Other specified dissociative disorder

From Dissociative Identity Disorder, Dissociation and Trauma Disorders
Jump to: navigation, search

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

What you are looking at in the left image is a minute section of a 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/> scan showing activity as a switch results in one distinct state (ANP) switchingFull dissociation is when an alter switches with the alter currently in executive control, resulting in amnesia for that alter. (see executive control) <ref name=Howell2011/>{{Rp|4-6}} In full dissociation, there is complete amnesia between dissociated states, which is a <ref name=Dell2009/>{{Rp|228}} criteria for a diagnosis of dissociative identity disorder in the DSM-5. {{See also| Dissociation}} with another distinct state (ANP). The images catches the leaving distinct state (ANP) before it fully exits consciousness, which is a process that is only possible in 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}}). In "other specified dissociative disorder" (OSDD) only one distinct state exists, and so obviously a switching of distinct states will never be seen on an fMRI. In both dissociative identity disorder (DID) and other specified dissociative disorder (OSDD) there will be at least two, and usually several - less than distinct states (EP) switching with each other. In posttraumatic stress disorder (PTSD) there is only one less than distinct state (EP) and only one distinct state (ANPA distinct state who performs the job of daily activities and does not hold trauma memories. Dissociative identity disorder is the only mental disorder where an individual can have two or more ANP. <ref name=HauntedSelf/> {{See also| structural dissociation}}), and both states will remain lit up until something triggers the less than distinct state (EP), and then the distinct state (ANP) is no longer visible. That triggerA reactivating stimulus in trauma disorders. A stimulus in the present which is a reminder of a part of a traumatic [[memory]], which can cause the part of an individual that hold the trauma (EP) to feel as if it is reliving past trauma experience. <ref name=Boon2011/>{{Rp|166-186}} Also known as a trauma trigger. resulted in some sort of reaction (flashbackA flashback is a reactivated traumatic memory experienced as intrusive thoughts, feelings, or images associated with past trauma, but lacking a sense of being from the past. <ref name=Siegel2012/>{{Rp|30}} It is experienced by the state referred to as the EP. {{See also | Grounding techniques}} for example) to their unprocessed memories. When an individual has posttraumatic stress disorder (PTSD), with the dissociative symptoms of depersonalization and derealization, then there is always two less than distinct states (EP), which can be identified on an fMRI scan, but both will not always be visible together. The authors of the theory of Structural Dissociation call this form of PTSD, complex-posttraumatic stress disorder (C-PTSD). Borderline personality disorder is an odd ball in this bunch because the disorder is not caused by Structural Dissociation, but after the disorder already exists, the individual with BPD can be overwhelmed by trauma memories resulting in Structural Dissociation and then they will have dissociative symptoms. On their fMRI scans we see one distinct state (ANP) and one less than distinct state (EP), but the distinct state (ANP) is the only part visible until the individual is in distress, and then the less than distinct state (EP) shows up. This state will not take over as is seen in posttraumatic stress disorder (PTSD) and so there are no flashbacks or similar symptoms, but instead are the dissociative symptoms of derealization and depersonalization. Go to links for the referenced information. [2] [3] [4] [5] [6] [7] [8]

This diagnosis is given when an individual has an identity disturbance and symptoms that causes clinically significant distress and can include impaired functioning in social, occupational, or other significant areas of life. The symptoms must not meet the full criteria for any of the other Dissociative Disorders, and are not a normal part of a broadly accepted collective cultural or religious practice. [9]:306-307 An individual only needs to fit into one of the following criteria to be given a diagnosis of other specified dissociative disorder, and a less than marked discontinuity in sense of self and agency can be a temporary state, as is reflected by criteria B, C, D, or it can stem from childhood traumaThe most fundamental effect of trauma is dissociation, so we define trauma as the event(s) that cause dissociation. <ref name=Howell2011/>{{Rp|75}} The original trauma in those with dissociative identity disorder was failure of secure attachment with a primary attachment figure in early childhood. <ref name=Howell2011/>{{Rp|83}}, as is the case in individuals that fit into criteria A. The disorder described by criteria A will continue until the individual's trauma memories are processed and personality states unify. Other specified dissociative disorder broadly replaced "dissociative disorder not otherwise specified" (DDNOS) which was included in the previous DSM.

