional Inventory of Dissociation (28), self reporting—the affected person’s subjective perception—is sufficient for a diagnosis. It is not necessary for the investigating person or third parties to directly observe a change in identity.

It is also important to note that the DSM-based diagnosis employing the SCID-D does not take into account the ICD-11 requirement that the symptoms can not be better explained by other mental disorders. The overwhelming majority of empirical studies is, however, based on the DSM system (5).

Since the concept of DID has been introduced, clinical experts have pointed out the challenges of making the diagnosis: many years would pass before the diagnosis was assigned, the symptoms were diagnosable in only very limited time windows, at the initial examination no signs of the disorder are detectable in many cases, and before treatment, even close relatives would not identify any obvious symptoms (e28). An alternative explanation for the instability of the clinical picture might also be the low validity of the DID diagnosis.

Differential diagnoses

Dissociative symptoms such as derealization, depersonalization, amnesia, altered perception of time, consciousness gaps, and sensory misperceptions occur in PTSD and even more commonly in complex post-traumatic stress disorder (cPTSD) (29). But the diagnostic criteria of the ICD-11 list only some of the symptoms explicitly. cPTSD develops mostly after long-term trauma and in addition to the symptoms of PTSD also includes sustained difficulties in emotion regulation, a negative self-image with feelings of shame and guilt, and difficulties in relationships.

Borderline personality disorder (BPD) is characterized by instability in social relationships, self-image, and affect as well as pronounced impulsivity. The BPD diagnosis criteria include dissociative symptoms (for example, derealization, depersonalization) and an identity disturbance. Dissociative symptoms in BPD are associated with overall symptom severity, fantasy proneness, and fragmentation of the personality (30). Clinically, dissociative symptoms and identity disturbance in BPD may strongly resemble the “dissociative identities” of DID, even though ICD-11 emphasizes conceptual differences.

Histrionic personality disorder is characterized by excessive emotionality and attention-seeking behavior. Individuals may feign medical symptoms in this context (e29).

In schizophrenia and other primarily psychotic disorders, delusions, disturbances of the sense of self, and auditory hallucinations (for example, in the shape of hearing voices) can mimic the symptoms of DID. Especially hearing voices and delusions of control have also been described in DID (e30). The presence of negative symptoms, formal thought disorders, and delusional content typical for schizophrenia can help in the differentiation (e31).

Factitious disorder imposed on self entails simulating, falsifying, or intentionally triggering or aggravating symptoms (ICD-11). Substantively, those affected are aiming to obtain treatment or take the role of a patient.

Simulation is the feigning, intentional producing, or substantial exaggeration of symptoms in which the deceit is motivated by unequivocal external rewards or stimuli (ICD-11). Empirical studies have shown that those simulating DID have less pronounced symptoms than those affected with a diagnosis of DID (e32).

Comorbidities

The highest comorbidity rate applies to PTSD, whose criteria 81–100% of patients with DID meet (e33). Furthermore, 30–70% have BPD. Also common are affective disorders, anxiety disorders, and further personality disorders (e35, e36). 48–78% reported self-harming and 60–86% reported at least one suicide attempt (e37).

Therapy

The most recent Cochrane meta-analysis did not find any studies of any specific treatment for DID, therefore no conclusions can be drawn about effectiveness or risks (31). Similarly, no international or German-language evidence-based treatment guidelines for (partial) DID currently exist (12).

Hypnosis, historically a central form of treatment, is not supported by evidence for the treatment of (partial) DID to date (31). In clinical practice, the treatment is often administered in the context of long-term individual psychotherapies based on the phase-oriented model of the International Society for the Study of Trauma and Dissociation (ISSTD, (32, 33)). This comprises:

• Establishing safety, symptom control, and emotional regulation,
• Trauma-focused interventions, and
• Integration of personality states and psychosocial integration.

Indications of symptom improvement mostly derive from case series and naturalistic studies. One international study in 280 patients found improvements in dissociative and PTSD symptoms after 30 months, as well as a reduction in suicidality and inpatient admissions (34). The results are interpretable only to a limited degree because of the lack of a control group.

