Abstracts
Résumé
Nous décrivons la trajectoire d’une femme de 24 ans connue pour un trouble de la personnalité limite (TPL) et une histoire traumatique complexe, qui présente des crises dissociatives importantes. L’évaluation initiale comprenant un entretien psychiatrique, l’utilisation d’échelles (PCL-5, CAPS-5) et la récolte d’informations collatérales permet d’identifier un Trouble de stress post-traumatique (TSPT) complexe comorbide ainsi qu’un trouble dissociatif de l’identité (TDI) et un TPL ne rencontrant plus les pleins critères diagnostiques. Le traitement consiste en une approche psychiatrique et psychothérapeutique intégrée selon le modèle TCD-TSPT. Après un suivi d’un peu plus d’un an et 45 séances de thérapie, la patiente est considérée en rémission clinique du TSPT, alors que les symptômes dissociatifs attribuables au TDI persistent, mais sont d’intensité moindre. Ce cas illustre que la réponse à la TCD-TSPT peut être favorable chez les patients ayant un TDI comorbide. Le suivi à un an post-thérapie met en lumière une persistance des crises dissociatives et un maintien de la rémission clinique du TSPT. La patiente partage sa perspective par rapport à son expérience en thérapie. Il s’agit à notre connaissance du premier cas rapporté des résultats à un an post-thérapie d’un traitement par l’approche TCD-TSPT chez une personne avec la comorbidité TSPT complexe et TDI.
Mots-clés :
- dissociation,
- traitement centré sur le trauma,
- cas clinique,
- trouble de personnalité limite,
- trouble dissociatif d’identité
Abstract
We describe the trajectory of a 24-year-old woman with a history of borderline personality disorder (BPD) and complex trauma who presented with significant dissociative episodes. The initial assessment—including a psychiatric interview, the use of standardized measures (PCL-5, CAPS-5), and collateral information gathering—identified complex post-traumatic-stress disorder (PTSD) comorbid with dissociative identity disorder (DIID) and incomplete diagnostic criteria for BPD. Treatment consisted of an integrated psychiatric and psychotherapeutic approach based on the DBT-PTSD model. After just over one year of follow-up and 45 therapy sessions, the patient was in clinical remission from PTSD, while dissociative episodes attributable to DID persisted at a lower intensity. This case illustrates that response to DBT-PTSD may be favorable in patients with comorbid DID. The one-year follow-up highlights the persistence of dissociative episodes alongside sustained clinical remission of PTSD. The patient also shares her perspective on her therapeutic experience. This is, to our knowledge, the first reported case of the results of DBT-PTSD on a person with both complex PTSD and DID, at one year of follow-up after finishing therapy.
Keywords:
- dissociation,
- trauma-focused treatment,
- case report borderline personality disorder,
- dissociative identity disorder
Appendices
Bibliographie
- Ahern, J., O’Connor, L. et Fortune, D. G. (2025). Navigating usage of complex PTSD in adult mental health services : A scoping review. Psychological Trauma.10.1037/tra0002061 Google Scholar Search this bibliographic reference on Google Scholar
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5e éd., texte révisé ; DSM-5-TR). American Psychiatric Publishing.10.1176/appi.books.9780890425787 Google Scholar Search this bibliographic reference on Google Scholar
- Bachrach, N. et Huntjens, R. J. C. (2025). Recent evidence-based developments in the treatment of dissociative identity disorder. Frontiers in Psychiatry, 16, 1650164.10.3389/fpsyt.2025.1650164 Google Scholar Search this bibliographic reference on Google Scholar
- Bachrach, N., Rijkeboer, M. M., Arntz, A. et Huntjens, R. J. C. (2023). Schema therapy for dissociative identity disorder : A case report. Frontiers in Psychiatry, 14.10.3389/fpsyt.2023.1151872 Google Scholar Search this bibliographic reference on Google Scholar
- Baekkelund, H., Ulvenes, P., Boon-Langelaan, S. et Arnevik, E. A. (2022). Group treatment for complex dissociative disorders. BMC Psychiatry, 22, 387.10.1186/s12888-022-03970-8 Google Scholar Search this bibliographic reference on Google Scholar
- Barnicot, K. et Crawford, M. (2018). Posttraumatic stress disorder in patients with borderline personality disorder. Journal of Traumatic Stress, 31(6), 899-908.10.1002/jts.22340 Google Scholar Search this bibliographic reference on Google Scholar
- Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K. et Domino, J. L. (2015). The PTSD Checklist for DSM-5 (PCL-5). Journal of Traumatic Stress, 28(6), 489-498.10.1002/jts.22059 Google Scholar Search this bibliographic reference on Google Scholar
- Bohus, M., et al. (2020). Dialectical behavior therapy for PTSD. JAMA Psychiatry, 77(12), 1235-1245.10.1001/jamapsychiatry.2020.2148 Google Scholar Search this bibliographic reference on Google Scholar