  • A. Identity disturbance associated with "less than marked discontinuities in sense of self and agency," in which there is no overt amnesia between the states. In addition, there will be disturbing dissociative symptoms that 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}} the individual.
  • B. Identity disturbance due to prolonged and intense coercive persuasion in individuals who have been subjected to intense coercive persuasion which may present in prolonged changes in, or conscious questions of their identity. The individuals have often been victim to cult abuse"interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)" <ref name=VandenBos2007/>, terror organizations, brainwashing, thought reform, indoctrination while captive, torture, and political imprisonment. [9]:306-308:322
  • C. Acute dissociative reactions to stressful events that can last a few hours to a month, and may include a variety of dissociative symptoms, such as micro-amnesias, analgesia, paralysis and depersonalization.
  • D. 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 the immediate surroundings. There is a profound unresponsiveness or insensitivity to environmental stimuli, which may be accompanied by minor stereotyped behaviors of which the individual is unaware, but that the individual cannot control. There can also be transient paralysis or loss of consciousness that is not due to a medical condition.

A brief history and where we are today

"Criteria A" in the DSM-5 uses the terminology less than marked discontinuities in sense of self and agency, which perfectly describe what must be identified in this Dissociative Disorder to diagnosis it. [3]:1-242 Research this year has come to the point where the differences between a distinct state and a less than marked discontinuity in sense of self and agency is. This is important because in other specified dissociative disorder there is only one distinct state, which is in contrast to dissociative identity disorder where there is always two or more distinct states. This can and has been repeatedly verified using fMRI scans. The page on dissociative identity disorder offers a vignette that can be used to identify when two or more distinct states switch, which would rule out dissociative identity disorder in favor of other specified dissociative disorder. [10]

That there are distinct states and less than distinct states is not new information, but instead is buried information that was reported by Pierre Marie Félix Janet, (born May 30, 1859, in Paris, France and died February 24, 1947, Paris, France.) a French psychologistPsychologists usually have an advanced degree, most commonly in clinical psychology, and often has extensive training in research. Psychologists use psychotherapy (often referred to as "talk therapy" or just "therapy") to treat mental disorders. Some psychologists specialize in psychological testing and evaluation.<ref name=AboutPsychiatry/> and neurologist who literally understood, lectured and wrote about these concepts in his lifetime. Modern day researchers and clinicians, Ellert Nijenhuis, Onno van der Hart and Kathy Steele brought Janet's work back to the spotlight in their 2006 book, The Haunted Self, where they explain in great detail how there is one distinct state in "other specified dissociative disorder", and two or more distinct states in dissociative identity disorder, and how both very different disorders each have two or more states that can be described as less than marked discontinuities in sense of self and agency. [4]:vii-xi A distinct state is referred to as the "apparently normal part 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}}" and the "less than distinct state" is known as the "emotional part of the personality". [4]:28-43 What is now known as Structural Dissociation reports that the only disorder with two or more distinct states is dissociative identity disorder. [4]:8 In 2014, other authors found themselves in agreement and many have done their own research, and have also come to the conclusion that dissociative identity disorder has two or more distinct states and other specified dissociative disorder has only one distinct state. Not everyone shares the same terminology, and so for ease of use on this page we will use the terms distinct state and less than distinct state.

Pierre-Marie-Felix-Janet.jpg
Charles-myers.jpg
Vonderhart.png
Nijenhuis.jpg

There is 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}} in OSDD

In other specified dissociative disorder there is only one distinct state. This is the state that many with this disorder describe as their "frontA term sometimes used by those with dissociative identity disorder to refer to the alter who is either in executive control of the individual, or who has come close to the one that is in executive control. (see executive control)." It is quite interesting and acutely different from the distinct states found in dissociative identity disorder, a curiosity that appears to be partly due to their chemical, physical and neurological makeup, but there might also be other reasons they differ so much. The one distinct state in other specified dissociative disorder presents as a isolated state that appears to be highly influenced by the less than marked discontinuities in sense of self and agency, which through "passive dissociation" are "triggeredA reactivating stimulus in trauma disorders. A stimulus in the present which is a reminder of a part of a traumatic [[memory]], which can cause the part of an individual that hold the trauma (EP) to feel as if it is reliving past trauma experience. <ref name=Boon2011/>{{Rp|166-186}} Also known as a trauma trigger." to release their fears and vehement emotions onto the distinct state. In other specified dissociative disorder this is experienced in such a way that it's hard to ignore, and these people often seek out treatment, which, in contrast to those with dissociative identity disorder normally have no idea there is anything wrong with them. This is in great part to the makeup of the dissociative boundaries around the distinct states found in individuals with dissociative identity disorder.

