The more I listen to the retro CD’s the more I lean towards Vanessa having D.I.D. and Autism. Vanny being an alter and Patient 46. They’re different people so obviously they’d be separate patients. Vanessa also kind of seems to disassociate in the 3rd CD. She doesn’t remember the encrypted messages and shady stuff because Vanny is responsible for that.
Patient 46 displays sensory sensitivity (the curtains in CD 2, the flowers in CD 4), they also display a lack of awareness towards social norms (not sitting properly, not speaking when spoken to, fidgeting) which is a trait common amongst autistic individuals and children. Vanny is selective mute alter, she doesn’t speak to the therapists and hardly talks throughout the game.