Simulated Presentations of Dissociative Identity Disorder in Adolescence: A Case Report and Clinical Reflections

Adolescents with trauma histories may present with dissociative features resembling dissociative identity disorder (DID) yet diverging from formal diagnostic criteria. This case report describes a 17-year-old female with five distinct alters and a background of sexual abuse, bullying, and punitive parenting. Treated with Janet’s phase-oriented model across 45 sessions in 8 months, she demonstrated marked improvement in mood, reduced self-harming behavior, and decreased disruption from alters while maintaining functional engagement. The presentation was conceptualized descriptively as self-simulated DID, characterized by deliberate switching, intact trauma recall and lack of external incentives, distinguishing it from both genuine DID and malingering. This case spotlights the importance of clinician expertise in differential diagnosis, the utility of phase-oriented treatment, and systemic barriers, particularly ongoing family dynamics, as critical challenges to sustained recovery, reinforcing the value of family-focused interventions.