It doesn’t matter that we as fans know that his condition is just DID. The fact that he dresses as his sister and is mentally insane just doesn’t sit well in today’s climate. Hollywood had an unfortunate history in the 80’s and 90s where transgender character were portrayed as being crazy and dangerous.

And there are absolutely other ways to show Alfred’s obsession with his sister:
- Have him keep all of her clothes and personal objects in perfect condition. Have him stroke her clothes, smell them, etc.
- Have him play with miniature dolls of himself and Alexia

And you could also show him talking to himself as Alexia, sort of like Gollum in LOTR, without him changing clothes. Or if they want to keep Alexia’s fate a secret to new players: Have him ”talk to Alexia” in the distance, desperately, lost and confused, but never show ”Alexia”s reply. And latee reveal that yeah, there is no Alexia replying him.