To evaluate the initial therapeutic phase (emotional regulation), two randomized controlled trials have been reported in which some of the participants met the diagnostic criteria for DID: a group intervention did not produce any effects on psychosocial functioning (primary outcome) and PTSD symptoms (35), whereas an accompanying online program achieved moderate effects for emotional regulation and PTSD symptoms; an improvement in dissociative symptoms, was, however, not found (4).

In view of the high comorbidity with PTSD, the ISSTD recommends applying relevant treatment guidelines. In Germany, this is the guideline of the Association of the Scientific Medical Societies in Germany (AWMF) for the treatment of PTSD, which prioritizes trauma-focused interventions (36). To date, no controlled studies are available on its application in DID.

Because of the high comorbidity and symptom overlap, dialectical behavior therapy—originally developed for BPD—has also been applied to DID (e44); a systematic evaluation is not yet available. Currently, a controlled trial of schema therapy is being carried out (12), and preliminary data suggest that the transdiagnostic Unified Protocol is effective (37).

Whether dissociative symptoms should be reduced before administering trauma-focused treatment is not clear to date. A meta-analysis did not find any effect on therapeutic success (38), whereas other studies reported negative effects of dissociative symptoms (39, e45).

No data are currently available for pharmacotherapy for DID. Smaller studies in other patient groups do, however, indicate possible efficacy of naloxone and naltrexone in dissociative symptoms (e46).

Conclusions for clinical practice

Since it was introduced into the DSM-III in 1980, the diagnosis of dissociative identity disorder (DID) has undergone wideranging conceptual changes in spite of limited empirical evidence (Box 4). Relevant assumptions such as amnesia between personality states that have been described as typical have not been confirmed in recent research (9).

Box 4

Historical development

As part of the ICD-11 development, the World Health Organization (WHO) has abstained from field validation of the two new diagnoses; explanatory literature barely exists. Dissociative symptoms often occur in the context of other disorders, especially in cPTSD and BPD. The diagnosis of (partial) DID should therefore be assigned only if other explanations for the reported symptoms have been ruled out, including factitious disorder and simulation.

Since to date, no sufficiently evaluated treatment is available for (partial) DID, the focus should be on treating comorbidities, such as PTSD or BPD, for which effective evidence-based treatments are available.

To prevent the iatrogenic development of this disorder, dissociative symptoms and identity disturbances, key symptoms of cPTSD and BPD, should not be attributed to different identities in the therapeutic setting.

Therapeutic attempts to recover presumed repressed memories are contraindicated; instead, the risk of inducing false memories should be explained (22). In patients with a pronounced conviction of having DID, even without diagnostic confirmation, as well as in patients with a confirmed diagnosis, the subjective experience should be validated. At the same time, interventions that promote further elaboration of identities should be avoided. Instead, therapy should be directed at developing and strengthening a coherent feeling of identity.

Conflict of interest statement
SR was remunerated for advisory board activities by Boehringer Ingelheim, Bionorica SE, Janssen, and Otsuka and received funding from the German Research Foundation (DfG), the Federal Ministry of Education and Research, and the EU Innovation Fund.

KP received honoraria for book publications and lectures.

ChSch was remunerated for consultancy services by Boehringer Ingelheim and Atai Pharma and received funding from the German Research Foundation (DfG) and the Federal Ministry of Education and Research.

BK received lecture honoraria; furthermore she received research funding from the Swiss National Fund, Horizon Europe, HMZ Hochschulmedizin Zürich (a collaborative initiative (2011–2024) between the University of Zurich (UZH), ETH Zurich, and university hospitals, fostering translational research in medicine, engineering, and natural sciences).

RR received honoraria for book publications and lectures, as well as funding from the German Research Foundation (DfG), the Federal Ministry of Education and Research, and the EU Innovation Fund.

TE received honoraria for lectures and consultancy services from Oberberg GmbH (a leading specialized psychiatric and psychotherapeutic clinic group in Germany). He also received funding from the German Research Foundation (DfG), the Federal Ministry of Education and Research, the EU Innovation Fund, and the Wellcome Trust.

Manuscript received on 2 May 2025, revised version accepted on 12 January 2026.

Translated from the original German by Birte Twisselmann, PhD.

