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In the mental health profession, the diagnostic criterion for each disorder is clearly defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is to provide practitioners with a reliable guide for diagnostic judgments to some of the most complex cases in the cognitive, behavioral and emotional realm.

Usually, an introductory interview with the client may tentatively surface some of these criteria, but in most cases, these explorative sessions will likely lead toward more detailed investigative procedures for diagnostic clarity, followed by an appropriate treatment strategy.

In this article, due to privacy issues, I shall only review some of the symptomatology as interviews and treatment unfolded with a few of my previous clientele. Pseudonyms have been used for names.

The commencement of my first identified case of dissociative identity disorder (DID) was rather uneventful as the client’s initial presenting issues were constant occurrences of violent partner relational tensions and recurrent fainting spells. She was on medication for schizophrenia, an anxiety disorder, depression, insomnia, high blood pressure, and diabetes.

At the second session, this 60+ years old lady suddenly induced a trance state that alerted my immediate suspicion as to how involved the case was going to be. Conversations with that personality state tended to be in the third person, while the individual had no memory of what had transpired after being brought back to consciousness.

This meant that the person was not co-conscious with at least the first alter that surfaced. Eventually, she had over 20 alters.

In another case, the young lady, Jane, had been in supportive treatment for over two years for schizophrenia and an anxiety disorder. In one of these sessions, she lowered her head, and with her hand, reassembled her hair to cover her face. Then, one of her alters instantaneously surfaced, speaking in a childlike voice, and calling herself by a different name.

She announced that she had been observing the treatment sessions all this time and is now ready to trust me. Jane had no recollection of this conversation with her alter when she came out of her trance state.

The young man seated before me was polite, and apparently, self-controlled. It was an initial interview for his dysthymia treatment, a persistent depressive disorder. We were exploring his childhood background, and I casually requested some information on his relationship with his father.

He looked sideways, tilted his head to one side, and immediately jumped out of his chair, screamed at me, waving his arms threateningly. Taken aback, I sought to calm him. John had no memory of the altercation.

She was in her mid-thirties, referred by her aunt, with whom she was staying with. She noticed that her niece, Mary, would be sitting by herself staring into the air for hours at a stretch. Once or twice a week, after midnight, she got into her aunt’s car and drove around for an hour or two.

On a couple of occasions, her aunt caught Mary returning to the house after her driving trips, walking right past her, ignoring her, despite her name being called. Mary had no recollection of her fugue state; nor where she had driven to or for how long she was away from the house.

A dissociative fugue is a temporary state where a person has amnesia and ends up walking or travelling to an unexpected place. People with this symptom can't remember who they are or details about their past.

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Coram Deo — before the face of God. This blog reflects on Scripture, world events, science, music, psychology, and the human mind — always through the lens of Christian faith. All of life is lived before the face of God.