{"id":988,"date":"2013-10-22T18:01:52","date_gmt":"2013-10-22T18:01:52","guid":{"rendered":"https:\/\/skepticink.com\/gps\/?p=988"},"modified":"2013-10-21T18:55:46","modified_gmt":"2013-10-21T18:55:46","slug":"dissociative-identity-disorder-in-the-dsm-5","status":"publish","type":"post","link":"https:\/\/skepticink.com\/gps\/2013\/10\/22\/dissociative-identity-disorder-in-the-dsm-5\/","title":{"rendered":"Dissociative Identity Disorder in the DSM-5"},"content":{"rendered":"

This post is part of a series of guest posts on GPS by the graduate students in my\u00a0Psychopathology<\/a>\u00a0course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare three 1,000ish word posts on a particular class of mental disorders, with one of those focusing on changes made from the DSM-IV to the DSM-5.<\/em><\/p>\n

______________________________________________<\/p>\n

Dissociative Identity Disorder in the DSM-5\u00a0<\/em>by Kelley R. Bailey<\/strong><\/p>\n

\"\"With the new Diagnostic Statical Manual of Mental Disorders<\/a> (fifth edition, released in May 2013) comes changes in several categories.\u00a0 My job is to explain the changes that occur under the category of Dissociative Identity Disorder (DID).\u00a0 The diagnosis had four criterion specifiers in the DSM-IV but in the DSM-5 there are now five criteria.\u00a0 Two criteria out of the DSM-IV are completely gone and two new ones have been added to the 5th edition.\u00a0 So, if you are following me mathematically we have three general criterions that have remained the same, but with each of these three the DSM-5 has broadened the definition.\u00a0 The three that remain the same are:<\/p>\n

1. Two or more distinct personality states are experienced in the individual.<\/strong><\/p>\n

The DSM-5 broadened the description and added that the personality state is one way of viewing the alter personality or that it could be an \u201cexperience of possession.\u201d \u00a0Either of these two states, according to the DSM-5 (but not IV), \u201cinvolves 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.\u00a0 These signs and symptoms may be observed by others or reported by the individual.<\/a>\u201d \u00a0By referring to \u2018experience of possession\u2019 this new definition encompasses DSM-IV’s\u00a0Trance and Possession Disorder<\/a>\u00a0and makes it more globally useful.<\/p>\n

So now, according to this broader definition, in criterion A the person diagnosed with DID can report their own symptoms of transition from one personality state to another along with others who may also report they have observed the transition.\u00a0 The thought behind this broader definition<\/a> is that it will help to decrease the use of Dissociative Disorder Not Otherwise Specified.<\/p>\n

2. Gaps in recall or the person is unable to recall important personal information, and this inability is too severe to be attributed to mere ordinary forgetfulness.<\/strong><\/p>\n

The DSM-5 broadens the definition to say the person is unable recall important personal information and\/or traumatic events that are inconsistent with ordinary forgetting. \u00a0It used to be the inability to recall only traumatic events, now the criterion includes events not necessarily traumatic.<\/p>\n

3.\u00a0 These disturbances are not an outcome of substance abuse or general medical condition. \u00a0<\/strong><\/p>\n

The DSM 5 further explains the symptoms of DID as being \u201cnot attributable to the direct physiological effects of substances (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or another medical condition (e.g., complex partial seizures)<\/a>.\u201d\u00a0 Now we have a differentiation between completely drunk and blacking out or wild and crazy behavior while being intoxicated. (Not sure this was needed, but apparently the writers of the DSM thought so, either way that\u2019s cleared up.)<\/p>\n

Taken out<\/i> of the new definition was the DSM-IV criterion B, which stated \u201cthese distinct identities take control over the behavior recurrently.”\u00a0Added to the DSM-V definition are criteria C and D.<\/p>\n

    \n
  1. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.<\/li>\n
  2. The disturbance is not a normal part of a broadly accepted cultural or religious practice.\u00a0 (Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play).<\/li>\n<\/ol>\n

    In other words they\u2019re saying “Hey, if you\u2019re good with a possession or your culture accepts this type of behavior and it doesn’t interfere with your job, family, or other important areas of life then we are good with it too.” \u00a0This helps to delineate between those who are distressed over their multiple personalities and those who are not.<\/p>\n