Corresponding author
Prof. Dr. med. Stefan Roepke

References

1. World Health Organization. ICD-11: International classification of diseases. 2022. https://icd.who.int/ (last accessed on 9 November 2025).

2. American Psychiatric Association: Diagnostic and statistical manual of mental disorders. 2013. doi.org/10.1176/appi.books.9780890425596 (last accessed on 9 November 2025).

3. Foote B, Smolin Y, Kaplan M, Legatt ME, Lipschitz D: Prevalence of dissociative disorders in psychiatric outpatients. Am J Psychiatry 2006; 163: 623–9

4. Brand BL, Schielke HJ, Putnam K, et al.: A randomized controlled trial assists individuals with complex trauma and dissociation in finding solid ground. Psychol Trauma 2025; 17: 1717–27

5. Boysen GA: Dissociative identity disorder: A review of research from 2011 to 2021. J Nerv Ment Dis 2024; 212: 174–86

6. Statistisches Bundesamt, Sonderauswertung, PEPP-Statistik, Abfrage 2025.

7. Kate MA, Hopwood T, Jamieson G: The prevalence of dissociative disorders and dissociative experiences in college populations: A meta-analysis of 98 studies. J Trauma Dissociation 2020; 21: 16–61

8. Dalenberg CJ, Brand BL, Gleaves DH, et al.: Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychol Bull 2012; 138: 550–88

9. Lynn SJ, Polizzi C, Merckelbach H, et al.: Dissociation and dissociative disorders reconsidered: Beyond sociocognitive and trauma models toward a transtheoretical framework. Annu Rev Clin Psychol 2022; 18: 259–89

10. Merckelbach H, Otgaar H, Lynn SJ: Empirical research on fantasy proneness and its correlates 2000–2018: A meta-analysis. Psychology of Consciousness: Theory, Research, and Practice 2022; 9: 2–26

11. Vonderlin R, Kleindienst N, Alpers GW, Bohus M, Lyssenko L, Schmahl C: Dissociation in victims of childhood abuse or neglect: A meta-analytic review. Psychol Med 2018; 48: 2467–76

12. Huntjens RJC, Rijkeboer MM, Arntz A: Schema therapy for dissociative identity disorder (DID): Further explanation about the rationale and study protocol. Eur J Psychotraumatol 2019; 10: 1684629

13. Elzinga BM, Phaf RH, Ardon AM, van Dyck R: Directed forgetting between, but not within, dissociative personality states. J Abnorm Psychol 2003; 112: 237–43

14. Huntjens RJC, Wessel I, Ostafin BD, Boelen PA, Behrens F, van Minnen A: Trauma-related self-defining memories and future goals in dissociative identity disorder. Behav Res Ther 2016; 87: 216–24

15. Huntjens RJ, Verschuere B, McNally RJ: Inter-identity autobiographical amnesia in patients with dissociative identity disorder. PLoS One 2012; 7: e40580

16. Huntjens RJ, Postma A, Peters ML, Woertman L, van der Hart O: Interidentity amnesia for neutral, episodic information in dissociative identity disorder. J Abnorm Psychol 2003; 112: 290–7

17. Huntjens RJ, Postma A, Hamaker EL, Woertman L, van der Hart O, Peters M: Perceptual and conceptual priming in patients with dissociative identity disorder. Mem Cognit 2002; 30: 1033–43

18. Kong LL, Allen JJB, Glisky EL: Interidentity memory transfer in dissociative identity disorder. J Abnorm Psychol 2008; 117: 686–92

19. Dimitrova LI, Lawrence AJ, Vissia EM, et al.: Inter-identity amnesia in dissociative identity disorder resolved: A behavioural and neurobiological study. J Psychiatr Res 2024; 174: 220–9

20. Lilienfeld SO: Psychological treatments that cause harm. Perspect Psychol Sci 2007; 2: 53–70

21. Lynn SJ, McNally RJ, Loftus EF: The memory wars then and now: The contributions of Scott O. Lilienfeld. Clin Psychol Sci 2023; 11: 725–43

22. McNally RJ: The return of repression? Evidence from cognitive psychology. Top Cogn Sci 2024; 16: 661–74

23. Elliott DM: Traumatic events: Prevalence and delayed recall in the general population. J Consult Clin Psychol 1997; 65: 811

