Dissociative Identity Disorder 297
flashbacks. Individuals with dissociative iden tity disorder experience these symptoms as
caused by alternate identities, do not have  delusional explanations for the phenomena,
and often describe the symptoms in a personified way (e.g., “I feel like someone else wants
to cry with my eyes”). Persecutory and derogato ry internal voices in dissociative identity
disorder associated with depressive symptoms  may be misdiagnosed as major depression
with psychotic features. Chaotic identity change and acute intrusions that disrupt thought
processes may be distinguished from brief psychotic disorder by the predominance of dis-
sociative symptoms and amnesia for the episode,  and diagnostic evaluation after cessation
of the crisis can help confirm the diagnosis. 
Substance/medication-induced disorders. Symptoms associated with the physiological
effects of a substance can be distinguished from dissociative identity disorder if the sub-
stance in question is judged to be et iologically related to the disturbance.
Personality disorders. Individuals with dissociative identity disorder often present identi-
ties that appear to encapsulat e a variety of severe personality disorder features, suggesting a
differential diagnosis of personality disorder, especially of the borderline type. Importantly,
however, the individual’s longitudinal variabi lity in personality style (due to inconsistency
among identities) differs from the pervasive an d persistent dysfunctio n in affect management
and interpersonal relationships typical of those with personality disorders.
Conversion disorder (functional neurological symptom disorder). This disorder may be
distinguished from dissociative identity disord er by the absence of an identity disruption
characterized by two or more distinct personality states or an experience of possession.
Dissociative amnesia in conver sion disorder is more  limited and circumscribed (e.g., am-
nesia for a non-epileptic seizure).