Psychological Assessment of Patients
with Dissociative Identity Disorder
Bethany L. Brand, PhD
a,
*
, Judith G. Armstrong, PhD
b
,
Richard J. Loewenstein, MD
c,d
a
Towson University, 8000 York Road, Towson, MD 21252, USA
b
University of Southern California, Los Angeles, CA, USA
c
Sheppard Pratt Health Systems, Baltimore, MD, USA
d
Department of Psychiatry, University of Maryland
School of Medicine, Baltimore, MD, USA
This article discusses how psychologic assessment can assist in the diag-
nosis of dissociative identity disorder (DID) and in planning treatment for
patients who are dissociative. A battery of tests that can assess the extent
of dissociation is outlined, the research on dissociation on various psycho-
logic tests is reviewed, and new Rorschach data on severely dissociative pa-
tients that can be useful in planning treatment is presented.
Diagnosing DID is a complex process and requires assessors to have
knowledge of the assessment and treatment literature on posttraumatic
stress disorder (PTSD), dissociative disorders, and personality disorders.
The literature provides excellent reviews of assessment of posttraumatic
states [1–4]. In addition to the complexity of assessing PTSD itself, assess-
ment of DID requires the patient to reveal what is often a private, hidden
world to a powerful stranger [5]. These challenges may be further com-
pounded because many of the measures, particularly the projective tests,
can open up emotional wounds and stir potentially painful memories, trig-
gering dissociation and switching among dissociated states during the test-
ing itself [5,6]. Clinicians must develop a collaborative relationship with
patients who have DID before beginning the assessment to make the expe-
rience therapeutic rather than retraumatizing. A collaborative relationship
Psychiatr Clin N Am 29 (2006) 145–168will also help yield meaningful, rather than defended, test results.
* Corresponding author.
E-mail address: bbrand@towson.edu (B.L. Brand).
0193-953X/06/$ - see front matter
2005 Elsevier Inc. All rights reserved.
doi:10.1016/j.psc.2005.10.014 psych.theclinics.com

The assessment battery
People who have PTSD can present in testing as flooded with intense af-
fect or emotionally numb and constricted [1,2,4]. DID is even more variable
and complex, partially because PTSD is almost always a comorbid condi-
tion, and partially because of the complexity found in patients who have se-
vere dissociative psychopathologies [7–9]. No specific recipe for ‘‘smoking
out’’ DID exists, although a consistent finding across tests and researchers
is that many individuals who have DID experience a wide variety of severe
symptoms. Researchers believe this is because of disturbances in many dif-
ferent dimensions of functioning, including problems with affect tolerance
(eg, severe anxiety and mood and state instability); dissociativity; interper-
sonal difficulties; impaired self functions such as an inability to self-soothe;
disturbances of body image and somatization; and posttraumatic cognitive
distortions [10]. In addition, individuals who have DID often experience
various comorbid conditions, including mood disorders; PTSD and other
anxiety disorders; eating disorders; substance abuse disorders; and personal-
ity disorders [7,11]. These fluctuating comorbid conditions, compounded by
the shifting personality states found in DID, ensure that no one set of signs
will be found for all individuals who have DID. Armstrong [12] suggests
that the ability to dissociate during sustained childhood maltreatment al-
lows for an atypical developmental pathway, a pathway in which contradic-
tions and complexities can coexist. This pathway helps the person preserve
intellectual skills and emotions, such as humor, hope, and joy, and maintain
the capacity for attachment despite the abuse. The following review of the
literature shows that the dissociative developmental pathway results in per-
sonality strengths and weaknesses that are important considerations in plan-
ning treatment.
The authors typically use a battery of tests tailored to the individual, de-
signed to capture developmental strengths and weaknesses. Assessment usu-
ally begins with a phase of rapport-building and a thorough psychosocial
history, including a trauma history. This step is followed by a cognitive
test, a structured and objective personality test with validity scales (eg, the
Minnesota Multiphasic Personality Inventory [MMPI]-2), projective per-
sonality tests, a self-report measure of dissociation, and a structured inter-
view for dissociation. The authors then review the findings regarding
dissociation for each of these types of tests, with emphasis placed on those
considered most useful. However, limited research exists on DID patients on
many measures.
Cognitive assessment
Cognitive testing is useful because it often provides important informa-
146 BRAND et altion about differential diagnosis. Intelligence tests such as the Wechsler
Adult Intelligence Scale-III (WAIS-III) can clarify if a patient who hears
voices is psychotic, or if their psychotic-like phenomena are actually of