Electroconvulsive therapy in an adolescent with dissociative identity disorder and depression: a case report

Background: Dissociative identity disorder (DID) is a psychiatric condition characterized by the existence of at least two distinct identities. This disorder often serves as a defense mechanism, a response to severe childhood trauma, aimed at protecting the individual from overwhelming emotions or experiences. There is no specific targeted treatment for DID at present. Objective: The purpose of this report is to explore the safety and efficacy of electroconvulsive therapy (ECT) in combination with pharmacological treatment for the treatment of concomitant depression in an adolescent female with DID, and to provide new clinical ideas and empirical evidence for similar cases. Case summary: A 15-year-old adolescent female presented with three distinct personality states, accompanied by hallucinations, negative thoughts, and self-harming behaviors. She was diagnosed with dissociative identity disorder and depression according to DSM-5 criteria. Following combined ECT and medication treatment, the patient's disparate personalities were integrated, and depressive symptoms were alleviated. During ECT administration, no significant adverse reactions occurred beyond mild headaches and transient memory impairment. Conclusion: For adolescent patients with DID comorbid with depression who are at high risk of suicide, ECT combined with pharmacological treatment may be considered an effective and relatively safe treatment strategy in emergency situations. It is likely that the combined use of ECT, medication and psychotherapy has led to an improvement in the patient's condition.