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 (less than distinct states)

These states are often child-like and usually identify with a particular age or age range, which is unlike the states in dissociative identity disorder. [4] When the less than distinct states in other specified dissociative disorder switch with each other they experience it in two ways. The first is they know they have switched and are aware of the actions that state will carry out after switching, and the other is they have no knowledge of a switch or the actions performed by the state they switched with. These less than distinct states can also switch with the distinct state, which when its a full switch, almost always results in a lack of continuity between the two states. This means that the distinct state probably has no knowledge of the switch until the individual has done a great deal of integration work. The less than distinct states however, often do know what each of the other states is doing, but they can't interject and stop those actions.

Differences between OSDD and DID

This point has been addressed on this page, but to make it clear, 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 will always have two or more "distinct states", while other specified dissociative disorder will only ever have one, [11] [6] [4] which is a fact which has been shown repeatedly on fMRI scans. The less than distinct states contain vehement emotion and usually act child-like, [11] [12] [6] and the less than distinct states in other specified dissociative disorder are less elaborate than the less than distinct states in dissociative identity disorder. [13] [14]:337-366 [6] [5] [4] If a less than distinct state in other specified dissociative disorder is in executive controlThe state that has control of an individual at that moment has executive control, and the dissociated state most often in executive control is commonly called the host. <ref name=Boon2011/>{{Rp|27}} a great deal and appears elaborate, that still does not change its chemical and neurological makeup, and so it's still a less than distinct state. Individuals with dissociative identity disorder rarely know anything is wrong with them due to the dissociative boundaries around their distinct states, [11] [4] but in other specified dissociative disorder the symptoms can be felt as overwhelming, which is most likely because they are not bound by dissociative boundaries in the same way and of the same neurological, chemical and physical makeup that the states in dissociative identity disorder are. [4]

