Diagnostic and Statistical Manual of Mental Disorders

The DSM-5 is used to aid diagnosis of mental disorders. It is published by the APA, previous editions include DSM-IV, DSM-III, DSM-II, DSM-I. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the manual used by most psychiatrists and therapists, especially in the US and UK, to aid diagnosing mental disorders. The DSM-5, was released at the American Psychiatric Association's (APA) 2013 Annual Meeting in San Francisco, CA, in May, 2013. The DSM-5 includes the following Dissociative Disorders (DD) and Trauma and stressor-related disorders. For specific diagnostic criteria see the individual mental disorder.

Dissociative Disorders

 * Dissociative Identity Disorder (DID)
 * Dissociative Amnesia (DA) with or without Dissociative Fugue
 * Depersonalization/Derealization Disorder
 * Other specified Dissociative Disorder (OSDD)
 * Unspecified Dissociative Disorder

Trauma and Stressor-Related Disorders

 * Reactive Attachment Disorder (RAD)
 * Disinhibited Social Engagement Disorder
 * Post-traumatic Stress Disorder(PTSD)
 * Acute Stress Disorder (ASD)
 * Adjustment Disorder
 * Other Specified Trauma and Stressor-Related Disorder
 * Unspecified Trauma and Stressor-Related Disorder

DSM-5 Criteria for dissociative identity disorder
Code 300.14

A The presentation of two or more distinct personality states/alters must present, and each must have their own way of being.

"'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 Amnesia is a requirement, but the DSM-5 has altered the wording to be:

"'Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.'"

Amnesia in dissociative identity disorder is understood to mean amnesia between two or more of the distinct identities; the host alter will experience "losing time" in the present another alter takes the place of the one the host alter. Rarely is the host alter aware of their time loss. Note that even though the DSM does not make it clear that they mean current [amnesia], 20% of the population who appear to not be traumatized do not remember their childhood.

C An individual must be distressed by the disorder or have an impaired ability to function in a major area of life as a result. This is described as follows: "'The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.'"

D Normal cultural or religious practice is excluded, and fantasy play in children are excluded. "The disturbance is not a normal part of a broadly accepted cultural or religious practice."

E Dissociative identity disorder cannot be diagnosed if symptoms are attributable to substance use or other medical conditions.

"'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).'" Diagnosis is normally performed by a clinically trained mental health professional through clinical evaluation, interviews with family and friends, and consideration of other ancillary material. Specially designed interviews and personality assessment tools may be used for evaluation. A diagnosis of dissociative identity disorder takes precedence over any other dissociative disorders.

The DSM-5 criteria references "experience of possession" and includes Pathological Possession Trance (PPT).

DSM-5 criteria for other specified dissociative disorder 300.15
This covers a variety of different presentation, including some symptoms similar to dissociative identity disorder but not matching the distinct criteria.

Unspecified dissociative disorder
This category is used in an emergency room setting where there is insufficient information to make a diagnosis.

DSM History
The DSM is a product of the American Psychiatric Association and it is the standard classification of mental disorders used by United States mental health professionals. It includes the diagnostic classification, the diagnostic criteria sets, and the descriptive text. The DSM I was published in 1952, the DSM II in 1968, the DSM III on 1980, the DSM-IV in 1994, and the DSM-5 was released in May 2013. An alternative diagnostic manual is the ICD-10 manual which classifies mental and physical health problems.

The DSM-II (1968) listed multiple personalities in the description of hysterical neurosis, dissociative type. It described the possible occurrence of alterations in the patient's state of consciousness or identity, and included the symptoms of "amnesia, somnambulism, fugue, and multiple personalities."

The DSM-III (1980) changed multiple personality from a symptom to it's own diagnosis and grouped the diagnosis with the other four major dissociative disorders using the term "multiple personality disorder".

