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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., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Institutional Review Board of Keieikai Yashio Hospital issued approval #29-1. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sakae et al.)