    \"\"<\/a>It appears some of the changes in language <\/a>also helps to clarify some somatic symptoms often seen in DID.\u00a0 This is beneficial for several reasons, as depending on the somatic symptom there could be cause for a different medical diagnosis and therefore, different treatment.\u00a0 It is often the case that those who do have DID also have conversion symptoms (experiencing physical distress with no biological or medical reason for them).\u00a0 These are generally directly related to their DID and call for other treatment.\u00a0 The language used in the new DSM will help facilitate these demarcations in-house, culturally, and globally.<\/p>\n

    The chart below (adapted from Durand & Barlow, 2013<\/a>) is a breakdown of the changes from DSM-IV to DSM-5 in a succinct form.<\/p>\n\n\n\n\n\n\n\n\n\n\n
    Diagnostic Criteria for Dissociative Identity Disorder<\/b><\/td>\n<\/tr>\n
    MAJOR CHANGES:\u00a0<\/b><\/p>\n
      \n
    • DSM-5 notes that symptoms of Dissociative Identity Disorder may either be reported by the individual or observed by others.<\/li>\n
    • DSM-IV Criterion B (at least two of the person\u2019s identity states routinely take control) has been removed.<\/li>\n
    • DSM-5 Criterion C is new (distress or impairment).<\/li>\n
    • DSM-5 Criterion D is new (distinction from cultural or religious practices).<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    Diagnostic Criterion<\/b><\/td>\nDSM-5\u00a0<\/b><\/td>\nHighlights of changes from DSM-IV to DSM-5<\/b><\/td>\n<\/tr>\n
    Criterion A\u00a0<\/b>Preoccupation with somatic symptoms<\/i><\/td>\nDisruption 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><\/td>\n\n
      \n
    • Changed wording.<\/li>\n
    • Added note that the disturbance may be described as an experience of possession. This change was made to make the criteria more broadly applicable across cultures.<\/li>\n
    • Expanded upon the ways in which individual personality states differ from each other.<\/li>\n
    • Added note that symptoms may be either reported by the patient or observed by others.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    Criterion B<\/b>Forgetting\u00a0<\/i><\/td>\nRecurrent gaps in the recall of everyday events,<\/b> important personal information, and\/or traumatic events <\/b>that are inconsistent with ordinary forgetting.<\/td>\n\n
      \n
    • Previously listed under DSM-IV Criterion C.<\/li>\n<\/ul>\n

       <\/p>\n

        \n
      • Noted that forgetting may occur for everyday events or traumatic events in addition to personal information.<\/li>\n<\/ul>\n

         <\/p>\n

          \n
        • Changed wording.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    Criterion C\u00a0<\/b>Distress or Impairment<\/i><\/td>\nThe symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.<\/b><\/td>\n\n
      \n
    • This is a new criterion in DSM-5.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    Criterion D<\/b>Distinction from cultural or religious practices<\/i><\/td>\nThe disturbance is not a normal part of a broadly accepted cultural or religious practice.<\/b> Note:<\/i> In children, the symptoms are not attributable to imaginary playmates or other fantasy play.<\/td>\n\n
      \n
    • This is a new criterion of DSM-5.<\/li>\n<\/ul>\n

       <\/p>\n

        \n
      • The distinction from imaginary play was\u00a0 previously listed in DSM-IV Criterion D.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    Criterion E\u00a0<\/b>Distinction from other conditions<\/i><\/td>\nThe 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).<\/td>\n\n
      \n
    • Previously listed under DSM-IV Criterion D.<\/li>\n<\/ul>\n

       <\/p>\n

        \n
      • Changed wording.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

         <\/p>\n","protected":false},"excerpt":{"rendered":"

        In which one of my students examines the changes that took place from DSM-IV to DSM-5 with the diagnosis of Dissociative Identify Disorder (formerly called Multiple Personality Disorder).<\/p>\n","protected":false},"author":25,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[29,12,52],"tags":[276,275,264,81,274,273,265],"class_list":["post-988","post","type-post","status-publish","format-standard","hentry","category-mental-health","category-psychology","category-teaching","tag-changes","tag-diagnostic-critiera","tag-dissociative-identify-disorder","tag-dsm","tag-dsm-5","tag-dsm-iv","tag-multiple-personality-disorder"],"_links":{"self":[{"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/posts\/988","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/users\/25"}],"replies":[{"embeddable":true,"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/comments?post=988"}],"version-history":[{"count":0,"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/posts\/988\/revisions"}],"wp:attachment":[{"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/media?parent=988"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/categories?post=988"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/tags?post=988"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}