24. Pope HG Jr, Hudson JI, Bodkin JA, Oliva P: Questionable validity of ‚dissociative amnesia‘ in trauma victims. Evidence from prospective studies. Br J Psychiatry 1998; 172: 210–5; discussion 216–7

25. Misitano A, Moro AS, Ferro M, Forresi B: The dissociative subtype of post-traumatic stress disorder: A systematic review of the literature using the latent profile analysis. J Trauma Dissociation 2024; 25: 349–65

26. Steinberg M: The SCID-D: Dissociation assessment in therapy, forensics, and research. Washington, DC: American Psychiatric Association Publishing 2023.

27. Ross CA, Heber S, Anderson G: The dissociative disorders interview schedule. Am J Psychiatry 1990; 147: 1698–9

28. Dell PF: The multidimensional inventory of dissociation (MID): A comprehensive measure of pathological dissociation. J Trauma Dissociation 2006; 7: 77–106

29. White WF, Burgess A, Dalgleish T, et al.: Prevalence of the dissociative subtype of post-traumatic stress disorder: A systematic review and meta-analysis. Psychol Med 2022; 52: 1629–44

30. Al-Shamali HF, Winkler O, Talarico F, et al.: A systematic scoping review of dissociation in borderline personality disorder and implications for research and clinical practice: Exploring the fog. Aust N Z J Psychiatry 2022; 56: 1252–164

31. Ganslev CA, Storebø OJ, Callesen HE, Ruddy R, Søgaard: Psychosocial interventions for conversion and dissociative disorders in adults. Cochrane Database Syst Rev 2020; 7: CD005331

32. International Society for the Study of Trauma and Dissociation:Guidelines for treating dissociative identity disorder in adults, third revision: Summary version. J Trauma Dissociation 2011; 12: 188–212

33. Yeates S, Korner A, McLean L: A systematic review and narrative analysis of the evidence for individual psychodynamically informed psychotherapy in the treatment of dissociative identity disorder in adults. J Trauma Dissociation 2024; 25: 248–78

34. Brand B, Classen C, Lanins R, Loewenstein, et al.: A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians. Psychol Trauma 2009; 1: 153–171

35. Bækkelund H, Ulvenes P, Boon-Langelaan S, Arnevik EA: Group treatment for complex dissociative disorders: A randomized clinical trial. BMC Psychiatry 2022; 22: 338

36. Schäfer I, Gast U, Hofmann A, et al.: S3-Leitlinie Posttraumatische Belastungsstörung. 2019. https://doi.org/10.1007/978-3-662-59783-5_1

37. Mohajerin B, Lynn SJ, Bakhtiyari M, Dolatshah B: Evaluating the unified protocol in the treatment of dissociative identity disorder. Cogn Behav Pract 2020; 27: 270–89

38. Hoeboer CM, De Kleine RA, Molendijk ML, et al.: Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: Meta-analysis. BJPsych Open 2020; 6: e53

39. Kleindienst N, Steil R, Priebe K, et al.: Is dissociation predicting the efficacy of psychological therapies for PTSD? Results from a randomized controlled trial comparing dialectical behavior therapy for PTSD (DBT-PTSD) and cognitive processing therapy (CPT). Psychol Med 2025; 55: e59

e1. Vermetten E, Schmahl C, Lindner S, Loewenstein RJ, Bremner JD: Hippocampal and amygdalar volumes in dissociative identity disorder. Am J Psychiatry 2006; 163: 630–6

e2. Chalavi S, Vissia EM, Giesen ME, et al.: Abnormal hippocampal morphology in dissociative identity disorder and post-traumatic stress disorder correlates with childhood trauma and dissociative symptoms. Hum Brain Mapp 2015; 36: 1692–704

e3. Chalavi S, Vissia EM, Giesen ME, et al.: Similar cortical but not subcortical gray matter abnormalities in women with posttraumatic stress disorder with versus without dissociative identity disorder. Psychiatry Res 2015; 231: 308–19

e4. Vissia EM, Giesen ME, Chalavi S, et al.: Is it trauma- or fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls. Acta Psychiatr Scand 2016; 134: 111–28

