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Dissociative Identity Disorder - Definition, sypmptoms, DSM5 - great article

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Felicity Lee
Felicity Lee

Dissociative Identity Disorder - Definition, sypmptoms, DSM5 - great article

Post by felicity on 4/1/2016, 9:56 pm

Dissociative Identity Disorder - Definition, sypmptoms, DSM5 - great article

Key Facts


Dissociative Identity Disorder used to be called Multiple Personality Disorder(MPD), but was always classified as a dissociative disorder; not a personality disorder. [3][5][6]

Only around 6% of people with DID make their diagnosis obvious on an ongoing basis (R. P. Kluft, 2009). [1]

Dissociative Identity Disorder is not rare, but relatively common, affecting around 1-3% of the population [1].

Most people with DID have a mix of dissociative and posttraumatic symptoms, as well as non-trauma related symptoms.[2]

Amnesia in people with DID can take many different forms, including amnesia for significant events in the past OR for events in everyday life.

Amnesia is not limited to traumatic or stressful events. [4]:293

Read more: http://traumadissociation.com/dissociativeidentitydisorder




DSM-5 Diagnostic Criteria
The newest guide used in psychiatry to diagnose mental disorders is the DSM-5, released by the APA in 2013.[3] It gives the following diagnostic criteria for Dissociative Identity Disorder:

Code 300.14

  • "A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
  • B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
  • C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.
  • E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures)." [3]:292

Understanding the DSM criteria for DID
The key characteristic of Dissociative Identity Disorder is the presence of at least two distinct personality states, (or in some cultures, an experience of "possession"); amnesia is the next most important characteristic.[3]:292 The alternate personality states are often referred to as "alters" or alternate identities,[4]:193 although many other terms may be used including Apparently Normal Part of the personality (ANP), and Emotional Part of the personality (EP).[1] Alters are only overt (obvious) in a small minority of people with DID in clinical situations. A change introduced in the DSM-5 is that it is possible to diagnose DID without directly observing the alternate personality states by identifying two clusters of symptoms, described in the DSM-5 as:

  1. Sudden alterations or discontinuities in sense of self and sense of agency (Criteria A),
  2. and recurrent dissociative amnesias (Criteria B).[3]:292


Sense of self and Sense of agency - Criterion A (Alters)
A discontinuity in a person's sense of self can affect any part of someone's functioning. For example, involves a person feeling or behaving in a way that is out of character for them. Attitudes, outlooks and personal preferences like preferred foods or clothes may change sudden and inexplicably.
Discontinuity in a person's sense of agency means not feeling in control of, or as if you 'own' your feelings, thoughts or actions. For example, going from feeling that their thoughts, feelings and actions belong to themselves, to experiencing thoughts, feelings or actions that feel as if they are 'not mine' or belong to someone else. This is not the delusional belief that they belong to an outside person, it is the perception that they do not they do not 'own' their own speech, thoughts, and/or behavior.
Recurrent Amnesia: Criterion B
Many different types of amnesia can occur.[3]:293 If no recurrent gaps in memory for the past or prescent occur but all other criteria are met then a diagnosis of Other Specified Dissociative Disorder Presentation 1 is given.[3]:292
Healthy Multiplicity
Healthy multiplicity is achieved when a person has multiple senses of identity, but does not have clinically significant distress or impairment as a result of their dissociative identities. A person who meets all the diagnostic criteria for Dissociative Identity Disorder except Criteria C (distress or impaired life) may be referred to as a healthy multiple, and does not have any dissociative disorder since all of them require distress or impaired functioning.
ICD Diagnostic Criteria
The last edition of the International Classification of Diseases, the diagnostic guide published by the World Health Organization is the ICD-10, published in 1992.[2] The draft ICD-11 beta criteria for Dissociative Identity Disorder classifies it as a Mixed Dissociative Disorder, and proposes this definition:
ICD 11 draft - Dissociative Identity Disorder
Code 7B35
"Dissociative identity disorder is characterized by the presence of two or more distinct, nonintegrated or incompletely integrated subsystems of the personality (dissociative identities), each of which exhibits a distinct pattern of experiencing, interpreting, and relating to itself, others, and the world. At least two dissociative identities are capable of functioning in daily life, recurrently take executive control of the individual’s consciousness and functioning and include a substantial set of sensations, affects, thoughts, memories, and behaviours. The symptoms are not consistent with a recognized neurological disorder or other health condition. The disturbance is sufficiently severe to cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning."[6]

Alternative names:

  • Multiple Personality
  • Multiple Personality Disorder

Last updated July 2015.

