Psych Vivas · General adult psychiatry — DID and dissociative amnesia
DID and dissociative amnesia — structured clinical viva
Fellowship viva covering DID and amnesia/fugue, Dalenberg vs Lynn framing, ISSTD phases, TOP DD caveats, suicide risk, and iatrogenic memory-recovery pitfalls.
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Target exams
Interpretation
Reveal interpretation
Viva stations
Station A — Nosology and differential (4–5 min)
Expected: Define DID (identity disruption + amnesia inconsistent with ordinary forgetting); define dissociative amnesia and fugue; discriminate psychosis (reality testing, thought form) and BPD; list organic amnesia mimics.[1][6]
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; protect during amnesia/fugue.[5][1][6]
Station D — Management (5 min)
Expected: Acute safety and organic exclusion for fugue; ISSTD Phase 1 first; delay hypnosis-for-memory; phase 2 trauma work only when stable; medications for comorbidity; naturalistic TOP DD gains with limited RCT certainty.[4][7][1]
Model synthesis answer
Reveal model synthesis
"I will treat the acute amnesia/fugue as a safety problem first — protect from exploitation, exclude organic causes when indicated, and re-orient without leading.[6] I will not confirm DID from a label alone; I will assess identity disruption, everyday amnesia, reality testing, and risk, using DES as a screen and structured interview methods when available.[1] Suicidality is elevated in dissociative outpatients, so safety planning is not optional.[5] Aetiology is contested: trauma-related models have substantial empirical support, while sociocognitive pathways and iatrogenesis remain real clinical risks — so I refuse aggressive memory recovery and premature abreaction.[2][3] Longer-term care follows ISSTD phase orientation: stabilisation before trauma processing; medications treat depression/PTSD/anxiety, not identity fusion; naturalistic cohorts support gradual improvement without overselling RCT certainty.[4][7] 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]Staniloiu A, Markowitsch HJ Dissociative amnesia Lancet Psychiatry, 2014.PMID 26360734
- [7]Myrick AC, Webermann AR, Loewenstein RJ, et al. Six-year follow-up of the treatment of patients with dissociative disorders study Eur J Psychotraumatol, 2017.PMID 28680542