Other specified dissociative disorder

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The final overt difference is that individuals with dissociative identity disorder rarely know it due to the dissociative boundaries around the distinct parts of the personalityEvery individual has a personality that is composed of many diverse, fragmentary and generally illusory images of [[Personality|self]]. (see multiples) <ref name=Noricks2011/>The DSM-IV uses the term identity in its definition of dissociation. (see identity) <ref name=Dell2009/>{{Rp|127}}, [1] [2] but with other specified dissociative disorder the symptoms are usually so overwhelming that they are hard for the individual and others to ignore. [2]

Etiology

"Other specified dissociative disorder" OSDD is a disorder of trauma induced anywhere from infancy to adulthood. In contrast, dissociative identity disorder must begin in infancy prior to any significant integration of personality states. Both disorders have many other factors that contribute to their etiologyThe study of the cause of a disorder or disease. In the case of dissociative identity disorder, early and severe childhood trauma, especially abuse is considered to be the cause. <ref name=ISSTD.org/> {{See also| Etiology}}. [1] [2]

DSMPublished by the American Psychiatric Association as the standard classification of mental disorders used by US mental health professionals. It consists of diagnostic classification, the diagnostic criteria sets, and descriptive text. The DSM-II listed multiple personality disorder as a symptom of hysterical neurosis, dissociative type. The DSM-III (1980) moved Multiple Personality Disorder from a symptom to its own disorder. The DSM-IV changed the name to dissociative identity disorder (1994) and the DSM-5 (May 2013) updated the listing to current standards. <ref name=DSMIV/> <ref name=DSM5/> <ref name=Dell2009/>{{Rp|384}}-5 Diagnostic Criteria for Other Specified Dissociative Disorder

This disorder broadly replaced Dissociative Disorder Not Otherwise Specified from the older DSM-IV. This diagnosis can only be given if there are "symptoms characteristic of a dissociative disorder" that cause clinically significant distress" and/or "impaired functioning in social, occupational, or other significant areas of life. In addition, the full criteria for another dissociative disorder must not be met. [3]:306-307 The clinician must record (specify) a reason for this giving diagnosis. If none can be specified then a diagnosis of Unspecified Dissociative Disorder is appropriate instead.

The four example presentations included in the DSM-5 are:

  1. Chronic and recurrent syndromes of mixed dissociative symptoms. This category includes identity disturbance association with less than marked discontinuities in sense of selfNormal sense of self is experienced as alterations in consciousness, but the sense of self remains stable and consistent. In individuals with a Dissociative disorder the sense of self alternates and is inconsistent across time and experience. <ref name=Dell2009/>{{Rp|160}} There is no unified sense of self. and agency, or alterations of identityDefined as "objective behaviors that are manifestations of the assumption of different identities or ego states"<ref name=Steinberg1994/>{{Rp|14}} within DID, also known as "switching". The structured clinical interview for the dissociative disorders and other diagnostic tools assess identity alteration. {{See also| Identity alteration}} {{See also| Diagnosis}} or episodes of possession in an individual who reports no dissociative amnesia.
  2. Identity disturbance due to prolonged and intense coercive persuasion Individuals who have been subjected to intense coercive persuasion may present with prolonged changes in, or conscious questions of their identity.
  3. Acute dissociative reactions to stressful events these can last between a few hours and a month and may include a variety of dissociative symptoms such as micro-amnesias, analgesia (inability to feel pain), paralysis and depersonalization
  4. Dissociative trance"periods of absence-like staring and unresponsiveness; well documented in severely dissociative people for over 100 years"<ref name=Dell2009/>{{Rp|229}} characterized by an acute narrowing or complete loss of awareness of immediate surroundings that manifest as profound unresponsiveness or insensitivity to environmental stimuli. May may be accompanied by minor stereotyped behaviors of which the individual is unaware and/or that he or she cannot control, as well as transient paralysis or loss of consciousness. The dissociative trance is not a normal part of a broadly accepted collective cultural or religious practice.

Temporary dissociative states

That third example presentation,, referring to "acute dissociative reactions" in the DSM-5 for other specified dissociative disorder speak of a temporary state only. In medical terminology, "acute" refers to having immediate consequences but a shorter duration, and "chronic" refers to occurring over a long period of time. [3]:306-308:322 Similarly, the trauma diagnosis of Acute stress disorder occurs over a maximum of a month.

OSDD presentation 1 compared with Dissociative Identity DisorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder, which was from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading. No one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}

The first example presentation is "chronic and recurrent syndromes of mixed dissociative symptoms",, which includes identity disturbance. This form of the disorder is most similar to Dissociative Identity Disorder. Two forms of this presentation are given within the DSM-5; firstly, identity disturbance with "less marked discontinuities in sense of self and agency" (less distinct personality states), and secondly "alterations of identity or episodes of possession" without amnesiaMemory loss. {{See also| amnesia}}. The former of these is well researched and explained clearly within the model of Structural dissociation, as explained below.