Differences between the ICD-10 and Draft ICD-11 for DID
Several significant changes have been made, including recognizing each alter identity/dissociative part of the personality as a "subsystem of the personality" rather than a complete personality. It also recognizes that some alters may be partially integrated with each other, for example co-consciousness (sharing memory and/or feelings in the present). The name has changed from Multiple Personality, and it has been given greater prominence.
ICD 10 Diagnostic Criteria
Code F44.81
In the World Health Organization's ICD diagnostic manual, Dissociative Identity Disorder is still referred to as Multiple Personality, and classified as one of several Other dissociative [conversion] disorders within code F44.8. The diagnostic criteria are:

  • "A. The existence of two or more distinct personalities within the individual, only one being evident at a time.
  • B. Each personality has its own memories, preferences and behaviour patterns, and at some time (and recurrently) takes full control of the individuals behaviour.
  • C. Inability to recall important personal information, too extensive to be explained by ordinary forgetfulness.
  • D. Not due to organic mental disorders (F0) (e.g. in epileptic disorders) or psychoactive substance-related disorders (F1) (e.g. intoxication or withdrawal).
  • E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures)."[5]:123

Diagnostic Tests and Interviews
The Dissociative Experiences Scale is a self-assessment screening tool (a questionnaire)that is useful for identifying people who experience a high degree of dissociation. A definite diagnosis should only be made by an qualified clinician. This can be done using a clinical interview based on the Dissociative Experiences Scale, or by using one of the two clinical interviews developed for Dissociative Disorders: [1]:126-127[11]:21, [12], [14]

  • Dissociative Disorders Interview Schedule (DDIS), developed by Dr Colin A. Ross et al.[13] This uses some observation from a trained clinician, and is a structured interview.
  • Structured Clinical Interview for Dissociative Disorders - Revised (SCID-D), is regarded as the gold-standard diagnostic tool for Dissociative Identity Disorder. [15]:102 It is a semi-structured clinical interview that uses observation from a trained clinician. It was developed primarily by Dr Marlene Steinberg and can accurately assess all Dissociative Disorders.[12], [14]

Another self-report tool, the Multidimensional Inventory of Dissociation (MID; Dell, 2006a), also exists.[1]:126, [15] This ignores normal experiences of dissociation, and assesses only pathological dissociation.[15] It is only available to clinicians and uses an Excel-based scoring system. It can reliably diagnose Dissociative Identity Disorder and Other Specified Dissociative Disorder.[15]
Treatment
The Adult Treatment Guidelines were first produced over 20 years ago, they were developed by expert consensus and guided by large-scale clinical research. The current Adult version, from 2011, is free to download from the International Society for the Study of Trauma and Dissociation.[7] The treatment guidelines for Dissociative Identity Disorder also cover similar forms of Dissociative Disorder Not Otherwise Specified (DDNOS), which is now known as Other Specified Dissociative Disorder. [1]

Research shows that treatment based on the treatment guidelines, which focuses primarily on outpatient psychotherapy, improves symptoms, increases functioning and reduce the rates of hospitalization.[7], [9]:169 Poor outcomes were found when treatment did not follow the guidelines, for example treatment which did not directly engage alter identities and seek to reduce amnesia,[9]:169 or when treatment was focused on "memory recovery". [9]:180 Harm was far more likely to occur when DID was not treated at all. [9]:169 Treating Dissociative Identity Disorder did not only consistently improve dissociative symptoms, it also improved patients' general distress and depression.[9]:175
Psychotherapy
Psychotherapy (talking therapy) is the primary method of treatment, and has the most evidence-based research showing significant improvements with psychotherapy which adheres to the treatment guidelines. No specific type of psychotherapy is recommended. [7], [9] Psychotherapy for Dissociatve Identity Disorder follows the basic principles of general psychotherapy[7] with additional of techniques which address dissociative symptoms, for example guidance on working with alters. Treating Dissociative Identity Disorder is not primarily based around uncovering trauma memories or trauma exposure techniques. A recent study that compared experts in the treatment of Dissociative Disorders to community clinicans found that experts spent more time on techniques for the containment of trauma memories than uncovering them.[8]:4 Experts also spent more time on grounding and safety interventions.[8]:4

