Meeting abstract

https://doi.org/10.24869/spsih.2026.328

When Identities Speak: The Diagnostic Dilemma Between Dissociation and Psychosis

Ena Bandov ; Clinic for Psychiatry, University Hospital Centre Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia *
Valentin Kordić ; Clinic for Psychiatry, University Hospital Centre Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia; Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
Andrijana Šantić ; Clinic for Psychiatry, University Hospital Centre Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia; Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
Filip Kralik ; Clinic for Psychiatry, University Hospital Centre Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
Luka Malenica ; Department of Psychiatry, National Memorial Hospital „Dr. Juraj Njavro“ Vukovar, Županijska 35, 32000 Vukovar, Croatia
Josipa Ivanušić Pejić ; Clinic for Psychiatry, University Hospital Centre Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
Dunja Degmečić ; Clinic for Psychiatry, University Hospital Centre Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia; Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia

* Corresponding author.

Abstract

Dissociative identity disorder and psychotic
disorders can have overlapping clinical manifestations,
which may complicate differential diagnosis.
We present the case of a young female
patient hospitalized because of episodes in which
she described the presence of different identity
states with separate names, characteristics, and
autobiographical content, accompanied by pronounced
anxiety and a decline in functioning.
In the initial clinical assessment, dissociative
symptomatology predominated, with marked
amnestic episodes and a subjective experience of
self-switching. During hospitalization, the clinical
picture changed, with more prominent negative
symptoms in the form of affective flattening,
avolition, alogia, anhedonia, and social withdrawal, along with the presence of hallucinatory experiences.
Dissociative elements remained present
but became less dominant over time compared
with psychotic symptomatology. Anamnestic
data pointed to traumatic experiences in childhood
and previously present auditory hallucinations.
In the diagnostic workup, dissociative
identity disorder, schizophrenia, schizoaffective
disorder, and borderline personality disorder with
dissociative–psychotic features were considered.
After the introduction of an antipsychotic (risperidone),
there was an improvement in mental state
with gradual fading of psychotic symptoms. At
this point, a diagnosis of unspecified psychotic
disorder was made, with a need for further follow-
up. The case highlights the importance of dynamic
assessment of psychopathology, given that
a clinical picture initially marked by dissociative
features may, over time, develop into a predominantly
psychotic syndrome. Traumatic experiences
in the history require careful assessment
of dissociative phenomena, but in themselves
do not rule out the possibility of a psychotic disorder.
Longitudinal follow-up, including assessment
of symptom quality, level of insight, degree
of functional decline, and treatment response, is
crucial for more precise diagnosis and an optimal
therapeutic approach.

Keywords

dissociation; psychotic disorder; hallucinations

Hrčak ID:

353018

URI

https://hrcak.srce.hr/353018

Publication date:

15.6.2026.

Article data in other languages: croatian

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