eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Child Abuse & Neglect: Dissociative Identity Disorder: Follow-up

Author: Muhammad Waseem, MD, Associate Professor of Emergency Medicine in Clinical Pediatrics, Weill Medical College of Cornell University; Consulting Staff, Department of Pediatrics, Bronx Lebanon Hospital; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Coauthor(s): Muhammad Aslam, MD, Clinical Fellow, Department of Newborn Medicine, Children's Hospital Boston; Richard M Switzer, Jr, MD, Consulting Staff, Department of Pediatrics, Brooklyn Hospital Center; Orlando Perales, MD, Associate Director of Pediatric Emergency Services, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Contributor Information and Disclosures

Updated: Nov 28, 2007

Follow-up

Further Inpatient Care

  • Hospital admission is indicated for children in the following cases:
    • When medical or surgical condition requires inpatient management
    • When the diagnosis is unclear
    • When no alternative safe place for custody is immediately available

Further Outpatient Care

  • If a child or adolescent is being treated, the parent or guardian must be seen. The guardian or parent must learn how to deal with the child during expression of multiple personalities or amnestic episodes.
  • A mental health professional with special experience in this area should provide follow-up care for these patients.

Inpatient & Outpatient Medications

  • Pharmacologic management is the same as for PTSD.

Deterrence/Prevention

  • Stopping child abuse as early as possible maximizes chances for prevention.
  • With suspicion of abuse, siblings should undergo full examinations within 24 hours.

Complications

  • In 1981, Allison found criminal activity in patients with MPD.16
  • Other literature also notes complications of other social problems, such as prostitution and antisocial outbursts and actions.
  • Childhood sexual and physical abuse are highlighted as predictors of both paranoid and antisocial personality disorders. Patients with dissociative disorder also reported suicide attempts and self-mutilative behavior.

Prognosis

  • A patient with MPD who seeks and finds adequate treatment has an excellent prognosis. Physicians and therapists who have worked with patients with MPD are optimistic about recovery. Recovery requires specially trained skilled psychiatrists who thoroughly understand the condition.

Patient Education

  • Patient education is of utmost importance. When patients with MPD understand what is really happening in their lives, they become excellent, cooperative patients.
  • For excellent patient education resources, visit eMedicine's Children's Health Center and Public Health Center. Also, see eMedicine's patient education articles Child Abuse and Sexual Assault.

Miscellaneous

Medicolegal Pitfalls

  • Legal requirements for reporting abuse to the proper social services and CPS should be thoroughly understood. Reporting abuse is required by law; it is not optional. Physicians must neither overlook nor mismanage the opportunity to identify abuse.
  • Physicians are sometimes hesitant to report suspected cases of abuse because they are not absolutely certain of the diagnosis. Remember that physicians are required by law to report all suspicious cases. Additionally, physicians are protected by law from legal retaliation by the parents.

Special Concerns

  • Physicians must first maintain an open mind to the possibility that abuse commonly occurs.
  • If an injury is incompatible with the history provided or with the child's development, abuse should be suspected.
  • A delay in seeking medical help should increase suspicion.
 


More on Child Abuse & Neglect: Dissociative Identity Disorder

Overview: Child Abuse & Neglect: Dissociative Identity Disorder
Differential Diagnoses & Workup: Child Abuse & Neglect: Dissociative Identity Disorder
Treatment & Medication: Child Abuse & Neglect: Dissociative Identity Disorder
Follow-up: Child Abuse & Neglect: Dissociative Identity Disorder
References
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References

  1. Cicchetti D, Lynch M. Toward an ecological/transactional model of community violence and child maltreatment: consequences for children's development. Psychiatry. Feb 1993;56(1):96-118. [Medline].

  2. Cicchetti D, Rogosch FA. Psychopathology as risk for adolescent substance use disorders: a developmental psychopathology perspective. J Clin Child Psychol. Sep 1999;28(3):355-65. [Medline].

  3. Kluft RP. Diagnosing multiple personality disorder. Pa Med. Sep 1984;87(9):44, 46. [Medline].

  4. Kluft RP. An update on multiple personality disorder. Hosp Community Psychiatry. Apr 1987;38(4):363-73. [Medline].

  5. Carmen EH, Rieker PP, Mills T. Victims of violence and psychiatric illness. Am J Psychiatry. Mar 1984;141(3):378-83. [Medline].

  6. Mills T, Reiker P, Carmen E. Hospitalization experiences of victims of abuse. Victimology. 1984;9:436-59.

  7. Edwards VJ, Holden GW, Felitti VJ, Anda RF. Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry. Aug 2003;160(8):1453-60. [Medline].

  8. Anderson SC, Bach CM, Griffith S. Psychosocial sequelae in intrafamilial victims of sexual assault and abuse. Amsterdam, Netherlands: April1981. Third international conference on child abuse and neglect.

  9. Tuft's New England Medical Center, Division of Child Psychiatry. Sexually exploited children: Service and research project. Final report for the office of Juvenile Justice and Delinquency Prevention. Washington, DC: US Department of Justice; 1984.

  10. Putnam FW, Guroff JJ, Silberman EK. The clinical phenomenology of multiple personality disorder: review of 100 recent cases. J Clin Psychiatry. Jun 1986;47(6):285-93. [Medline].

