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Clinical Atlas Prestige · Evidence-first

Psych VivasGeneral adult psychiatry — DID and dissociative amnesia

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.

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 found after a fugue-like episode who later describes 'alters', intermittent everyday amnesia, childhood abuse, and weekly cutting. She wants hypnosis to 'find all memories' and an MRI to 'prove DID'. Defend nosology of DID vs dissociative amnesia, organic exclusion, trauma vs sociocognitive models, DES/SCID-D, phase treatment, risk, and what you will not do.

Interpretation

Reveal interpretation

This station tests whether you can hold safety, organic exclusion, careful DID nosology, trauma evidence, sociocognitive caution, and phase-based care without polarising into "all real" or "all fake". Hypnosis-for-memory and MRI-as-proof are examiner traps.[1][2][3][6]

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. [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]Staniloiu A, Markowitsch HJ Dissociative amnesia Lancet Psychiatry, 2014.PMID 26360734
  7. [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