The Overlap of Dissociative Identity Disorder and Narcissistic Features in an Adolescent: A Case Report

Abstract

Developmental trauma is a primary etiological factor in dissociative identity disorder (DID) and may lead to misdiagnosis due to symptom overlap with other psychiatric and neurological conditions. This case report describes an adolescent male with pronounced narcissistic vulnerability. The patient’s background features an inconsistent parenting style—characterized by both overprotection and severe criticism—and significant paternal pressure to achieve academic success and embody an idealized, wise persona. Chronic exposure to these psychosocial stressors is hypothesized to have contributed to acute narcissistic rage, potentially associated with dissociative identity fragmentation. The initial clinical presentation involved functional neurological symptoms, which progressed to distinct identity states with amnesia. Treatment focused on supporting the patient’s disrupted grandiose self‐structure through an empathetic, mirroring psychotherapeutic approach. This intervention was associated with a marked reduction in dissociative symptoms. Further research is needed to clarify the complex role of narcissistic vulnerabilities in the development of dissociative identity presentations.