Dissociative Disorders and DSM-5

DSM 5Since I started writing about dissociation with a plan to explain the different forms of dissociative disorders, our way of understanding them has changed. Or at least our way of characterizing them in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) has changed.

Previously, four main categories of dissociative disorders were identified in the DSM-IV-R: Dissociative Amnesia, Dissociative Fugue, Dissociative Identity Disorder, and Depersonalization Disorder. Those who did not meet all the criteria for one of those four could be diagnosed with Dissociative Disorder Not Otherwise Specified.

Changes regarding the diagnosing of dissociative disorders in the  DSM-5 include the following:

  1. Derealization is included in the name and symptom structure of what previously was called depersonalization disorder and is now called depersonalization/derealization disorder.
  2. Dissociative fugue is now a specifier of dissociative amnesia rather than a separate diagnosis.
  3. The criteria for dissociative identity disorder have been changed to indicate that symptoms of disruption of identity may be reported by the client as well as observed by the clinician, and that gaps in the recall of events may occur for everyday and not just traumatic events. Also, experiences of pathological possession in some cultures are included in the description of identity disruption.
  4. Dissociative Disorder Not Otherwise Specified is now referred to as Other Specified Dissociative Disorder
  5. A diagnosis of Unspecified Dissociative Disorder has been added.

Are you familiar with these changes? Do they make sense? Further our understanding or improve treatment? Let me know what you think!

This entry was posted in Dissociation, Psychologist, Trauma and tagged , , , . Bookmark the permalink.

9 Responses to Dissociative Disorders and DSM-5

  1. Hope says:

    My understanding is that the requirement that parts take executive control of the body from the DSM-IV-TR criteria (“B. At least two of these identities or personality states recurrently take control of the person’s behavior.”) was dropped from the DSM-V criteria. I’m a patient, not a professional, but it seems to me like this could profoundly change the diagnosis for people who have all the sx of DID except for parts taking executive control. Previously, they would’ve been diagnosed with DDNOS, but now they could be diagnosed with DID. Is that correct, or am I misinterpreting?

    • Yes, the requirement that at least two of the person’s identity states routinely take control has been removed. This, along with allowing for self report by client vs. only observation by clinician of symptoms of disruption of identity, is likely to result in some who would have been diagnosed DDNOS in the past now being diagnosed with DID.

    • Hope, it’s been rephrased rather than completely removed. It now says “Disruption of identity characterized by two or more distinct personality parts. This disruption may be observed by others, or reported by the patient.”
      http://www.dissociative-identity-disorder.org/DSM-5.html

      The problem was the criteria involved obviously observable switching in the presence of a clinician, giving how hidden DID is and the fact that about 95% of people don’t very obviously switch, it was leading to far too many misdiagnoses – people with DID were ending up in DDNOS. As well as self-report it can be reported by spouse or close friend or another professional. I think it was possibly the only mental health disorder where it had to observed rather than just believing the patient/other health staff/spouse, so its good the change brought this into line.

      The amnesia criteria was expanded a bit too – as Dr Young said it can be for everytime “time loss” as well as significant personal information.

      DDNOS (OSDD) got a few new examples and Derealization without Depersonalization was moved out of it, into the Depersonalization/Derealization disorder.
      http://dissociative-identity-disorder.net/wiki/Other_Specified_Trauma_and_Stressor-Related_Disorder

  2. Sam Ruck says:

    It’s too bad most continue to ignore the critical role the supporting family/spouse/whatever can make. My wife’s counselor took my word (via my wife) for the diagnosis, and I’ve been there every step of the way she has been healing..often seeing things no one else can see including my “wife” the host, but I’m always left out of the counseling sessions…sigh…

    • Hi Sam-

      If you read around in my blog you will see that I emphasize the importance of healthy relationships and supportive people. Every trauma survivor also has the right to their own treatment process and therapy relationship. Although support people can provide valuable roles, each survivors trauma is their own and only they get to decide how they need to heal.

      • Sam Ruck says:

        Kathleen,

        I’m sorry you feel that way. In a very real sense my wife’s trauma has become mine as it affects nearly every aspect of our 26-year marriage. Additionally attachment theory makes it clear that I am placed in a key role of the healing process as her primary adult attachment figure. And finally d.i.d. causes my wife’s decision-making process to be truncated and split among the various girls in her network. Hence, they NEED my help and feedback and involvement and even guidance in the healing process. Many of the women who visit my blog wish they had husbands/so’s likewise involved.

        Take care,

        Sam

      • Sam-

        I do indeed feel that relationships are important AND that each survivor deserves their own healing process. I can tell that you are invested in your views and I don’t expect anything I write here will change that. I am responding to you again for the benefit of other readers. I want everyone to know that they can heal whether they have a partner’s support or not. And that no matter how much loved ones can also be impacted that is not the same thing as the survivor’s lived experience. My goal is to empower clients and help them gain the inner resources to make healthy decisions about their own lives. Each survivor also gets to decide how involved they want their loved ones in that process.

        Best wishes to you and your wife.

  3. Pingback: Dissociative Identity Disorder and Amnesia | Dr. Kathleen Young: Treating Trauma in Tucson

  4. Pingback: What Causes Dissociative Identity Disorder? | Dr. Kathleen Young: Treating Trauma in Tucson

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