Etiology (Biopsychosocial Model)

Biological: High hypnotizability, altered brain activity (e.g., in limbic system)

Psychological: Chronic childhood trauma, attachment disruptions

Social: Repeated abuse or neglect, cultural acceptance of possession

Symptoms & Diagnosis (Mnemonic: IDENTITY)

• I - Identity disruption with ≥2 distinct states
• D - Discontinuity in sense of self and agency
• E - Episodes of memory gaps for everyday and traumatic events
• N - Not part of cultural or religious practice
• T - Trauma history often present
• I - Impairment in functioning
• T - Testing reality remains intact
• Y - Youth often confused with fantasy play (rule this out)

Treatment

• Long-term trauma-focused psychotherapy
• Phase-oriented therapy (stabilization, trauma processing, integration)
• EMDR and dialectical behavior therapy (DBT) for comorbidities