Psychopathological riddles of multiple personality disorder (dissociative identity disorder). The case of Daniel A.

Abstract

The article presents a unique clinical case of Daniil A. with multiple personality disorder (dissociative identity disorder according to ICD-11) — the first detailed description of a rare syndrome in the Russian-language scientific literature. The patient also had dissociative movement disorders in the form of pseudoepileptic seizures. The clinical picture of the disease was dominated by the symptoms of “alternative of personality”, “second essence”, “Alter ego” and “voices”. The article provides a clinical analysis of the legitimacy of designating the identified phenomena as hallucinations and delusions. The theoretical analysis included an assessment of the possibility of diagnosing psychotic symptoms within non-psychotic disorders.

Keywords

multiple personality disorder / dissociative identity disorder / psychotic disorders / hallucinations / hallucinoids / delusions / delusional fantasies / hysteria

References

[1] Ribolsi M, Fiori Nastro F, Pelle M et al. Recognizing psychosis in autism spectrum disorder. Front Psychiatry. 2022;13:768586. DOI: 10.3389/fpsyt.2022.768586.

[2] Ribolsi M., Fiori Nastro F., Pelle M. et al. Recognizing psychosis in autism spectrum disorder // Front. Psychiatry. 2022. Vol. 13 . P. 768586. DOI: 10.3389/fpsyt.2022.768586.

[3] Savero N, Aji AP, Alim AH et al. Hallucination in patients with borderline personality disorder. Journal of Psychiatry Psychology and Behavioral Research. 2022;3(1):40–42. DOI: 10.21776/ub.jppbr.2022.003.01.10.

[4] Savero N., Aji A.P., Alim A.H. et al. Hallucination in patients with borderline personality disorder // Journal of Psychiatry Psychology and Behavioral Research. 2022. Vol. 3. N. 1. P. 40–42. DOI: 10.21776/ub.jppbr.2022.003.01.10.

[5] Hayward M, Jones A-M, Strawson WH et al. A cross-sectional study of auditory verbal hallucinations experienced by people with a diagnosis of borderline personality disorder. Clinical Psychology & Psychotherapy. 2022;29(2):631–641. DOI: 10.1002/cpp. 2655.

[6] Hayward M., Jones A.-M., Strawson W.H. et al. A cross-sectional study of auditory verbal hallucinations experienced by people with a diagnosis of borderline personality disorder // Clinical Psychology & Psychotherapy. 2022. Vol. 29. N. 2. P. 631–641. DOI: 10.1002/cpp. 2655.

[7] Mendelevich VD, Gatin FF, Hamitov RR et al. Psihoticheskie simptomy pri nepsihoticheskih rasstrojstvah: oshibki diagnostiki ili novaya real’nost’? Nevrologicheskij vestnik. 2022;2:5–12. (In Russ.) DOI: 10.17816/nb108655.

[8] Менделевич В.Д., Гатин Ф.Ф., Хамитов Р.Р. и др. Психотические симптомы при непсихотических расстройствах: ошибки диагностики или новая реальность? // Неврологический вестник. 2022. Т. 2. С. 5–12. DOI: 10.17816/nb108655.

[9] Kutlubaev MA, Mendelevich VD, Dyukova GM, Belousova ED. Problema komorbidnosti epilepsii i psihogennyh paroksizmov. Zhurnal nevrologii i psihiatrii im SS Korsakova. 2020;120(5):138–145. (In Russ.) DOI: 10.17116/jnevro2020120051138.

[10] Кутлубаев М.А., Менделевич В.Д., Дюкова Г.М., Белоусова Е.Д. Проблема коморбидности эпилепсии и психогенных пароксизмов // Журнал неврологии и психиатрии им. С.С. Корсакова. 2020. Т. 120. №5. С. 138–145. DOI: 10.17116/jnevro2020120051138.

[11] Rybal’skij MI. Illyuzii i gallyucinacii. Baku: Maarif; 1983. 304 р. (In Russ.)

