Peer-reviewed article
The gordian knot of overlapping symptoms between dissociative identity disorder and borderline personality disorder, the need for a clear cut: A case report
Romanos I, Preve M, Traber R ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a clinical case report about a 45-year-old adult woman with dissociative identity disorder and borderline personality disorder. The report discusses diagnostic challenges in distinguishing between these two psychiatric conditions in adult mental health settings. It describes the patient's symptoms, including trauma history, emotional dysregulation, and dissociative features, and the eventual correct diagnosis after initial misdiagnosis.
Key points
- DID and BPD share overlapping symptoms including emotional dysregulation, alterations in sense of self, amnesia, and depersonalization, leading to potential misdiagnosis
- The patient had a history of childhood intrafamilial sexual abuse and domestic violence
- Correct diagnosis of DID was made when three Apparently Normal Personalities and several Emotional Personalities emerged
- Accurate diagnosis enabled appropriate treatment including pharmacological management and phase-oriented therapy
Limitations
This is a single case report of an adult patient and does not provide evidence about children's well-being or interventions affecting child health outcomes. The focus is on adult psychiatric diagnosis and treatment.
Abstract
Introduction One of the central debates in the psychiatric community is the difficulty in distinguishing Dissociative Identity Disorder (DID) from Borderline Personality Disorder (BPD). The fact that core symptoms of these pathologies such as emotional dysregulation, alterations in sense of Self, amnesia, depersonalization, self harm, hearing voices, difficulties in maintaining relationships, are symptoms that feature in both disorders can lead physicians to a misdiagnosis, thus depriving patients with DID of adequate treatment. Objectives To report a complex clinical case of a DID patient initially misdiagnosed as BPD. Methods Clinical case report. Results A 45-year-old Caucasian woman with a history of childhood intrafamilial sexual abuse and domestic violence, substance use disorder, autolesionistic and suicidal behaviour with an active diagnosis of BPD presented to our ambulatory mental health care service. A more thorough examination revealed a history of emotional and affect dysregulation, depersonalization, amnesia, intrusive traumatic memories and nightmares with affective, cognitive, and sensorimotor aspects, persistent negative Self-perception. Auditory verbal hallucinations were also present described as inner space with commentary and derogatory nature with one of them being a child voice. The diagnosis of tertiary structural dissociation and DID was finally made when three Apparently Normal Personalities emerged with several Emotional Personalities, authorising for cautious partial pharmacological washout and initiation of three phase-orientated treatment approach. Conclusions DID is more common than is assumed and the overlap of core symptoms with other disorders can lead to a misdiagnosis. A careful clinical interview and evaluation of symptoms is mandatory to a correct DID diagnosis with a consequent appropriate therapy. Disclosure No significant relationships.