Treatment Outcomes in 20 Children with Dissociative Identity Disorder

Abstract
The authors completed a retrospective chart review of 20 children with clinical diagnoses of dissociative identity disorder (DID). Their average age was 7.9 years (SD=3.9), range 3-17 years, 11 were male and 9 were female. Two participants had incomplete treatment and one took 89 months to reach integration because of multiple treatment interruptions due to the Covid pandemic and other factors: for the remaining 17 children the average time to integration was 21.8 months (SD=11.9). This is the first report of a sizable series of children and adolescents with DID treated to stable integration.

This case series indicates that DID in children and adolescents can be treated to stable integration on an outpatient basis in an average of under two years. No comparable series of child and adolescent cases treated to integration has been published previously. Kluft’s criteria for integration were followed in the present case series except for criteria 4 and 5:

The time to integration in the present case series was very close to the time of 21.6 months Kluft observed in 33 adult patients. In the same report, Kluft stated that in his full series of 123 patients with DID (then called multiple personality disorder) 67.5% were treated to integration, however he did not apply his full set of six criteria to all cases, resulting in his final sample of 33 cases who were integrated by all six of his criteria.

Future research on DID in children and adolescents should focus on: epidemiology and prevalence in a variety of non-clinical and clinical populations, including different races, cultures and socio-economic statuses; types and severity of trauma reported; independent observation and confirmation of DID by friends, teachers, parents and others prior to initial diagnosis (observing switching and claims of amnesia, knowing alter personalities by name); phenomenology across the years from early childhood to age 18; rates of diagnosis in standard clinical practices prior to systematic evaluation of those populations in research studies; a detailed description of treatments and development of treatment protocols; a comparison of DID-specific treatment to treatment as usual; diagnoses made by other clinicians prior to diagnosis of DID; reductions in health care utilization and improvements in function post-integration; and scores and findings on standardized measures of dissociation and comorbidity.