(200) Inpatient Management of Dissociative Identity Disorder on the Perinatal Psychiatry Consult Service

Abstract: Background/Significance: Dissociative identity disorder (DID) is a complex and controversial disorder that classically involves a traumatic event in childhood (Boon, Suzette). The disorder’s place in popular culture has led to several myths surrounding the diagnosis (Brand, Bethany). There is currently a dearth of literature on the management of patients with DID in inpatient medical and surgical settings. We report on the management of a woman with self-reported DID who presented to the Labor & Delivery unit with reported manifestations of several different identities that posed a challenge to labor.

Case: Ms. R is a 24-year pregnant female with a history of schizophrenia, borderline personality disorder, DID, sexual trauma and multiple psychiatric hospitalizations due to suicide attempts who was admitted to the hospital for induction of labor. The Consultation-Liaison (CL) team was consulted for recommendations as the Obstetrical team was unsure of how to manage the patient if one of her other identities presented during labor, particularly her identities that were children.

The patient described 9 different personalities, ranging from ages 2 to 24. In collaboration with the patient, calming techniques were identified for each identity. The CL team generated a behavioral plan for each identity during the hospitalization which also included contingencies for emergency decision making if one of the patient’s minor identities presented when medical decisions needed to be made.



Discussion: The management of our patient with DID presented multiple challenges including prejudice about the diagnosis from her Obstetrics team, the patient’s fear of being mistreated by her obstetrical providers because of her psychiatric history, and concerns about capacity if another identity presented. We present management tips and a sample behavioral plan to provide a template for management of patients with DID on an inpatient medical or surgical unit

Conclusion/Implications: When Consultation-Liaison Psychiatrists are consulted for a patient with DID, they serve an important role in advocating for these patients when interacting with providers whose understanding of this complex diagnosis may be limited.

Learning Objectives:

• Understand the management of patients with trauma and DID in a Labor and Delivery unit


• Explain the role of consultation-liaison psychiatry service in advocating for patients with a psychiatric history

References:

1. Dorahy MJ, Brand BL, Şar V, Krüger C, Stavropoulos P, Martínez-Taboas A, et al. Dissociative identity disorder: An empirical overview. Aust N Z J Psychiatry. 2014 May;48(5):402–17.

2. Brand BL, Sar V, Stavropoulos P, Krüger C, Korzekwa M, Martínez-Taboas A, et al. Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder. Harv Rev Psychiatry. 2016 Jul;24(4):257–70.

3. Boon S, Draijer N. Multiple personality disorder in The Netherlands: a clinical investigation of 71 patients. Am J Psychiatry. 1993 Mar;150(3):489–94.