Psych Vivas · General adult psychiatry — dissociative disorders
Dissociative disorders — structured clinical viva
Fellowship viva covering DID evidence base, DES/SCID-D, Dalenberg vs Lynn framing, ISSTD phases, TOP DD caveats, DPDR CBT, suicide risk, and iatrogenic pitfalls.
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Target exams
Interpretation
Reveal interpretation
Viva stations
Station A — Nosology and differential (4–5 min)
Expected: Define DID with amnesia + identity disruption; list DPDR, amnesia, OSDD; discriminate psychosis (reality testing, thought form) and BPD; mention PTSD dissociative features.[1]
Station B — Aetiology debate (3–4 min)
Expected: Trauma associations supported in Dalenberg synthesis; sociocognitive risks (suggestion, iatrogenesis, scripts) from Lynn et al.; no individual diagnostic biomarker; MRI does not "prove DID".[2][3]
Station C — Assessment and risk (4 min)
Expected: Trauma-informed non-leading history; DES screen; SCID-D if available; collateral; suicide/self-injury elevated — safety plan now, not after "finding memories".[5][1]
Station D — Management (5 min)
Expected: ISSTD Phase 1 first (safety, stabilisation, skills); delay hypnosis-for-memory; phase 2 trauma work only when stable; medications for comorbidity; CBT pointer for depersonalisation; evidence quality modest/naturalistic for DID-specific protocols.[4][6][1]
Model synthesis answer
Reveal model synthesis
"I will not confirm or refute DID based on TikTok alone. I will assess risk today because dissociative outpatients show elevated suicidality.[5] I will take a paced trauma-informed history, screen with DES, and use structured interview methods rather than suggestive techniques.[1] Aetiology is contested: trauma-related models have substantial empirical support, while sociocognitive pathways and iatrogenesis remain real clinical risks — so I avoid leading memory recovery.[2][3] Treatment follows phase-oriented ISSTD principles: safety and stabilisation before trauma processing; medications treat depression/PTSD/anxiety, not identity fusion; CBT has open evidence for DPDR symptoms.[4][6] MRI is for neurological red flags, not DID certification."
References
- [1]Dorahy MJ, Brand BL, Sar V, et al. Dissociative identity disorder: An empirical overview Aust N Z J Psychiatry, 2014.PMID 24788904
- [2]Dalenberg CJ, Brand BL, Gleaves DH, et al. Evaluation of the evidence for the trauma and fantasy models of dissociation Psychol Bull, 2012.PMID 22409505
- [3]Lynn SJ, Maxwell R, Merckelbach H, et al. Dissociation and its disorders: Competing models, future directions, and a way forward Clin Psychol Rev, 2019.PMID 31494349
- [4]International Society for the Study of Trauma and Dissociation Guidelines for treating dissociative identity disorder in adults, third revision J Trauma Dissociation, 2011.PMID 21391103
- [5]Foote B, Smolin Y, Neft DI, Lipschitz D Dissociative disorders and suicidality in psychiatric outpatients J Nerv Ment Dis, 2008.PMID 18195639
- [6]Hunter EC, Baker D, Phillips ML, et al. Cognitive-behaviour therapy for depersonalisation disorder: an open study Behav Res Ther, 2005.PMID 16005701