L’adolescence marque le temps de profonds remaniements susceptibles d’induire des expériences de dépersonnalisation, de déréalisation dans la quête de soi, de son identité. Cette période de l’existence est aussi empreinte de fragilité amplifiée par l’étrangeté, l’inquiétude, ainsi que de suggestibilité souvent peu admise par le sujet lui-même. Par ailleurs, les cliniciens savent combien le parcours de vie de nombreux patients est émaillé par des événements traumatiques vécus durant l’enfance, tels que les maltraitances. Enfin, l’adolescence est la période où les pathologies psychiatriques de l’âge adulte commencent à apparaître et à causer une morbidité importante. Nous proposons de parcourir une vignette clinique illustrant le parcours d’un adolescent en proie aux tumultes liés au vacillement de son identité entraînant désarroi et incertitude chez les professionnels rencontrés. La situation éprouvante vécue par ce jeune et sa famille interroge, d’une part, la pertinence, le fondement même du diagnostic à ce temps de l’existence et, d’autre part, la notion de trouble dissociatif de l’identité à l’adolescence. Rappelons combien la fragmentation de l’identité varie selon les cultures et les contextes sociaux, culturels ainsi que les circonstances de vie.

To evoke the notion of dissociative identity disorder in adolescence requires a nuance so many questions arise among others on the relevance of the juxtaposition of a complex disorder fluctuating at an age group marked by transition. In other words, is it appropriate to speak of dissociation of identity or multiple personality at this specific time of existence? It should also be noted that this diagnosis is controversial both because there is no consensus on definitions such as personality or identity and because some cultures take into account the possibility of possession to explain these tables without reference to pathology.

To illustrate our point, we will draw on the situation of a young person admitted to our institutional therapy centre located in a general hospital. The structure accommodates young people aged between fourteen and twenty for six to nine months. As we have also developed, these are usually directed in the course of ambulatory and/or residential therapeutic follow-ups, after experiencing moments of crisis or decompensation. The evaluation then carried out consolidates the prospect of a medium-term stay in a psychotherapeutic centre before considering a possible reintegration into daily life and activities. This clinical case illustrating the path of a teenager in prey to the tumults of wobbling of his identity causing confusion and uncertainty in the chief of the professionals encountered. The difficult situation experienced by this young person and his family questions on the one hand the relevance, the very basis of the diagnosis at this time of existence and on the other the notion of dissociative identity disorder in adolescence.

The dissociative identity disorder meets a number of criteria, the first of which is identity disturbance characterized by several distinct personality states. Clinically, we first observe a discontinuity in the integration of consciousness, of self-meaning. Registers of affects and sensory-motor functioning (perception, representation of the body) are also concerned. There are then disturbances of the agentivity (motor control, behaviors). In some cases, non-epileptogenic seizures and other conversive manifestations may be at the forefront of these complex clinical tables. The dissociative disorder of identity is also noticed by memory failures (dissociative amnesia) concerning the recall of daily events, personal information, which do not correspond to ordinary forgetfulness. This then leads to signs of impairment of social, professional or other relational functioning. Being an interruption in the tranquility of growth, adolescence is characterized by extreme conflicting positions, changing, fluctuating that give this period of life its appearance of tumult and crisis without being able to speak of frank psychic disturbances. Differential diagnosis between teen upheaval and true pathology is a difficult task.

Consequently, we think it is important to pay attention to the diachronic and synchronic litters of what the young person in question is deploying. In order to do so, we advocate repeated clinical interviews with the patient and his or her entourage beside rigorous anamnesis. Time is an important element, the time of observation and encounter. Let us avoid precipitation without adopting an attitude of fatalism or even laxity, recalling that, for Winnicott, there is only one remedy for adolescence and only one; it is the passing time and gradual maturation processes that ultimately lead to the appearance of the adult person. Accompany a dissociative identity disorder, proven or suspected, includes the mobilization of a partnership envelope involving experienced institutional structures ready for the necessary clinical flexibility allowing continuous therapeutic adjustment.