On average a multiple will be in the mental health system for 7 years prior to diagnosis and during this time may receive several varying diagnosis’s. They often include:
Temporal lobe epilepsy’
Dissociation is more common in patients with temporal lobe epilepsy than in any other neurologic disorder. The clinician should refer patients with dissociative symptoms for a thorough neurologic workup to rule out the presence of temporal lobe epilepsy or other organic processes. The standard EEG is of little help in distinguishing MPD from temporal lobe epilepsy because a high rate of nonspecific abnormalities has been detected in patients with MPD, most commonly bilateral temporal lobe slowing.
The differentiation between dissociation identity disorder and schizophrenia can be made along several lines.
Patients with schizophrenia hear voices emanating from the external world, whereas patients with dissociation identity disorder hear voices originating from within the individual’s own head.
Patients with schizophrenia may experience visual hallucinations, although they are less well formed than those observed with certain other brain disorders. Patients with MPD occasionally experience hypnagogic phenomena.
Poor reality testing is observed with schizophrenia, whereas patients with MPD have essentially intact reality testing.
Tangential or loose associations accompanied by inappropriate affect are commonly observed with schizophrenia. Patients with dissociation identity disorder may have circumstantial association with appropriate affect.
Borderline personality disorder
Borderline personality disorder has been diagnosed in 70% of a sample of 33 patients with dissociative disorder and in 23% of 70 patients with dissociative disorder. Putnam acknowledged that a large number of his cases resembled Briquet syndrome or somatization disorder, but, like other investigators, he proposed that once the diagnostic criteria for MPD are satisfied, MPD should be considered the superordinate diagnosis because working with the alternates can provide a therapeutic device that cannot be used in the unified individual.
Malingering is said to be an important differential diagnosis in times when an obvious gain may result from mental health intervention. Malingering is the deliberate and fraudulent production of false and exaggerated symptoms to deceive observers for secondary gain that is recognizable with an understanding of the individual’s circumstances.
Dissociative amnesic disorder
MPD may prove difficult to distinguish from other dissociative amnesic disorders. With other dissociative amnesic disorders, behavior may be complex, but recovery is often complete, recurrences are less common, and the onset of amnesic spells may be intimately related to stressful events or to ingestion or intoxication.