Dissociative Disorders

Question 1

What are the criteria for Dissociative Identity Disorder?

Answer 1

A. Disruption of identity characterized by two or more distance personality states that involve marked discontinuity in sense of self, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. Could be observed by others or reported by the individual.

B. Recurrent gaps in recall of everyday events, important personal information, and/or traumatic events inconsistent with ordinary forgetting

C. Symptoms cause clinically sig distress

D. Not a normal part of accepted cultural or religious practice

E. Symptom are not attributable to the physiological effects of a substance or other medical condition

Question 2

Differences between DID and MDD are:

Answer 2

• People with DID are often depressed and symptoms may appear to meet criteria for a MDE
• Other specified depressive disorder in individuals with DID often has an important feature: the conditions fluctuate because they are experienced in some identity states but not in others.

Question 3

Differential between DID and Bipolar Disorders?

Answer 3

• Individuals with DID are often misdiagnosed with bipolar disorder
• Rapid shifts in mood in DID (within minutes or hours) is in contrast to slower mood shifts in individuals with bipolar disorder
• DID elevated or depressed mood may be seen in other identities and

Question 4

Difference between DID and PTSD?

Answer 4

• Some individuals have both PTSD and DID
• Crucial to differentiate between both
• Differential dx requires clinician to establish presence or absence of dissociative symptoms not characteristic of a trauma disorder
• PTSD dissociative symptoms that ALSO occur DID
  
  • amnesia for some aspects of trauma
  • dissociative flashbacks
  • symptoms of intrusion and avoidance, negative alterations in cognition and mood, and hyperarousal
• DID symptoms NOT SEEN in PTSD
  
  • Amnesias for many everyday events
  • dissociative flashbacks that may be followed by amnesia
  • disruptive intrusion (unrelated to traumatic material) by dissociative identity states into the individual’s sense of self and agency
  • infrequent, full-blown changes among different identity states

Question 5

Differentiating DID from psychotic disorders:

Answer 5

• DID may be confused with schizophrenia
• Personified internal voices of DID may be mistaken for hallucination
• Individuals with DID may report visual, tactile, olfactory, etc. hallucinations that are usually related to posttraumatic factors
• Persecutory and derogatory internal voices in DID associated with depressive symptoms may be misdiagnosed as MDD with psychotic features.
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