Clinical Assessment of Dissociative Identity Disorder Among College Counseling Clients

College counseling professionals address a wide range of complex student mental health concerns. Among these, accurately identifying client presentations of dissociative identity disorder (DID) can be especially challenging because students with DID sometimes present as if they are experiencing another problem, such as a mood, anxiety, or psychotic disorder. This article reviews DID diagnostic criteria, introduces assessment strategies for use during intake and subsequent counseling sessions, and presents case illustrations. ********** College counseling center directors and practitioners continue to report that students are experiencing more severe mental health concerns (Gallagher, 2004; Gallagher & Weaver-Graham, 2005). Although cautions have been expressed about the need to conduct empirical research to confirm these impressions of increasing severity (Bishop, 2006; Bishop, Gallagher, & Cohen, 2000; Sharkin, 1997), counselors in college settings certainly do confront students with severe mental disorders and psychological disabilities in their day-to-day practice (Archer & Cooper, 1998), and college counselors' caseloads seem to be increasingly complex (Humphrey, Kitchens, & Patrick, 2000). Furthermore, Sharf (1989) suggested that even a few difficult cases can have a draining effect on staff. Although other classes of severe or complex mental disorders, such as substance use and eating disorders, have received attention in the recent literature, less information is available to inform college counselors' work with dissociative disorders. To help fill this gap, in this article, we discuss procedures for the assessment of dissociative identity disorder (DID; formerly multiple personality disorder) as it is experienced by college students. First, we review the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) diagnostic criteria describing symptoms of the disorder. Next, we discuss the use of screening measures and diagnostic structured interviews in the college context. We then provide three case illustrations drawn from the experiences of staff at one university mental health center and offer some conclusions. What Is Dissociation? Dissociation is defined in the DSM-IV-TR (APA, 2000) as a significant disruption in a person's usually integrated functions of consciousness, memory, identity, or perception of the environment. An individual may develop the disturbance suddenly or gradually, and it may be transient or become chronic. People sometimes experience transient dissociation in the context of posttraumatic stress disorder, panic disorder, borderline personality disorder, obsessive-compulsive disorder, impulse control disorders, eating disorders, and substance abuse disorders (Gold, 2007). Transient dissociation also occurs during DSM-IV-TR-defined psychogenic amnesia or psychogenic fugue states. On the other hand, when a person begins to experience dissociation chronically, he or she is more likely to be experiencing a dissociative disorder (Putnam, 1989). The chronic dissociative disorders include depersonalization disorder, DID, and dissociative disorder not otherwise specified (DDNOS). This article focuses on DID and also discusses those forms of DDNOS that are characterized as clinical presentations similar to DID but failing to meet the full criteria. The reason to consider both DID and these forms of DDNOS together is that similar assessment procedures and counseling interventions have been recommended for both types of disorders (Kluft, 2006). An Overview of DID DSM-IV-TR Diagnostic Criteria The diagnostic criteria for DID in the DSM-IV-TR (APA, 2000) are the following: A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self). …