The DSM-IV (1994) made more changes to this category than any other dissociative disorder, and renamed it dissociative identity disorder. The name was changed for two reasons. First, to emphasize the main problem was not a multitude of personalities, but rather a lack of a single, unified identity and an emphasis on the identities as centers of information processing. Second, the term personality is used to refer to characteristic patterns of thoughts, feelings, moods and behaviors of the whole individual, while for a patient with dissociative identity disorder, the switches between identities and behavior patterns is the personality.

It is for this reason the DSM-IV-TR referred to distinct identities or personality states instead of personalities. The diagnostic criteria also changed to indicate that while the patient may name and personalize alters, they lack an independent, objective existence. The changes also included the addition of amnesia as a symptom, which was not included in the DSM-III-R, because despite being a core symptom of the condition, patients may experience "amnesia for the amnesia" and so of course it is not reported. Amnesia was replaced when it became clear that the risk of false negative diagnoses was low because amnesia was central to dissociative identity disorder.

Despite the lengthy history of the psychopathology of dissociative disorders, and the intense study by Pierre Janet and Morton Prince in the first part of the last century, and by Jean-Martin Charcot before, dissociative disorders have had only limited research since Sigmund Freud and did not received serious attention again until after the 1980s. Prior versions of the DSM have avoided discussing the etiology (cause) of dissociative disorders in an effort to create distance from Freudian psychology. The DSM-5 is reintroducing etiology; and the development of a pathophysiologically based classification system. This has been advocated as investigation of the neuroevolution of stress-induced and fear circuitry disorders and related amygdala-driven, species-atypical fear behaviors of clinical severity in adult humans.

The DSM-IV-TR criteria for dissociative identity disorder has been criticized for failing to capture the clinical complexity of the mental disorder, and lacking usefulness in diagnosing individuals with it. For instance, it focuses on the two least frequently occurring subtle symptoms, producing a high rate of false negatives and an excessive number of OSDD diagnoses. Also it includes only two "core" symptoms of Dissociative Identity Disorder: amnesia and self-alteration, while failing to discuss hallucinations, trance-like states, somatoform, depersonalization and derealization symptoms. Arguments have been made prior to the printing of the DSM-5 to allow diagnosis through the presence of some, but not all of the characteristics of Dissociative Identity Disorder rather than the current exclusive focus on the two least common and noticeable features.

The diagnostic criteria for Dissociative Identity Disorder changed only slightly. Changes included = instead of someone who is qualified to diagnose an individual having to witness a switch of control between identities with time loss (amnesia), now the client or another person can report this. This self reporting is consistent with other psychiatric diagnoses in the DSM-5.

Dissociative disorder not otherwise specified was renamed to other specified dissociative disorder (OSSD). There are minor wording changes to the criteria for dissociative identity disorder that should result in more people being diagnosed with dissociative identity disorder rather than OSDD. Unspecified Dissociative Disorder was also introduced.

Trauma and Stressor-related Disorder changes
Posttraumatic stress disorder and acute stress disorder were moved from the anxiety disorders section to the Trauma and Stressor-related Disorders section. Changes were also made to reactive attachment disorder, including the addition of disinhibited social engagement disorder.

Other chapters listed in the DSM-5
The chapters in the DSM-5 are:
 * Neurodevelopmental Disorders including ADHD
 * Schizophrenia|Schizophrenia Spectrum and Other Psychotic Disorders
 * Bipolar disorder|Bipolar and Related Disorders
 * Major depressive disorder|Depressive Disorders
 * Anxiety Disorders
 * Obsessive-Compulsive and Related Disorders
 * Somatic Symptom Disorders
 * Eating disorders|Feeding and Eating Disorders
 * Elimination Disorders
 * Sleep-Wake Disorders
 * Sexual Dysfunctions
 * Gender Dysphoria
 * Disruptive, Impulse Control and Conduct Disorders
 * Substance Abuse|Substance Use and Addictive Disorders
 * Functional Neurological Symptom Disorder|Neurocognitive Disorders
 * Personality Disorders including borderline personality disorder
 * Paraphilic Disorders including Pedophilic Disorder
 * Other Disorders