e5. Pan X, Palermo CA, Kaplan CS, et al.: Anxiety sensitivity predicts depression severity in individuals with dissociative identity disorder. J Psychiatr Res 2022; 155: 263–8

e6. Reinders AATS, Dimitrova LI, Schlumpf YR, et al: Normal amygdala morphology in dissociative identity disorder. BJPsych Open 2022; 8: e70

e7. Reinders AATS, Marquand AF, Schlumpf YR, et al.: Aiding the diagnosis of dissociative identity disorder: Pattern recognition study of brain biomarkers. Br J Psychiatry 2019; 215: 536–44

e8. Reinders AATS, Chalavi S, Schlumpf YR, et al: Neurodevelopmental origins of abnormal cortical morphology in dissociative identity disorder. Acta Psychiatr Scand 2018; 137: 157–70

e9. Reinders AA, Willemsen AT, Vos HP, den Boer JA, Nijenhuis ER: Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLoS One 2012; 7: e39279

e10. Reinders AA, Willemsen AT, den Boer JA, Vos HP, Veltman DJ, Loewenstein RJ: Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: A PET study and neurobiological model. Psychiatry Res 2014; 223: 236–43

e11. Atilan Fedai Ü, Asoğlu M: Analysis of demographic and clinical characteristics of patients with dissociative identity disorder. Neuropsychiatr Dis Treat 2022; 18: 3035–44

e12. Loewenstein R, Frewen P, Lewis-Fernández R: Dissociative disorders. In: Sadock BJ, Sadock VA, Ruiz R (eds.): Kaplan & Sadocks comprehensive textbook of psychiatry (Vol. 1, 1866–1952). Lippincott: Williams & Wilkins 2017.

e13. Brand BL, Classen CC, McNary SW, Zaveri P: A review of dissociative disorders treatment studies. J Nerv Ment Dis 2009; 197: 646–54

e14. Modestin J: Multiple personality disorder in Switzerland. Am J Psychiatry 1992; 149: 88–92

e15. Sno HN, Schalken HF: Dissociative identity disorder: Diagnosis and treatment in the Netherlands. Eur Psychiatry 1999; 14: 270–7

e16. Nijenhuis E, van der Hart O, Steele K: Trauma-related structural dissociation of the personality. Act Nerv Super 2010; 52: 1–23

e17. Allen JJ, Movius HL 2nd: The objective assessment of amnesia in dissociative identity disorder using event-related potentials. Int J Psychophysiol 2000; 38: 21–41

e18. Herman JL, Harvey MR: Adult memories of childhood trauma: A naturalistic clinical study. J Trauma Stress 1997; 10: 557–71

e19. Vissia EM, Lawrence AJ, Chalavi S, et al.: Dissociative identity state-dependent working memory in dissociative identity disorder: A controlled functional magnetic resonance imaging study. BJPsych Open 2022; 8: e82

e20. Reinders AA, Nijenhuis ER, Quak J, et al.: Psychobiological characteristics of dissociative identity disorder: A symptom provocation study. Biol Psychiatry 2006; 60: 730–40

e21. Dimitrova LI, Dean SL, Schlumpf YR, et al.: A neurostructural biomarker of dissociative amnesia: A hippocampal study in dissociative identity disorder. Psychol Med 2023; 53: 805–13

e22. Schlumpf YR, Reinders AA, Nijenhuis ER, et al.: Dissociative part-dependent resting-state activity in dissociative identity disorder: A controlled FMRI perfusion study. PLoS One 2014; 9: e98795

e23. Schlumpf YR, Nijenhuis ER, Chalavi S, et al.: Dissociative part-dependent biopsychosocial reactions to backward masked angry and neutral faces: An fMRI study of dissociative identity disorder. Neuroimage Clin 2013; 3: 54–64

e24. Blihar D, Crisafio A, Delgado E, Buryak M, Gonzalez M, Waechter R: A meta-analysis of hippocampal and amygdala volumes in patients diagnosed with dissociative identity disorder. J Trauma Dissociation 2021; 22: 365–77

e25. Lotfinia S, Soorgi Z, Mertens Y, Daniels J: Structural and functional brain alterations in psychiatric patients with dissociative experiences: A systematic review of magnetic resonance imaging studies. J Psychiatr Res 2020; 128: 5–15

e26. Gast U, Oswald T, Zündorf F, Hofmann A: Strukturiertes Klinisches Interview für DSM-IV für Dissoziative Störungen (SKID-D). 2000.

