A psychiatrist evaluating a woman with dissociative identity disorder reviews her history for the most consistently documented antecedent. Which finding would be expected in the large majority of such cases?
- A Severe and prolonged physical or sexual abuse beginning in early childhood ✓
- B Temporal lobe epilepsy confirmed on EEG
- C Recent bereavement within the preceding six months
- D Chronic heavy alcohol use starting in adolescence
Correct answer: A. Severe and prolonged physical or sexual abuse beginning in early childhood
Explanation
Overwhelming majorities of patients with dissociative identity disorder across studies report severe, chronic childhood physical or sexual abuse, and the disorder is conceptualised as a developmental post-traumatic adaptation in which identity fails to integrate. Temporal lobe epilepsy is sometimes proposed as a mimic but is not the established antecedent. Recent bereavement and adolescent alcohol misuse lack any consistent association with the disorder.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
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