[12] Рыбальский М.И. Иллюзии и галлюцинации. Баку: Маариф; 1983. 304 с.

[13] Krylov VI. Psihopatologicheskaya kvalifikaciya i diagnosticheskoe znachenie narushenij chuvstvennogo poznaniya (gallyucinacii, psevdogallyucinacii, gallyucinoidy). Psihiatriya i psihofarmakoterapiya. 2017;19(6):4–9. (In Russ.)

[14] Крылов В.И. Психопатологическая квалификация и диагностическое значение нарушений чувственного познания (галлюцинации, псевдогаллюцинации, галлюциноиды) // Психиатрия и психофармакотерапия. 2017. Т. 19. №6. С. 4–9.

[15] Bekhterev VM. O slyshanii sobstvennyh myslej. Antologiya izbrannyh testov otechestvennyh psihiatrov. Pod red. PV Morozova. M.: Gorodec; 2016. 368 р. (In Russ.)

[16] Бехтерев В.М. О слышании собственных мыслей. Антология избранных тестов отечественных психиатров / Под ред. П.В. Морозова. М.: Городец; 2016. 368 с.

[17] Shishkovskaya TI. Vnutrennyaya rech’: razmytaya gran’ mezhdu patologiej i normoj. PsyAndNeuro. Psihiatriya & Nejronauki. 2020. http://psyandneuro.ru/stati/private-speech/ (access date: 05.01.2023). (In Russ.)

[18] Шишковская Т.И. Внутренняя речь: размытая грань между патологией и нормой // PsyAndNeuro. Психиатрия & Нейронауки. 2020. http://psyandneuro.ru/stati/private-speech/ (дата обращения: 05.01.2023).

[19] Alderson-Day B, Fernyhough C. Inner speech: development, cognitive functions, phenomenology, and neurobiology. Psychological bulletin. 2015;141(5):931–965. DOI: 10.1037/bul0000021.

[20] Alderson-Day B., Fernyhough C. Inner speech: development, cognitive functions, phenomenology, and neurobiology // Psychological bulletin. 2015. Vol. 141. N. 5. P. 931–965. DOI: 10.1037/bul0000021.

[21] Price CJ. A review and synthesis of the first 20 years of PET and fMRI studies of heard speech, spoken language and reading. Neuroimage. 2012;62(2):816–847. DOI: 10.1016/j.neuroimage.2012.04.062.

[22] Price C.J. A review and synthesis of the first 20 years of PET and fMRI studies of heard speech, spoken language and reading // Neuroimage. 2012. Vol. 62. N. 2. P. 816–847. DOI: 10.1016/j.neuroimage.2012.04.062.

[23] Mendelevich DM. Verbal’nyj gallyucinoz. Kazan’: Kazan State Unviersity; 1980. 246 р. (In Russ.)

[24] Менделевич Д.М. Вербальный галлюциноз. Казань: Казанский ГУ; 1980. 246 с.

[25] Moskowitz A, Corstens D. Auditory hallucinations: Psychotic symptom or dissociative experience? Journal of Psychological Trauma. 2007;6(2–3):35–63. DOI: 10.1300/J513v06n02_04.

[26] Moskowitz A., Corstens D. Auditory hallucinations: Psychotic symptom or dissociative experience? // Journal of Psychological Trauma. 2007. Vol. 6. N. 2–3. P. 35–63. DOI: 10.1300/J513v06n02_04.

[27] Mendelevich VD. Terminologicheskie osnovy fenomenologicheskoj diagnostiki v psihiatrii. M.: Gorodec; 2016. 128 р. (In Russ.)

[28] Менделевич В.Д. Терминологические основы феноменологической диагностики в психиатрии. М.: Городец; 2016. 128 с.

[29] Pyatnickiĭ NYu. Sindrom “bredopodobnogo fantazirovaniya” v koncepcii K. Birnbauma. Zhurnal nevrologii i psihiatrii. 2016;10:76–81. (In Russ.) DOI: 10.17116/jnevro201611610176-81.