The goal of treatment is integrated functioning, which means a workable form of integration or harmony among identities.[1]
Integrating Alters is not essential
Some people mistakenly believe that the goal is to have a single identity rather than different separate alter identities, this is known as final fusion. This is a goal for some people, but resolution is more common, this is a co-operative arrangement between the identities.
See also: Healthy Multiplicity

Dissociative Identity Disorder treatment - integration, fusion or a co-operative arrangement



Medication and DID

Although psychotropic (psychiatric) medication is not a primary treatment for complex dissociative disorders, most DID patients do take some form of medication. This typically targets the comorbid conditions, including PTSD, mood disorders (e.g., depression), and any obsessive-compulsive symptoms.[1] The use of anti-depressants is particularly common. People with DID or other complex posttraumatic conditions may only partially respond to medication, in DID there is the further complication of potential amnesia for whether other alters have refused to take medication or taken too much. The DID treatment guidelines for adults state that alters may report different responses to the same medication, possibly due to physiological differences, physical symptoms which have a psychological cause (somatoform symptoms), and/or the alters' experience of separateness.[1]

References

   International Society for the Study of Trauma and Dissociation. (2011). Guidelines For Treating Dissociative Identity Disorder In Adults, Third Revision: Summary Version. Journal of Trauma & Dissociation,12(2), 188-212. DOI: 10.1080/15299732.2011.537248.
   World Health Organization. (2014). Classification of Diseases. Retrieved November 16, 2014, from http://www.who.int/classifications/icd/revision/en/
   American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association. ISBN 0890425558.
   Black, Donald W. (2014) (coauthors: Grant, Jon E.). DSM-5 Guidebook: The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Pub. ISBN 9781585624652.
   World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research. Retrieved November 17, 2014, from http://www.who.int/classifications/icd/en/GRNBOOK.pdf
   World Health Organization. (November 15, 2014). ICD-11 Beta Draft (Joint Linearization for Mortality and Morbidity Statistics).
   International Society for the Study of Trauma and Dissociation. Adults Treatment Guidelines. Retrieved November 17, 2014, from http://www.isst-d.org/default.asp?contentID=49
   Myrick, A. C., Chasson, G. S., Lanius, R. A., Leventhal, B., & Brand, B. L. (2014). Treatment of Complex Dissociative Disorders: A Comparison of Interventions Reported by Community Therapists Versus those Recommended by Experts. Journal of Trauma & Dissociation, (16)1:51-67 doi:10.1080/15299732.2014.949020
   Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2014). Dispelling myths about dissociative identity disorder treatment: An empirically based approach. Psychiatry, 77(2), 169-189
   Carlson, E.B. & Putnam, F.W. (1993). An update on the Dissociative Experience Scale. Dissociation 6(1), p. 16-27. Note: Dissociative Experiences Scale-II included in Appendix.
   Bernstein, E.M. & Putnam, F.W. (1986). Development, reliability and validity of a dissociation scale. Journal of Nervous & Mental Diseases. 174 p.727-735. Note: Dissociative Experiences Scale-II included in Appendix but with Q25 missing.
   Ross, C.A., Heber, S., Norton, G.R., Anderson, D., Anderson, G. & Barchet, P. (1989). The Dissociative Disorders Interview Schedule: A structured interview. Dissociation, 2(3). p.169-189.
   Steinberg M. (1994). Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R). Washington, DC, American Psychiatric Press. ISBN 088048562.
   Steinberg M. (1994). Interviewers Guide to the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) (Revised). Washington, DC, American Psychiatric Press. ISBN 1585623490.
   Dell, P. F. (2006). The Multidimensional Inventory of Dissociation (MID): A comprehensive measure of pathological dissociation. Journal of Trauma & Dissociation, 7(2), 77-106 doi: 10.1300/j229v07n02_06 PMID: 16769667

Cite this page
Dissociative Identity Disorder. (Apr 01, 2016). Traumadissociation.com, Retrieved Apr 1, 2016 from http://traumadissociation.com/dissociativeidentitydisorder.

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