Dissociative identity disorder (DID) in clinical practice - what you don't see may hurt you.

Objectives: To identify problems that interfere with the recognition, diagnosis and management of people with dissociative identity disorder (DID) presenting to psychiatric outpatient and inpatient services and suggest solutions. Method: Problems and suggested solutions associated with clinical presentations and management of people with DID are outlined with references to relevant literature. Results: Problems in the recognition and management of DID are described. These lead to delays in diagnosis and costly, inappropriate management, destructive to services, staff and patients alike. Problems include lack of understanding and experience and scepticism about the disorder, resulting in failure to provide appropriate treatment. Some suggestions to improve recognition and management are included. Conclusion: Better recognition, diagnosis and management of DID will lead to better and more cost effective outcomes.