[30] Пятницкий Н.Ю. Синдром «бредоподобного фантазирования» в концепции К. Бирнбаума // Журнал неврологии и психиатрии. 2016. Т. 10. С. 76–81. DOI: 10.17116/jnevro201611610176-81.

[31] Kravchenko IV. Sindrom fantazirovaniya u detej: klinika, dinamika, sistematika. Dis. … kand. med. nauk. SPb.; 2021. 155 р. (In Russ.)

[32] Кравченко И.В. Синдром фантазирования у детей: клиника, динамика, систематика. Дис. … канд. мед. наук. СПб.; 2021. 155 с.

[33] Patnem FV. Diagnostika i lechenie rasstrojstva mnozhestvennoj lichnosti. Zhurnal Prakticheskoj Psihologii i Psihoanaliza. 2004;1. https://psyjournal.ru/articles/diagnostika-i-lechenie-rasstroystva-mnozhestvennoy-lichnosti (access date: 05.01.2023). (In Russ.)

[34] Патнем Ф.В. Диагностика и лечение расстройства множественной личности // Журнал практической психологии и психоанализа. 2004. Т. 1. https://psyjournal.ru/articles/diagnostika-i-lechenie-rasstroystva-mnozhestvennoy-lichnosti (дата обращения: 05.01.2023).

[35] Longden E, Branitsky A, Moskowitz A et al. The relationship between dissociation and symptoms of psychosis: A meta-analysis. Schizophrenia Bulletin. 2020;46(5):1104–1113. DOI: 10.1093/schbul/sbaa037.

[36] Longden E., Branitsky A., Moskowitz A. et al. The relationship between dissociation and symptoms of psychosis: A meta-analysis // Schizophrenia Bulletin. 2020. Vol. 46. N. 5. P. 1104–1113. DOI: 10.1093/schbul/sbaa037.

[37] Nesbit A, Dorahy MJ, Palmer Ret al. Dissociation as a mediator between childhood abuse and hallucinations: An exploratory investigation using dissociative identity disorder and schizophrenia spectrum disorders. J Trauma Dissociation. 2022;23(5):521–538. DOI: 10.1080/15299732.2022.2064579.

[38] Nesbit A., Dorahy M.J., Palmer R.et al. Dissociation as a mediator between childhood abuse and hallucinations: An exploratory investigation using dissociative identity disorder and schizophrenia spectrum disorders // J. Trauma Dissociation. 2022. Vol. 23. N. 5. P. 521–538. DOI: 10.1080/15299732.2022.2064579.

[39] Martinez AP, Dorahy MJ, Nesbit A, Middleton W. Delusional beliefs and their characteristics: A comparative study between dissociative identity disorder and schizophrenia spectrum disorders. Journal of Psychiatric Research. 2020;131(7):263–268. DOI: 10.1016/j.jpsychires.2020.09.015.

[40] Martinez A.P., Dorahy M.J., Nesbit A., Middleton W. Delusional beliefs and their characteristics: A comparative study between dissociative identity disorder and schizophrenia spectrum disorders // Journal of Psychiatric Research. 2020. Vol. 131. N. 7. P. 263–268. DOI: 10.1016/j.jpsychires.2020.09.015.

[41] Ross CA. Voices: Are they dissociative or psychotic? J Nerv Ment Dis. 2020;208(9):658–662. DOI: 10.1097/NMD.0000000000001206.

[42] Ross C.A. Voices: Are they dissociative or psychotic? // J. Nerv. Ment. Dis. 2020. Vol. 208. N. 9. P. 658–662. DOI: 10.1097/NMD.0000000000001206.

[43] Dorahy MJ, Shannon C, Seagar L et al. Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history: Similarities and diffe-rences. J Nerv Ment Dis. 2009;197(12):892–898. DOI: 10.1097/NMD.0b013e3181c299ea.

[44] Dorahy M.J., Shannon C., Seagar L. et al. Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history: Similarities and diffe-rences // J. Nerv. Ment. Dis. 2009. Vol. 197. N. 12. P. 892–898. DOI: 10.1097/NMD.0b013e3181c299ea.

