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Clinical Atlas Prestige · Evidence-first

Psych VivasGeneral adult psychiatry — dissociative disorders

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.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar. A consultant asks you to discuss a 34-year-old patient who self-identifies as having DID after online videos, reports 'alters', intermittent amnesia, chronic depersonalisation, and past sexual abuse. She wants hypnosis to 'find all memories', is cutting weekly, and asks whether an MRI will prove DID. Defend nosology, assessment, trauma vs sociocognitive models, phase treatment, risk, and what you will not do.

Interpretation

Reveal interpretation

This is a high-risk, high-complexity differential station: social-media-influenced self-diagnosis does not equal DID, but dismissing distress is also wrong. You must show you can hold trauma evidence, sociocognitive caution, structured assessment, and phase-based care simultaneously.[1][2][3]

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. [1]Dorahy MJ, Brand BL, Sar V, et al. Dissociative identity disorder: An empirical overview Aust N Z J Psychiatry, 2014.PMID 24788904
  2. [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. [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. [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. [5]Foote B, Smolin Y, Neft DI, Lipschitz D Dissociative disorders and suicidality in psychiatric outpatients J Nerv Ment Dis, 2008.PMID 18195639
  6. [6]Hunter EC, Baker D, Phillips ML, et al. Cognitive-behaviour therapy for depersonalisation disorder: an open study Behav Res Ther, 2005.PMID 16005701