- Brand, B. L., et al. (2016). Six myths about dissociative identity disorder. Harvard Review of Psychiatry, 24(4), 257-270.10.1097/HRP.0000000000000100 Google Scholar Search this bibliographic reference on Google Scholar
- Brogan, K., et al. (2020). Lifestyle interventions and DID. Advances in Mind-Body Medicine, 34(3), 4-10.Google Scholar Search this bibliographic reference on Google Scholar
- Chien, W. T. et Fung, H. W. (2022). Challenges in diagnosis and treatment of dissociative disorders. Alpha Psychiatry, 23(2), 45-46.10.5152/alphapsychiatry.2022.0001 Google Scholar Search this bibliographic reference on Google Scholar
- di Marco, S., et al. (2025). Knowledge and perceptions of DID. L’Encéphale, 51(2), 133-140.10.1016/j.encep.2024.02.003 Google Scholar Search this bibliographic reference on Google Scholar
- Fast, I. (1974). Multiple identities in borderline personality organization. British Journal of Medical Psychology, 47(4), 291-300.10.1111/j.2044-8341.1974.tb02293.x Google Scholar Search this bibliographic reference on Google Scholar
- Ford, J. D. et Courtois, C. A. (2021). Complex PTSD and BPD. Borderline Personality Disorder and Emotion Dysregulation, 8, 16.10.1186/s40479-021-00155-9 Google Scholar Search this bibliographic reference on Google Scholar
- Fung, H. W., et al. (2023). Betrayal trauma and dissociation. Journal of Interpersonal Violence, 38, NP1630–NP1653.10.1177/08862605221090568 Google Scholar Search this bibliographic reference on Google Scholar
- Ganslev, C. A., et al. (2020). Psychosocial interventions for dissociative disorders. Cochrane Database.10.1002/14651858.CD005331.pub3 Google Scholar Search this bibliographic reference on Google Scholar
- Gagnier, J. J., et al. (2013). CARE guidelines. Journal of Clinical Epidemiology, 67(1), 46-51.10.1016/j.jclinepi.2013.08.003 Google Scholar Search this bibliographic reference on Google Scholar
- Harned, M. S., et al. (2018). Functional outcomes in BPD and PTSD. Behaviour Research and Therapy, 103, 67-76.10.1016/j.brat.2018.02.002 Google Scholar Search this bibliographic reference on Google Scholar
- Krause-Utz, A., et al. (2021). Dissociation in BPD. Current Psychiatry Reports, 23, 37.10.1007/s11920-021-01246-8 Google Scholar Search this bibliographic reference on Google Scholar
- Laddis, A., et al. (2017). Dissociation in DID and BPD. Journal of Trauma & Dissociation, 18(2), 139-173.10.1080/15299732.2016.1194358 Google Scholar Search this bibliographic reference on Google Scholar
- Lim, E. C. N. et Lim, C. E. D. (2025). Diagnostic odyssey of DID. Cureus, 17(6), e86278.Google Scholar Search this bibliographic reference on Google Scholar
- Lynn, S. J., et al. (2019). Dissociation and its disorders. Clinical Psychology Review, 73, 101755.10.1016/j.cpr.2019.101755 Google Scholar Search this bibliographic reference on Google Scholar
- Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C. et Bohus, M. (2022). Complex post-traumatic stress disorder. The Lancet, 400(10345), 60-72. https://doi.org/10.1016/S0140-6736(22)00821-2 10.1016/S0140-6736(22)00821-2 Google Scholar Search this bibliographic reference on Google Scholar
- Martins, H. A. L., et al. (2022). Case report DID and BPD. Frontiers in Psychiatry, 13, 662290.10.3389/fpsyt.2022.662290 Google Scholar Search this bibliographic reference on Google Scholar
- Reisinger, B. A. A. et Gleaves, D. H. (2022). Social stigma of DID. Journal of Nervous and Mental Disease.Google Scholar Search this bibliographic reference on Google Scholar
- Ross, C. A., et al. (2014). DID and BPD co-occurrence. Journal of Trauma & Dissociation, 15(1), 79-90.10.1080/15299732.2013.834861 Google Scholar Search this bibliographic reference on Google Scholar
- Schreiber, F. R. (1973). Sybil. Warner Books.Google Scholar Search this bibliographic reference on Google Scholar
- Scognamiglio, C., et al. (2024). Childhood trauma and dissociation. Frontiers in Psychology, 15, 1332914.10.3389/fpsyg.2024.1332914 Google Scholar Search this bibliographic reference on Google Scholar
- Storebø, O. J., et al. (2020). Psychological therapies for BPD. Cochrane Database, CD012955.10.1002/14651858.CD012955.pub2 Google Scholar Search this bibliographic reference on Google Scholar
- van Minnen, A. et Tibben, M. (2021). CBT for PTSD and DID. Journal of Behavior Therapy and Experimental Psychiatry.Google Scholar Search this bibliographic reference on Google Scholar
- Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., Keane, T. M. et Marx, B. P. (2018). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) : Development and initial psychometric evaluation in military veterans. Psychological assessment, 30(3), 383-395. https://doi.org/10.1037/pas0000486 10.1037/pas0000486 Google Scholar Search this bibliographic reference on Google Scholar
- World Health Organization. (2019). International classification of diseases (11e éd.).Google Scholar Search this bibliographic reference on Google Scholar