[45] Moskowitz A. Commentary on “dissociation and psychosis in dissociative identity disorder and schizophrenia” (Laddis & Dell). Journal of Trauma & Dissociation. 2012;13(4):414–417. DOI: 10.1080/15299732.2011.621017.

[46] Moskowitz A. Commentary on “dissociation and psychosis in dissociative identity disorder and schizophrenia” (Laddis & Dell) // Journal of Trauma & Dissociation. 2012. Vol. 13. N. 4. P. 414–417. DOI: 10.1080/15299732.2011.621017.

[47] Antje A, Reinders TS, Veltman DJ. Dissociative identity disorder: Out of the shadows at last? The British Journal of Psychiatry. 2021;219:413–414. DOI: 10.1192/bjp.2020.168.

[48] Antje A., Reinders T.S., Veltman D.J. Dissociative identity disorder: Out of the shadows at last? // The British Journal of Psychiatry. 2021. Vol. 219. P. 413–414. DOI: 10.1192/bjp.2020.168.

[49] Korolenko CP, Dmitrieva NV. Lichnostnye i dissociativnye rasstroĭstva: rasshirenie granic diagnostiki i terapii. Novosibirsk; 2006. 437 р. (In Russ.)

[50] Короленко Ц.П., Дмитриева Н.В. Личностные и диссоциативные расстройства: расширение границ диагностики и терапии. Новосибирск; 2006. 437 с.

[51] Koren’ EV, Kupriyanova TA, Ponomareva KI, Kuz’mina EA. Dissociativnoe rasstroĭstvo identichnosti: psihologicheskiĭ konstrukt ili klinicheskaya real’nost’ (nablyudenie iz praktiki detskoĭ psihiatrii). Voprosy psihicheskogo zdorov’ya deteĭ i podrostkov. 2020;20(3):58–64. (In Russ.)

[52] Корень Е.В., Куприянова Т.А., Пономарева К.И., Кузьмина Е.А. Диссоциативное расстройство идентичности: психологический конструкт или клиническая реальность (наблюдение из практики детской психиатрии) // Вопросы психического здоровья детей и подростков. 2020. Т. 20. №3. С. 58–64.

[53] Dorahy MJ, Huntjens RJC, Marsh RJ et al. The sense of self over time: Assessing diachronicity in dissociative identity disorder, psychosis and Healthy Comparison Groups. Front Psychol. 2021;12:620063. DOI: 10.3389/fpsyg.2021.620063.

[54] Dorahy M.J., Huntjens R.J.C., Marsh R.J. et al. The sense of self over time: Assessing diachronicity in dissociative identity disorder, psychosis and Healthy Comparison Groups // Front. Psychol. 2021. Vol. 12. Р. 620063. DOI: 10.3389/fpsyg.2021.620063.

[55] Gauld C, Espi P, Revol O, Fourneret P. Explanatory hypothe-ses of the ecology of new clinical presentations of dissociative identity disorders in youth. Front Psychiatry. 2022;13:965593. DOI: 10.3389/fpsyt.2022.965593.

[56] Gauld C., Espi P., Revol O., Fourneret P. Explanatory hypothe-ses of the ecology of new clinical presentations of dissociative identity disorders in youth // Front. Psychiatry. 2022. Vol. 13 . Р. 965593. DOI: 10.3389/fpsyt.2022.965593.

[57] Agarkov VA. Dissociaciya i pogranichnoe rasstroĭstvo lichnosti. Konsul’tativnaya psihologiya i psihoterapiya. 2014;81(2):10–37. (In Russ.)

[58] Агарков В.А. Диссоциация и пограничное расстройство личности // Консультативная психология и психотерапия. 2014. Т. 81. №2. С. 10–37.

[59] Petric D. Dissociation, dissociative disorders and partial psychosis. Open Journal of Medical Psychology. 2022;11:243–253. DOI: 10.4236/ojmp.2022.114018.

