Dissociative identity disorder and substance abuse: The forgotten relationship

The treatment and research of dissociative disorders, particularly dissocia tive identity disorder (DID), are hampered by professional skepticism and d iagnostic uncertainties. Almost always associated with severe and sustained childhood trauma, its chief manifestations are at least two distinct and s eparate identities which have an independent manner of existing in the worl d. It is also associated with a high degree of psychiatric comorbidity. Amo ng the most frequent diagnoses found in patients with DID are substance use and dependence. For a variety of reasons there has been little dialogue am ong the disciplines that study patients with trauma and those that study an d treat substance abuse. Clinicians dealing with a primarily substance-abus ing population are likely to encounter but not recognize these patients. Th e authors present several representative cases illustrative of features of patients with DID. The epidemiology, phenomenology and presentation of DID, as well as its relation to posttraumatic stress disorder are discussed. Li ttle systematic investigation exists on the treatment of DID in general, an d substance abuse in DID in particular The authors draw upon the existing l iterature, and their experience to discuss treatment strategies aimed at tr eating patients with both diagnoses. Ignoring either diagnosis is likely to be detrimental to patients; both disorders and their coexistence need to b e addressed.