Understanding OSDD: Structural DissociationStructural dissociation (SD) is one of the three accepted etiological ideas for the etiology of dissociative identity disorder. <ref name=HauntedSelf/> <ref name=Dell2009/>{{Rp|158-165}} It also explains other specified dissociative disorder, dissociative forms of borderline personality disorder, and dissociative posttraumatic stress disorder {{See also| Structural dissociation}}Structural dissociation of the personality is a theory that describes the effect of trauma on the personality. It applies to PTSD, complex PTSD, other specified dissociative disorder and dissociative identity disorder.

This section refers to only the form of OSDD mostly commonly confused with Dissociative Identity Disorder, this is the form described at the start of the chronic and mixed dissociative symptoms presentation. Individuals with dissociative identity disorder describe many different symptoms than those with other specified dissociative disorder. [1] [4] In dissociative identity disorder it's rare the individual even knows they have a disorder due to the significant barriers that separate the distinct states from one another. In other specified dissociative disorder almost the exact opposite is true. Those individuals are overwhelmed with emotion, pain and life in general.

One distinct personality statePersonality state - Many terms are used that have the same meaning including: parts, selves, part of the Self, subselves, selves, parts of the personality, subpersonalities, sides, internal Self-states, identities, states, ego states, part of the mind, and entity. The personality is an agglomeration of many personality states. <ref name=Noricks2011/>{{Rp|1}} and two or more less than distinct personality states

The two complex dissociative disorders listed in the DSM-5 are markedly different from each other. The most basic difference is that dissociative identity disorder (DIDDissociative identity disorder is a disorder of mental states, where a individual switches from one distinct state to another distinct state, which distinguished it from OSDD/DDNOS, BPD and PTSD. <ref name=Dell2009/>{{Rp|557-570,487-494,471-486}} {{See also| Dissociative Identity Disorder}}) will always have two or more "distinct parts of the personality", while other specified dissociative disorder has only one [1] [4] [2] which has been shown repeatedly on fMRIA type of neuroimaging. Neuroimaging is an approach that allows researchers to view areas of the brain that become active during behavioral events such as emotion, perception and cognition. It is part of the science of in psychophysiology.<ref name=Andreassi2010/> scans. [5] [6] The first DSM-5 criteria for other specified dissociative disorder expresses this fact as a state "includes identity disturbances associated with less-than-marked discontinuities in sense of self and agency."

Child-like dissociative parts are usually the less than distinct personality states

Both complex dissociative disorders have two or more less than distinct states and more often than not these states are full of emotion and they are child-like. [1] [7] [4]

Chemical, neurological and physical makeup of personality states and dissociative boundaries

The chemical, neurological and physical makeup of the states and the boundaries around them is inherently different. [6]

Elaboration of personality states

The less than distinct parts in other specified dissociative disorder are usually less elaborate than in dissociative identity disorder, [8] [9]:337-366 [4] [10] [2] If a less than distinct part is worked with a great deal then it can mature, but that still does not change it's chemical and neurological makeup. It is still a less than distinct state.

AmnesiaMemory loss. {{See also| amnesia}} is present between personality states in OSDD

A throughout understanding of the DSM-5 criteria, and clinical training is essential before attempting to diagnose anyone with a complex dissociative disorder. The DSM is not an explanation of a mental disorderThe DSM-5 psychiatric manual defines this as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expected or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above."<ref name=DSM5Deskref/>{{Rp|20}}. Other Specified Dissociative Disorder can only be diagnosed when an individual does not the full criteria for DID. In contract, amnesia between distinct states is looked for when diagnosing dissociative identity disorder because it's the only mental disorder than has distinct states and therefore only this disorder can have amnesia between it's distinct states.