[60] Petric D. Dissociation, dissociative disorders and partial psychosis // Open Journal of Medical Psychology. 2022. Vol. 11 . Р. 243–253. DOI: 10.4236/ojmp.2022.114018.

[61] Pick S, Rojas-Aguiluz M, Butler M et al. Dissociation and interoception in functional neurological disorder. Cognitive Neuropsychiatry. 2020;25:294–311. DOI: 10.1080/13546805.2020.1791061.

[62] Pick S., Rojas-Aguiluz M., Butler M. et al. Dissociation and interoception in functional neurological disorder // Cognitive Neuropsychiatry. 2020. Vol. 25. Р. 294–311. DOI: 10.1080/13546805.2020.1791061.

[63] Opjordsmoen S. Delusional disorder as a partial psychosis. Schizophrenia Bulletin. 2014;40:244–247. DOI: 10.1093/schbul/sbt203.

[64] Opjordsmoen S. Delusional disorder as a partial psychosis // Schizophrenia Bulletin. 2014. Vol. 40. P. 244–247. DOI: 10.1093/schbul/sbt203.

[65] Gillig PM. Dissociative identity disorder: A controversial diagnosis. Psychiatry (Edgmont). 2009;6(3):24–29.

[66] Gillig P.M. Dissociative identity disorder: A controversial diagnosis // Psychiatry (Edgmont). 2009. Vol. 6. N. 3. P. 24–29.

[67] Orlof W, Rozenek EB, Waszkiewicz N, Szewczak B. Dissociative identity (multiple personality) disorder in Poland: A clini-cal case description and diagnostic difficulties. Adv Psychiatry Neurol. 2021;30(3):213–218. DOI: 10.5114/ppn.2021.110804.

[68] Orlof W., Rozenek E.B., Waszkiewicz N., Szewczak B. Dissociative identity (multiple personality) disorder in Poland: A clinical case description and diagnostic difficulties // Adv. Psychiatry Neurol. 2021. Vol. 30. N. 3. P. 213–218. DOI: 10.5114/ppn.2021.110804.

[69] Haravuori H, Tuisku K, Torkkola K et al. Four selves of a student — a case report of dissociative identity disorder. Psychiatria Fennica. 2021;52:116–125.

[70] Haravuori H., Tuisku K., Torkkola K. et al. Four selves of a student — a case report of dissociative identity disorder // Psychiatria Fennica. 2021. Vol. 52. P. 116–125.

[71] Popov SM. Istoriya formirovaniya koncepcij i sovremennye predstavleniya ob isterii pri endogennyh psihicheskih rasstrojstvah. Psihiatriya. 2019;17(4):90–101. (In Russ.) DOI: 10.30629/2618-6667- 2019-17-4-90-101.

[72] Попов С.М. История формирования концепций и современные представления об истерии при эндогенных психических расстройствах // Психиатрия. 2019. Т. 17. №4. С. 90–101. DOI: 10.30629/2618- 6667- 2019 -17- 4-90-101.

[73] Kaplan AM, Smith CM. Schizotypal personality disorder disguised as dissociative identity disorder. BMJ Case Rep. 2021;14(7):e243454. DOI: 10.1136/bcr-2021-243454.

[74] Kaplan A.M., Smith C.M. Schizotypal personality disorder disguised as dissociative identity disorder // BMJ Case Rep. 2021. Vol. 14. N. 7. P. e243454. DOI: 10.1136/bcr-2021-243454.

[75] Ross CA. The theory of a dissociative subtype of schizophrenia. In: Dissociation and the dissociative disorders: DSM-V and beyond. PF Dell, JA O’Neil (eds.). 2009. р. 557–568.

[76] Ross C.A. The theory of a dissociative subtype of schizophrenia. In: Dissociation and the dissociative disorders: DSM-V and beyond. P.F. Dell, J.A. O’Neil (eds.). 2009. Р. 557–568.

