Underwriting considerations for dissociative disorders.

OBJECTIVE Dissociative identity disorder (DID) has been diagnosed more frequently and is under greater scrutiny. Because of the number of comorbid conditions, the underwriting risks must be evaluated to determine morbidity and mortality implications. BACKGROUND The number of diagnosed cases of DID has increased in recent years. The diagnosis often coexists with other diagnoses such as bipolar disorder, major depression, post-traumatic stress disorder, anxiety disorder, somatization, personality disorders, and psychotic disorder. A high incidence of substance abuse and eating disorders is found in the population diagnosed with DID. METHODS AND RESULTS A query of disability claim experience with DID indicated that these claims tended to reach the maximum duration for mental/nervous benefits despite case management and return to work activities. CONCLUSIONS The DID psychiatric population is a complex group with mental disorders that place them in a group likely to use maximum disability benefits and who would pose increased life underwriting risk. In addition, the literature indicates a high excess risk for early mortality and excess health care expenses compared to the normal population.