Dissociative Identity Disorder Cotreated With Zinc and L-carnosine: A Case Report

Abstract

Little is known about the effectiveness of pharmacotherapy in dissociative identity disorder (DID). Zinc is essential for proper brain function. Its deficiency can lead to mental health symptoms, possibly contributing to dissociation. L-carnosine is an endogenous dipeptide with a neuroprotective effect. We report on the case of a 30-year-old woman with DID and comorbid bipolar I disorder who had zinc deficiency and was successfully cotreated with zinc and L-carnosine. She displayed three alternate identities and exhibited signs of emotional/mood instability, flashbacks, binge eating, and self-harm. The patient also displayed several physical symptoms of zinc deficiency. She did not respond to aripiprazole (0.75 mg/d) and clonazepam (1.5 mg/d), but responded marginally to five months of zinc (50 mg/d) supplementation. Simultaneous administration of L-carnosine, gradually increased from 0.5 g/d to 2 g/d over four months, markedly improved her symptoms. Five months after adding 2 g/d L-carnosine, the patient's pronounced alternate identities that people around her could notice no longer appeared. However, the identities that were not noticeable to the people remained. They disappeared completely two years later and reappeared only when zinc and L-carnosine were discontinued during the subsequent three-year follow-up. The patient's severity scores for dissociation and depression were reduced. Furthermore, signs of emotional/mood instability, flashbacks, binge eating, and self-harm improved. The physical symptoms of zinc deficiency eventually resolved. Further investigation of cotreatment with zinc and L-carnosine for DID and related conditions, particularly the contribution of zinc deficiency to dissociation, is necessary.

Keywords: binge eating; bipolar disorder; dissociation; dissociative identity disorder; flashback; glutamate; l-carnosine; self-harm; zinc; zinc deficiency.

Figure 1. Course of treatment

Bands indicate symptom trajectory. Between 18 and 46 months of treatment, the zinc dosage was 25 mg/d. At 41 months of treatment, the patient received a farewell message from alternate identity (A), and the identity alteration was resolved. However, it recurred when zinc and L-carnosine were discontinued several times thereafter (not shown here). DES: Dissociative Experiences Scale; QIDS-SR₁₆: 16-item Quick Inventory of Depressive Symptomatology (self-report)