"Amnesia, which is a loss of memory"Memory is not a static thing, but an active set of processes." <ref name=Siegel/>{{Rp|51}} "Our earliest experiences shape not only what we remember, but also how we remember and how we shape the narrative of our lives. Memory can be seen as the way the mind encodes elements of experience into various forms of representation. As a child develops, the mind begins to create a sense of continuity across time, linking past experiences with present perceptions and anticipations of the future." <ref name=Siegel/>{{Rp|11}}, is a symptom of many different trauma and/or dissociative disorder, including PTSD, Dissociative Fugue, Dissociative Disorder Not Otherwise Specified and Dissociative Identity Disorder. Amnesia can affect"a person's present emotional responsiveness, which can be inferred from facial expressions" including both the degree and range of expressive behavior. This can also be shown in tone of voice, hand and body movements. <ref name=Sadock2008/>{{Rp| 6}} both implicit and explicit memory(Facts, events and autobiographical consciousness). Explicit Memory is the second layer of encoded memory to be laid down. Both factual and autobiographical memory develop after 18 months of age. <ref name=SiegelCD/> The narrative process is one way that the mind attempts to integrate."As a child develops, the mind begins to create a sense of continuity across time, linking past experiences with present perceptions and anticipations of the future. Within these representa­tional processes, generalizations or mental models of the self (see self) and the Self with others are created; these form an essential scaffold for the minds growing interactions with the world." <ref name=Siegel/>{{Rp|11}} It is late memory - present beginning in the first year of life.■ Semantic : Factual memory. Initial development by one or two years of age.■ Autobiographical : Collections of episodic memory. Progressive development with onset after second year of life.■ Requires conscious awareness for encoding and having the subjective sense of recollection (and, if autobiographical, of self and time).■ Focal attention required for encoding.■ Hippocampal processing required for storage and initial retrieval. Cortical consolidation makes selected events a part of permanent memory and independent of hippocampal involvement for retrieval. <ref name=Siegel/>{{Rp|57}}." [6]

Note that amnesia is not necessarily present in other forms of Other Specified Dissociative Disorder.

Related project

For more information see our other project site on dissociative identity disorder.

References

  1. ^ a b c d e Dorahy, Martin; van der Hart, Onno (2014). DSM-5’s PTSD with Dissociative Symptoms: Challenges and Future Directions. Journal of Trauma and Dissociation. (doi:10.1080/15299732.2014.908806)
  2. ^ a b c d e Vanderhart, Onno (2006) (coauthors: Nijenhuis, Ellert; Steele, Kathy). The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. New York:Norton.ISBN 978-0393704013.
  3. ^ a b DSM5, APA (2013). Diagnostic and Statistical Manual of Mental Disorders. ISBN 978-0890425558.
  4. ^ a b c d Nijenhuis, Ellert; van der Hart, Onno (2011). Dissociation in Trauma: A New Definition and Comparison with Previous Formulations. Journal of Trauma & Dissociation, volume 12, issue 4, 2011. (doi:10.1080/15299732.2011.570592)
  5. ^ Schlumpf, YR; Reinders, AATS, Nijenhuis, ERS, Luechinger, R, van Osch, MJP, et al. (2014). Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study. PLoS ONE, volume 9, issue 6, 2014. (doi:10.1371/journal.pone.0098795)
  6. ^ a b c Lanius, Ulrich (2014) (coauthors: Sandra L. Paulsen, Frank M. Corrigan). Neurobiology and Treatment of Traumatic Dissociation: Towards an Embodied Self. New York:Springer Publishing Company.ISBN 10: 0826106315.
  7. ^ Fisher, Sebern (2014). Neurofeedback in the Treatment of Developmental Trauma: Calming the Fear-Driven Brain. Norton.ISBN 978-0393707861.
  8. ^ Chu, James A. (2011). Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders. Hoboken, N.J.:John Wiley & Sons.ISBN 0470768746.
  9. ^ Dell, Paul (2009) (coauthors: Barlow, MR, Beere, DB, Bianchi, I, Blizard, RA, Bluhm, RL, Braude, SE, Bremner, JD, Bromberg, PM, Brown, LS, Bryan, RA, Butler, LD, Cardena, E, Carlson, EA, Carlson, E, Dalenbert, C, Dallam, S,Dell, PF, den Boer, JA, Dorahy, MJ, Dutra, L, Evans, C, Fairbank, JA, Farrelly, S, Ford, JA, Frankel, AS, Freyd, JJ, Ginzburg, K, Gold, SN, Howell, EF, Jager-Hyman, S, Jessop, MA, Kletter, H, Kluft, RP, Koopman, C, Lanius, RA, Lawson, D, Liotti, G, Lyons-Ruth, K, Moskowitz, A, Nijenhuis, ERS, Nurcombe, B, O'Neil, JA, Ozturk, E, Pain, C, Paulson, KL, Read, J, Ross, CA, Rudegeair, T, Saltzman, K, Sar, V, Schore, AN, Scott, JG, Seibel, SL, Siegel, DJ, Silbert, JL, Silvern, L, Simeon, D, Somer, E, Sroufe, LA, Steele, K, Stern, DB, Terhune, DB, van der Hart, O, van Duijl, Marjolein, Waelde, LC, Weiner, LA, Williams, O, Yates, TM, Zanarini, MC.). Dissociation and the Dissociative Disorders: DSM-V and Beyond. New York, NY:Routledge.ISBN 978-0415957854.
  10. ^ Siegel, Daniel (2012). The Developing Mind, Second Edition: How Relationships and the Brain Interact to Shape Who We Are. Guilford press.ISBN 978-1462503902.