  11. Middleton W, Butler J. Dissociative identity disorder: an Australian series. Aust N Z J Psychiatry. Dec 1998;32(6):794-804. [Medline].

  12. Macfie J, Cicchetti D, Toth SL. The development of dissociation in maltreated preschool-aged children. Dev Psychopathol. 2001;13(2):233-54. [Medline].

  13. Gast U, Rodewald F, Nickel V, Emrich HM. Prevalence of dissociative disorders among psychiatric inpatients in a German university clinic. J Nerv Ment Dis. Apr 2001;189(4):249-57. [Medline].

  14. Sar V, Akyuz G, Kundakci T, et al. Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatry. Dec 2004;161(12):2271-6. [Medline].

  15. Tezcan E, Atmaca M, Kuloglu M, et al. Dissociative disorders in Turkish inpatients with conversion disorder. Compr Psychiatry. Jul-Aug 2003;44(4):324-30. [Medline].

  16. Allison RB. Multiple personality and criminal behavior. Am J Forensic Psychiatry. 1981;2:32-38.

  17. Bierer LM, Yehuda R, Schmeidler J, et al. Abuse and neglect in childhood: relationship to personality disorder diagnoses. CNS Spectr. Oct 2003;8(10):737-54. [Medline].

  18. Brown GR, Anderson B. Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. Am J Psychiatry. Jan 1991;148(1):55-61. [Medline].

  19. Brown RJ. Different types of "dissociation" have different psychological mechanisms. J Trauma Dissociation. 2006;7(4):7-28. [Medline].

  20. Chu JA, Frey LM, Ganzel BL, et al. Memories of childhood abuse: dissociation, amnesia, and corroboration. Am J Psychiatry. May 1999;156(5):749-55. [Medline].

  21. DeFrancis V. Protecting the Child Victim of Sex Crimes Committed by Adults. Denver, CO: Children's Division, American Humane Association; 1969.

  22. Dorahy MJ, Lewis CA. Dissociative identity disorder in Northern Ireland: a survey of attitudes and experience among clinical psychologists and psychiatrists. J Nerv Ment Dis. Oct 2002;190(10):707-10. [Medline].

  23. Ellason JW, Ross CA. Two-year follow-up of inpatients with dissociative identity disorder. Am J Psychiatry. Jun 1997;154(6):832-9. [Medline].

  24. Foote B, Smolin Y, Kaplan M, Legatt ME, Lipschitz D. Prevalence of dissociative disorders in psychiatric outpatients. Am J Psychiatry. Apr 2006;163(4):623-9. [Medline].

  25. Lewis DO, Yeager CA, Swica Y. Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder. Am J Psychiatry. Dec 1997;154(12):1703-10. [Medline].

  26. Putnam FW. Diagnosis and Treatment of Multiple Personality Disorder. New York, NY: Guilford Press; 1989.

  27. Putnam FW. Ten-year research update review: child sexual abuse. J Am Acad Child Adolesc Psychiatry. Mar 2003;42(3):269-78. [Medline].

  28. Sar V, Koyuncu A, Ozturk E, et al. Dissociative disorders in the psychiatric emergency ward. Gen Hosp Psychiatry. Jan-Feb 2007;29(1):45-50. [Medline].

  29. Simeon D, Guralnik O, Schmeidler J, et al. The role of childhood interpersonal trauma in depersonalization disorder. Am J Psychiatry. Jul 2001;158(7):1027-33. [Medline].

  30. Wilbur CB. Multiple personality and child abuse. An overview. Psychiatr Clin North Am. Mar 1984;7(1):3-7. [Medline].

  31. Xiao Z, Yan H, Wang Z, et al. Trauma and dissociation in China. Am J Psychiatry. Aug 2006;163(8):1388-91. [Medline].

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Further Reading

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Keywords

dissociative identity disorder, DID, borderline personality disorder, posttraumatic stress disorder, PTSD, dissociative disorder, dissociation, dissociative psychopathology, child abuse, neglect, multiple personality disorder, MPD, auditory hallucinations, severe depression, suicidality, phobic anxiety, somatization, substance abuse, borderline features, passive disengagement, psychodynamic dividedness, pathological dissociation, conversion disorder, hypnosis, fugue states, sleepwalking, automatic writing, auditory hallucinations, detachment, compartmentalization, temporal lobe epilepsy, schizophrenia

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Contributor Information and Disclosures

Author

Muhammad Waseem, MD, Associate Professor of Emergency Medicine in Clinical Pediatrics, Weill Medical College of Cornell University; Consulting Staff, Department of Pediatrics, Bronx Lebanon Hospital; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Muhammad Waseem, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Muhammad Aslam, MD, Clinical Fellow, Department of Newborn Medicine, Children's Hospital Boston
Muhammad Aslam, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Medical Association, Massachusetts Medical Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Richard M Switzer, Jr, MD, Consulting Staff, Department of Pediatrics, Brooklyn Hospital Center
Richard M Switzer, Jr, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Orlando Perales, MD, Associate Director of Pediatric Emergency Services, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Orlando Perales, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Carol Diane Berkowitz, MD, Executive Vice Chair, Department of Pediatrics, Professor, Harbor-University of California at Los Angeles Medical Center
Carol Diane Berkowitz, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Pediatric Society, and North American Society for Pediatric and Adolescent Gynecology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation

Managing Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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