Dissociative Disorders

What are dissociative disorders

Disorders involving disruption or discontinuity in the normal integration of consciousness / memory / identity / emotion / perception / body representation / motor control / behavior

What disorders are included in the dissociative disorders chapter

Dissociative identity disorder / dissociative amnesia / depersonalization derealization disorder / other specified dissociative disorder / unspecified dissociative disorder

What psychological functions can dissociative symptoms disrupt

Potentially every area of psychological functioning

What are positive dissociative symptoms

Unbidden intrusions or discontinuities such as identity division / depersonalization / derealization

What are negative dissociative symptoms

Inability to access information or mental functions that are normally accessible such as amnesia

What major experiences are strongly associated with dissociative disorders

Psychological trauma / early neglect / physical abuse / sexual abuse / emotional abuse / cumulative adversity / sustained trauma / captivity or torture

Are dissociative disorders part of the trauma and stressor related disorders chapter

No / they are a separate diagnostic class but closely related to trauma related disorders

What dissociative symptoms can occur in PTSD or acute stress disorder

Amnesia / flashbacks / numbing / depersonalization / derealization

What is dissociative identity disorder or DID

Disruption of identity involving 2 or more distinct personality states plus recurrent dissociative amnesia

What is Criterion A for dissociative identity disorder

Disruption of identity involving 2 or more distinct personality states or culturally described possession experiences

What changes can accompany DID identity disruption

Changes in affect / behavior / consciousness / memory / perception / cognition / sensory motor functioning

What is sense of agency

Experience that one's thoughts / feelings / actions / body belong to and are controlled by oneself

How may sense of agency change in DID

Person may feel thoughts / emotions / speech / actions / or body are not their own or not under their control

Do distinct DID personality states have to be obvious to other people

No / switching and identity disruption are often subtle

Do DID identities need different names clothing accents or handwriting

No / dramatic differences occur only in a minority and are not required

What is Criterion B for dissociative identity disorder

Recurrent gaps in recall of everyday events / important personal information / or traumatic events beyond ordinary forgetting

Can DID amnesia involve ordinary everyday events

Yes

What are examples of everyday DID amnesia

Time loss / blackouts / not remembering conversations / finding oneself somewhere without remembering getting there / discovering possessions with no memory of obtaining them

Can DID cause loss of well learned skills or knowledge

Yes / temporary unexplained loss of abilities such as driving / cooking / work tasks / computer use may occur

What functional requirement applies to DID

Symptoms must cause clinically significant distress or impairment

What cultural exclusion applies to DID

The disturbance cannot be a normal part of a broadly accepted cultural or religious practice

What childhood exclusion applies to DID

Symptoms cannot be better explained by imaginary playmates or ordinary fantasy play

What substance and medical exclusion applies to DID

Symptoms cannot be caused by substances / medications / seizures / or another medical condition

What is possession form DID

Identity disruption experienced as if an outside spirit / person / deity / or other entity has taken control

When can possession experiences qualify as DID

When they are involuntary / unwanted / distressing / impairing / and outside accepted cultural or religious practices

Are most culturally accepted possession states DID

No

Can people with DID hear voices

Yes

How can voices present in DID

Voices may comment / argue / give commands / represent other identity states / or appear as independent thought streams

Can hallucination like experiences occur in multiple sensory modalities in DID

Yes / auditory / visual / tactile / olfactory / gustatory experiences may occur

Can DID involve depersonalization and derealization

Yes

What can stress do to DID symptoms

Stress can temporarily worsen identity disruption / amnesia / intrusions / or switching

What is a dissociative flashback in DID

Sensory reliving of a previous event as if occurring in the present often accompanied by altered identity or awareness

What common conditions co occur with DID

PTSD / depressive disorders / substance related disorders / eating disorders / OCD / personality disorder features / functional neurological symptoms

Is nonsuicidal self injury common in DID

Yes

Is suicide risk high in DID

Yes / suicidal behavior and repeated attempts are frequent

What major developmental risk factor is associated with DID

Severe repeated early life trauma particularly before about age 5 or 6

Does everyone with DID overtly switch personalities

No / most non possession presentations show subtle rather than dramatic switching

How may DID appear in children

Memory and concentration problems / attachment problems / traumatic play / unusual imaginary companions / personified mood states

How may DID appear in adolescents

Rapid behavioral changes / self destructive behavior / suicidality / irritability / externalizing behavior

How can DID be confused with bipolar disorder

Rapid changes in mood / activation / behavior may resemble bipolar mood shifts

What helps distinguish DID from bipolar disorder

DID shifts often occur within minutes or hours and involve identity changes or dissociative symptoms / bipolar episodes usually persist for days or longer

What sleep feature may help distinguish DID from bipolar disorder

DID often involves nightmares and nocturnal flashbacks rather than the classic decreased need for sleep seen in mania

How does DID differ from dissociative amnesia

DID includes identity disruption with 2 or more personality states / dissociative amnesia does not

How does DID differ from depersonalization derealization disorder

DID includes identity disruption and recurrent amnesia / depersonalization derealization disorder does not typically include either

How does DID differ from major depressive disorder

Depression does not cause dissociative identity shifts or recurrent dissociative amnesia

How does DID differ from PTSD

DID involves broader chronic identity disruption and complex everyday amnesia beyond trauma specific dissociative symptoms

Can DID and PTSD occur together

Yes / PTSD is common among people with DID

How does PTSD related amnesia usually differ from DID amnesia

PTSD amnesia usually concerns a specific trauma / DID amnesia can involve trauma plus everyday life and interpersonal events

How can DID resemble schizophrenia

Voices / thought intrusions / loss of agency / and unusual perceptions can resemble psychotic symptoms

