“The American Psychiatric Association Publishing Textbook of Psychiatry, 7th Edition [2019]”: Its mental status exam will miss multiple personality

This textbook, published by the American Psychiatric Association, has a chapter on Dissociative Disorders, which includes Dissociative Identity Disorder (Multiple Personality Disorder). But I am addressing the textbook’s first chapter, The Psychiatric Interview and Mental Status Examination, which is the textbook’s basic approach to making all psychiatric diagnoses.

The mental status examination includes an evaluation of memory. According to chapter one, it “screens for three types of memory dysfunction. Immediate recall…Recent or short-term memory…Long-term memory…Many patients with dementia will retain long-term memory, whereas patients with a dissociative disorder often present with clinically relevant memory gaps…” (p. 26).

It is saying that you should think of memory in the three traditional categories of immediate, short-term, and long-term, and that you should make sure to assess every patient for these types of memory. In the course of making that assessment, and in conducting the general interview, you may note a discrepancy characteristic of dementia (short-term worse than long-term). And if a patient “presents” with memory gaps, you should think of dissociative disorders like multiple personality.

When the textbook says that dissociative disorder patients “often present” with memory gaps, the implication is that memory gaps would be part of the patient’s “presenting problem” (the reason they came to see a psychiatrist) and/or it would be fairly obvious in the general interview.

Neither of those assumptions is true. You have to think of memory as having four categories: immediate, short, long, and gaps. And you have to explicitly ask patients (and people who know them) if they have memory gaps. Otherwise, you may never know, and never suspect that the patient has a dissociative disorder like multiple personality.

For previous discussions, search “memory gaps” and “mental status.”