[77] Smulevich AB, Ivanov SV, Myasnikova LK et al. Dissociativnye reakcii v traektorii razvitiya shizotipicheskogo rasstroĭstva lichnosti (na modeli nozogeniĭ u onkologicheskih bol’nyh). Zhurnal nevrologii i psihiatrii. 2014;12:12–22. (In Russ.) DOI: 10.17116/jnevro201411412112-22.

[78] Смулевич А.Б., Иванов С.В., Мясникова Л.К. и др. Диссоциативные реакции в траектории развития шизотипического расстройства личности (на модели нозогений у онкологических больных) // Журнал неврологии и психиатрии. 2014. Т. 12. С. 12–22. DOI: 10.17116/jnevro201411412112-22.

[79] Devillé C, Moeglin C, Sentissi O. Dissociative disorders: Between neurosis and psychosis. Hindawi Publishing Corporation. Case Reports in Psychiatry. 2014:425892. DOI: 10.1155/2014/425892.

[80] Devillé C., Moeglin C., Sentissi O. Dissociative disorders: Between neurosis and psychosis. Hindawi Publishing Corporation // Case Reports in Psychiatry. 2014. С. 425892. DOI: 10.1155/2014/425892.

[81] Motov VV. Rasstrojstvo v vide mnozhestvennoj lichnosti v SSHA. Klinicheskie i sudebno-psihiatricheskie aspekty. Nezavisimyj psihiatricheskij zhurnal. 2005;1:57–67. (In Russ.)

[82] Мотов В.В. Расстройство в виде множественной личности в США. Клинические и судебно-психиатрические аспекты // Независимый психиатрический журнал. 2005. Т. 1. С. 57–67.

[83] Brand BL, Sar V, Stavropoulos P et al. Separating fact from fiction: An empirical examination of six myths about dissociative identity disorder. Harvard Review of Psychiatry. 2016;24(4):257–270. DOI: 10.1097/HRP.0000000000000100.

[84] Brand B.L., Sar V., Stavropoulos P. et al. Separating fact from fiction: An empirical examination of six myths about dissociative identity disorder // Harvard Review of Psychiatry. 2016. Vol. 24. N. 4. P. 257–270. DOI: 10.1097/HRP.0000000000000100.

[85] Pietkiewicz IJ, Bańbura-Nowak A, Boon S. Revisiting false-positive and imitated dissociative identity disorder. Front Psychol. 2021;12:637929. DOI: 10.3389/fpsyg.2021.637929.

[86] Pietkiewicz I.J., Bańbura-Nowak A., Boon S. Revisiting false-positive and imitated dissociative identity disorder // Front. Psychol. 2021. Vol. 12. P. 637929. DOI: 10.3389/fpsyg.2021.637929.

[87] Perekhov AYa, Sidorov AA. Psihopatologiya “modnyh” dissociativnyh rasstroĭstv. Zhurnal social’noj i klinicheskoj psihiatrii. 2022;32(3):98–107. (In Russ.)

[88] Перехов А.Я., Сидоров А.А. Психопатология «модных» диссоциативных расстройств // Журнал социальной и клинической психиатрии. 2022. Т. 32. №3. С. 98–107.

[89] Kabene SM, Balkir Neftci N, Papatzikis E. Dissociative identity disorder and the law: Guilty or not guilty? Front Psychol. 2022;13:891941. DOI: 10.3389/fpsyg.2022.891941.

[90] Kabene S.M., Balkir Neftci N., Papatzikis E. Dissociative identity disorder and the law: Guilty or not guilty? // Front. Psychol. 2022. Vol. 13. P. 891941. DOI: 10.3389/fpsyg.2022.891941.

[91] Shmilovich AA, Svechnikova PS. Dissociativnoe rasstrojstvo identichnosti. Nezavisimyj psihiatricheskij zhurnal. 2021; 2:40–64.

[92] Шмилович А.А., Свечникова П.С. Диссоциативное расстройство идентичности // Независимый психиатрический журнал. 2021. Т. 2. С. 40–64.

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