Females with dissociative identity disorder pr edominate in adult clinical settings but not
in child clinical settings. Adult males with dissociative identity disorder may deny their
symptoms and trauma  histories, and this can lead to el evated rates of false negative di-
agnosis. Females with dissociative identity di sorder present more frequently with acute
dissociative states (e.g., flashb acks, amnesia, fugue, function al neurological [conversion]
symptoms, hallucinations, self-mutilation). Ma les commonly exhibit more criminal or vi-
olent behavior than females; among males, comm on triggers of acute dissociative states in-
clude combat, prison conditions, and physical or sexual assaults.
Suicide Risk
Over 70% of outpatients with dissociative id entity disorder have attempted suicide; mul-
tiple attempts are common, and other self-inj urious behavior is frequent. Assessment of
suicide risk may be complicated when there is amnesia for past suicid al behavior or when
the presenting identity does no t feel suicidal and is unaware that other dissociated iden-
tities do. 
Functional Consequences of 
Dissociative Identity Disorder
Impairment varies widely, from apparently minimal (e.g., in high-functioning profession-
als) to profound. Regardless of level of disability, individuals with dissociative identity
disorder commonly minimize the impact of their dissociative an d posttraumatic symp-
toms. The symptoms of higher-functioning in dividuals may impair their relational, mar-
ital, family, and parenting functions more th an their occupational and professional life
(although the latter also may be affected). With appropriate treatment, many impaired in-
dividuals show marked improvement in occupational and personal functioning. How-
ever, some remain highly impaired in most ac tivities of living. These individuals may only