Psychiatric comorbidity in dissociative identity disorder: A meta-analysis
- 1King's College London
Abstract
BackgroundDissociative identity disorder (DID) is associated with frequent psychiatric comorbidity. Its complex and overlapping symptom profile can complicate recognition of both DID and co-occurring psychiatric conditions, contributing to diagnostic uncertainty. Evidence regarding psychiatric comorbidity is limited and prevalence estimates vary across studies.
AimsThis meta-analysis aimed to examine the prevalence of psychiatric comorbidities in DID and factors associated with variation in prevalence estimates.
MethodsEligible studies were identified through PubMed, Scopus, Embase, PsycINFO, and MEDLINE from 1980 to 25 April 2026 (PROSPERO, no. CRD420261335819). Studies reporting psychiatric comorbidity in adults with DID were independently screened by two reviewers. Risk of bias was assessed. Random-effects meta-analyses using logit-transformed prevalence estimates were conducted. Meta-regressions examined moderators, whilst influence and sensitivity analyses assessed robustness. Certainty was evaluated using the GRADE approach.
ResultsTwenty-four studies (N = 858) contributed to the meta-analysis across 23 psychiatric comorbidities. Among individuals with DID, posttraumatic stress disorder had the highest pooled prevalence (87.44%, 95% CI 71.79-94.96), followed by major depressive disorder (62.64%, 95% CI 33.45-84.84), and borderline personality disorder (47.05%, 95% CI 34.21-60.32). Substantial heterogeneity was noted across most estimates. Meta-regressions identified significant associations with participant characteristics, recruitment, study quality, and diagnostic method. Risk of bias and certainty of evidence were heterogenous.
ConclusionsPsychiatric comorbidity in DID is substantial and spans multiple diagnostic categories, although considerable heterogeneity and methodological variation limit confidence in prevalence estimates. Standardised diagnostic assessment, more representative sampling, and longitudinal research are needed to clarify the extent and clinical significance of comorbidity in DID.
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BibTeX
@misc{mitchell2026psychiatric,
title = {{Psychiatric comorbidity in dissociative identity disorder: A meta-analysis}},
author = {E. Mitchell and A. Kazi and A. Watson and S. Pick and D. B. Terhune},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.06.26364737},
url = {https://www.medrxiv.org/content/10.64898/2026.10.06.26364737v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Psychiatric comorbidity in dissociative identity disorder: A meta-analysis
AU - E. Mitchell
AU - A. Kazi
AU - A. Watson
AU - S. Pick
AU - D. B. Terhune
PY - 2026
DA - 2026/10/06
PB - medRxiv
DO - 10.64898/2026.10.06.26364737
UR - https://www.medrxiv.org/content/10.64898/2026.10.06.26364737v1
AB - BackgroundDissociative identity disorder (DID) is associated with frequent psychiatric comorbidity. Its complex and overlapping symptom profile can complicate recognition of both DID and co-occurring psychiatric conditions, contributing to diagnostic uncertainty. Evidence regarding psychiatric comorbidity is limited and prevalence estimates vary across studies. AimsThis meta-analysis aimed to examine the prevalence of psychiatric comorbidities in DID and factors associated with variation in prevalence estimates. MethodsEligible studies were identified through PubMed, Scopus, Embase, PsycINFO, and MEDLINE from 1980 to 25 April 2026 (PROSPERO, no. CRD420261335819). Studies reporting psychiatric comorbidity in adults with DID were independently screened by two reviewers. Risk of bias was assessed. Random-effects meta-analyses using logit-transformed prevalence estimates were conducted. Meta-regressions examined moderators, whilst influence and sensitivity analyses assessed robustness. Certainty was evaluated using the GRADE approach. ResultsTwenty-four studies (N = 858) contributed to the meta-analysis across 23 psychiatric comorbidities. Among individuals with DID, posttraumatic stress disorder had the highest pooled prevalence (87.44%, 95% CI 71.79-94.96), followed by major depressive disorder (62.64%, 95% CI 33.45-84.84), and borderline personality disorder (47.05%, 95% CI 34.21-60.32). Substantial heterogeneity was noted across most estimates. Meta-regressions identified significant associations with participant characteristics, recruitment, study quality, and diagnostic method. Risk of bias and certainty of evidence were heterogenous. ConclusionsPsychiatric comorbidity in DID is substantial and spans multiple diagnostic categories, although considerable heterogeneity and methodological variation limit confidence in prevalence estimates. Standardised diagnostic assessment, more representative sampling, and longitudinal research are needed to clarify the extent and clinical significance of comorbidity in DID.
ER -