e27. Gast U: Das Konzept der Komplexen Dissoziativen Störungen. PDP – Psychodynamische Psychotherapie 2003, 2: 79–90.

e28. Piper A, Merskey H: The persistence of folly: Critical examination of dissociative identity disorder. Part II. The defence and decline of multiple personality or dissociative identity disorder. Can J Psychiatry 2004; 49: 678–83

e29. Torrico TJ, French JH, Aslam SP, Shrestha S: Histrionic personality disorder. In: StatPearls. Treasure Island (FL): StatPearls Publishing 2025.

e30. Moskowitz A, Heim G: The role of dissociation in the historical concept of schizophrenia. In: Moskowitz A, Dorahy MJ, Schäfer I (eds.): Psychosis, trauma and dissociation: Evolving perspectives on severe psychopathology: 55–67. Wiley 2019

e31. Foote B, Park J: Dissociative identity disorder and schizophrenia: Differential diagnosis and theoretical issues. Curr Psychiatry Rep 2008; 10: 217–22

e32. Boysen GA, VanBergen A: Simulation of multiple personalities: A review of research comparing diagnosed and simulated dissociative identity disorder. Clin Psychol Rev 2014; 34: 14–28

e33. Rodewald F, Wilhelm-Göling C, Emrich HM, Reddemann L, Gast U: Axis-I comorbidity in female patients with dissociative identity disorder and dissociative identity disorder not otherwise specified. J Nerv Ment Dis 2011; 199: 122–31

e34. Brand BL, Lanius RA: Chronic complex dissociative disorders and borderline personality disorder: Disorders of emotion dysregulation? Borderline Personal Disord Emot Dysregul 2014; 1: 13

e35. Ellason JW, Ross CA, Fuchs DL: Lifetime axis I and II comorbidity and childhood trauma history in dissociative identity disorder. Psychiatry 1996; 59: 255–66

e36. Foote B: Dissociative identity disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. In: Spiegel D, Hermann R (eds.): UpToDate. Waltham, MA 2013.

e37. Webermann AR, Myrick AC, Taylor CL, Chasson GS, Brand BL: Dissociative, depressive, and PTSD symptom severity as correlates of nonsuicidal self-injury and suicidality in dissociative disorder patients. J Trauma Dissociation 2016; 17: 67–80

e38. van der Hart O, Lierens R, Goodwin J. Jeanne Fery: A sixteenth-century case of dissociative identity disorder. J Psychohist 1996; 24: 18–35.

e39. Paris J: The rise and fall of dissociative identity disorder. J Nerv Ment Dis 2012; 200: 1076–9

e40. Putnam FW, Guroff JJ, Silberman EK, Barban L, Post RM: The clinical phenomenology of multiple personality disorder: Review of 100 recent cases. J Clin Psychiatry 1986; 47: 285–93.

e41. Mulhern S: Satanism, ritual abuse, and multiple personality disorder: A sociohistorical perspective. Int J Clin Exp Hypn 1994; 42: 265–88

e42. Faller KC: The witch-hunt narrative: Introduction and overview. J Interpers Violence 2017; 32: 784–804

e43. Fegert JM, Urbaniok F: Ritueller sexueller Missbrauch. Orientierung am Patientenwohl in einer polarisierten Debatte. Nervenarzt 2024; 95: 1071–8

e44. Foote B, Van Orden K: Adapting dialectical behavior therapy for the treatment of dissociative identity disorder. Am J Psychother 2016; 70: 343–64

e45. Kleindienst N, Priebe K, Görg N, et al.: State dissociation moderates response to dialectical behavior therapy for posttraumatic stress disorder in women with and without borderline personality disorder. Eur J Psychotraumatol 2016; 7: 30375

e46. Escamilla I, Juan N, Peñalva C, et al.: Treatment of dissociative symptoms with opioid antagonists: A systematic review. Eur J Psychotraumatol 2023; 14: 2265184