What helps distinguish DID from schizophrenia

DID includes identity discontinuity and dissociative amnesia / schizophrenia more typically includes psychotic beliefs and other schizophrenia symptoms

How can thought intrusion differ between DID and schizophrenia

DID experiences are often felt as ego alien and frightening / schizophrenia may involve delusional explanations such as an outside force inserting thoughts

How does DID differ from borderline personality disorder

DID involves marked discontinuities in identity and recurrent amnesia / personality disorder patterns are more pervasive and persistent across time

How does DID differ from traumatic brain injury

DID involves identity discontinuity and dissociative amnesia / TBI involves neurological injury with cognitive deficits such as confusion / slowed processing / attention problems

How does DID differ from functional neurological symptom disorder

Functional neurological disorder lacks the multiple identity states or possession experiences characteristic of DID

What features can raise suspicion of feigned DID

Highly stereotyped dramatic identities / symptoms appearing mainly while observed / obvious external gain / exaggerated media based presentation

How do many genuine DID patients react to their symptoms

They may feel ashamed / overwhelmed / frightened / minimize symptoms / or conceal trauma and dissociation

What is dissociative amnesia

Inability to recall important autobiographical information beyond ordinary forgetting

What type of information is usually forgotten in dissociative amnesia

Important autobiographical information often involving traumatic or stressful experiences

What functional requirement applies to dissociative amnesia

Memory loss must cause clinically significant distress or impairment

What substance and medical conditions must be excluded before diagnosing dissociative amnesia

Alcohol or drug effects / medications / seizures / traumatic brain injury / neurological conditions

What disorders must be excluded before diagnosing dissociative amnesia

DID / PTSD / acute stress disorder / somatic symptom disorder / major or mild neurocognitive disorder

What is localized dissociative amnesia

Failure to remember events during a specific period of time

What is selective dissociative amnesia

Ability to remember some but not all events during a specific period

What is generalized dissociative amnesia

Loss of memory for most or all of one's life history and sometimes personal identity

What is systematized dissociative amnesia

Loss of memory for a particular category of autobiographical information

Which types of dissociative amnesia are most common

Localized and selective amnesia

Is generalized dissociative amnesia common

No / it is rare

Are dissociative amnesia memory problems mainly retrograde or anterograde

Mainly retrograde

What does retrograde amnesia mean

Loss of previously stored memories

What does anterograde amnesia mean

Difficulty forming or retaining new memories after onset

What is dissociative fugue

Apparently purposeful travel or bewildered wandering associated with amnesia for identity or important autobiographical information

Is dissociative fugue a separate DSM diagnosis

No / it is a specifier for dissociative amnesia

Can behavior during a dissociative fugue appear organized

Yes / travel may appear purposeful and complex

How can dissociative fugue differ from seizure related wandering

Dissociative fugue can be purposeful complex and prolonged / seizure related wandering is generally limited to seizure activity

Are people with dissociative amnesia always aware of their memory gaps

No / many minimize / rationalize / or initially fail to recognize them

What commonly precipitates generalized dissociative amnesia

Extreme trauma / combat / rape / torture / severe emotional conflict / major social displacement

Is suicide risk associated with dissociative amnesia

Yes

When may suicide risk become especially concerning in dissociative amnesia

When amnesia suddenly resolves and intolerable memories return

How does dissociative amnesia differ from substance blackout

Substance related memory loss occurs in temporal association with intoxication / dissociative amnesia occurs independently of intoxication

How does dissociative amnesia differ from neurocognitive disorder

Neurocognitive disorders involve persistent deficits in learning and cognitive functioning / dissociative amnesia primarily involves autobiographical retrieval

How does dissociative amnesia differ from TBI related amnesia

TBI involves head injury with neurological or cognitive signs / dissociative amnesia is disproportionate to injury and follows a dissociative memory pattern

Can PTSD and dissociative amnesia both be diagnosed

Yes / when memory loss extends beyond the trauma specific amnesia explained by PTSD

What is depersonalization derealization disorder

Persistent or recurrent depersonalization / derealization / or both with intact reality testing

What is depersonalization

Feeling unreal / detached from oneself / or like an outside observer of one's thoughts feelings sensations body or actions

What is derealization

Feeling detached from surroundings or experiencing the environment as unreal dreamlike foggy lifeless or visually distorted

What is the single most important reality testing rule in depersonalization derealization disorder

Reality testing remains intact

What does intact reality testing mean in depersonalization derealization disorder

Person recognizes that the feeling of unreality is an experience rather than believing reality has literally changed

What functional requirement applies to depersonalization derealization disorder

Symptoms must cause clinically significant distress or impairment

What exclusion rule applies to depersonalization derealization disorder

Symptoms cannot be caused by substances / medical conditions / or better explained by another mental disorder

Can depersonalization involve emotional numbness

Yes

Can depersonalization involve feeling robotic or automated

Yes

Can depersonalization involve an out of body sensation

Yes

Can derealization cause visual distortions

Yes / surroundings may appear flat / distorted / unusually large or small / blurry / artificial

Are transient depersonalization or derealization experiences common

Yes / brief experiences occur in many people and do not automatically indicate a disorder

What is the average age of onset of depersonalization derealization disorder

About age 16

Is first onset of depersonalization derealization disorder after age 40 common

No / it is highly unusual and should prompt medical evaluation

What factors can worsen depersonalization derealization symptoms

Stress / anxiety / depressed mood / overstimulating environments / sleep deprivation

What common psychological conditions co occur with depersonalization derealization disorder

Depression / anxiety disorders

What common precipitants can trigger depersonalization derealization disorder

Severe stress / anxiety / panic attacks / depression / illicit drug exposure

Can marijuana or hallucinogens precipitate depersonalization derealization symptoms

Yes