Symptoms

The less than distinct states in other specified dissociative disorder are almost always child-like and they are also highly aware that they are in distress. [8] [4]:73-88 The main symptom of other specified dissociative disorder is dissociation. [12] [15] [14]:447-469 [8] The individual as a whole is subject to the following symptoms: Amnesia, which is experienced differently from what individuals with dissociative identity disorder experience. In other specified dissociative disorder the amnesia is almost entirely between the one distinct state and the state it directly switches with, which is similar to posttraumatic stress disorder (PTSD) in many ways. The distinct state is often unaware when a less than distinct state is re-experiencing trauma memories and memories associated with them. In dissociative identity disorder the amnesia is highly evident between the distinct states which tend to switch throughout the day and leavess the individual with that disorder confused, but also unable to accept the switches occur. Other symptoms include voices heard, conversion"The development of symbolic physical symptoms and distortions involving the voluntary muscles or special sense organs; not under voluntary control and not explained by any physical disorder." Sadock (2008). Functional Neurological Symptom Disorder is the new name for Conversion Disorder in the DSM-5 manual, and is part of the Somatic Symptom and Other Related Disorders category. Somatization Disorder was removed during the changes, but is represented in this category. <ref name=DSM5changes/>{{Rp|11}}Conversion symptoms are most common in conversion disorder, but also seen in a variety of mental disorders." <ref name=Sadock2008/>{{Rp|23}}"Conversion disorders" is the ICD-10 category includes somatoform dissociation within dissociative disorders of movement and sensation.<ref name=Nijenhuis2001/> {{Rp|9}}{{See also| Somatoform Disorders}} symptoms, self alteration, derealization, depersonalization, flashbacks, trance, identity confusionDefined as "a feeling of uncertainty, puzzlement, or conflict about one's own identity. "<ref name=Steinberg1994/>{{Rp|13}}. The structured clinical interview for the dissociative disorders and other diagnostic tools assess identity confusion. {{See also| Identity confusion}} {{See also| Diagnosis}}, and awareness of other states. They also experience the Schneiderian first-rank symptoms that include voices arguingTwo or more voices conversing, they may be arguing. Common in both schizophrenia and dissociative identity disorder. This is a type of auditory hallucination. <ref name=Sadock2008/>{{Rp|45}} In dissociative identity disorder the voices belong to alter identities and this may extend to alters who are contending for physical control, for example involving the person feeling a force or an "other" that ties to control or change the person's actions, or feeling or hearing an angry other that tries to control the person.<ref name=Dell2009/>{{Rp|230}}, voices commentingRefers to voices commenting (in the form of a running commentary) on the person's behavior or thoughts. Common in both schizophrenia and dissociative identity disorder. This is a type of auditory hallucination. <ref name=Sadock2008/>{{Rp|45}}<ref name=Dell2009/>{{Rp|230}}, thought withdrawalThe person believes thoughts have been taken away from his/her mind. This is a symptom of schizophrenia,<ref name=Sadock2008/>{{Rp|45}} but either thought withdrawal and thought insertion are also very common in people with Dissociative Identity Disorder. <ref name=Dell2009/>{{Rp|527}}, thought insertionThe person believes that thoughts that are not his/her own thoughts have been inserted into his/her mind. <ref name=Sadock2008/>{{Rp|45}}This is a symptom of schizophrenia, but either thought withdrawal and thought insertion are also very common in people with Dissociative Identity Disorder. <ref name=Dell2009/>{{Rp|527}}, made impulsesThese impulses for action are imposed on the person and do not feel like they belong to the person, who feels like the impulses are "coming from somewhere else or someone else". In dissociative disorders this can some other part is trying to overrule the host/apparently normal part of the personality. A Schnieder first-rank symptom often present in schizophrenia but common in DID.<ref name=Dell2009/>{{Rp|231}}In schizophrenia or psychosis the impulses may be given a delusional explanation, for example naming a person or object who the impulses appear the be coming from., made feelings'Made' or intrusive feelings and emotions are unexpected surges of feeling-pain, hurt, anger, fear, shame, and so on. Often these surges of feeling are inexplicable and frankly puzzling". A Schnieder first-rank symptom often present in schizophrenia. These tend to be partially dissociated intrusions from another self-state, fairly common in "PTSD, borderline personality disorder, bipolar disorder, panic disorder and ADHD."<ref name=Dell2009/>{{Rp|231}} and made actions. Finally these individuals will struggle with auditory hallucinationsThe DSM-IV-TR psychiatric manual defined hallucinations as a "sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ. Auditory hallucinations are common both in schizophrenia and dissociative identity disorder. <ref name=Dell2009/>{{Rp|525}}Hallucinations can be auditory (voices, noises or other sounds), voices commenting on the person's behavior or thoughts, voices conversing, somatic or tactile (peculiar physical sensations), olfactory (unusual smells), visual (shapes or people that are not present). <ref name=Sadock2008/>{{Rp|45}}Visual hallucinations are the most common type of hallucination and are often in geometric forms and figures <ref name=Sadock2008/>{{Rp|127}} Illusions are similar to visual hallucinations but are based on real images or sensations. and visual hallucinations which are not psychoticA person experiencing psychosis, or a characteristic of psychosis. <ref name=Sadock2008/>{{Rp|24}}, but the symptoms imitate psychotic symptoms. [14]:228-234

Epidemiology

In a 2011 study on Dissociative Disorders, the following was reported: "These (those included in this study) clinical case series have also documented that dissociative patients report highest frequencies of childhood psychological traumaThe most fundamental effect of trauma is dissociation, so we define trauma as the event(s) that cause dissociation. <ref name=Howell2011/>{{Rp|75}} The original trauma in those with dissociative identity disorder was failure of secure attachment with a primary attachment figure in early childhood. <ref name=Howell2011/>{{Rp|83}} among all psychiatric disorders. Childhood sexual (57.1%–90.2%), emotional (57.1%), and physical (62.9%–82.4%) abuse and neglect (62.9%) are among them (2–6)." The prevalence of Dissociative Disorders for inpatient and outpatient psychiatric settings is reported to be around 10%. A study conducted in Turkey on 648 females resulting in 18.3%, and the largest group had DDNOS (DSM-IV category that has been replaced by OSDD). [16]

Etiology

Criteria A is a function of childhood trauma. Criteria B,C,D are all temporary states that result from traumatic experience that can occur any time in life. [11] [4] [17] Other specified dissociative disorder results from a combination of factors that combine to create the perfect storm with neglect only needing to be experienced within one "childhood developmental stage". [13]:208-211 [6] Other specified dissociative disorder is a disorder of trauma. In the 2014 book, "The Body Keeps The Score," Bessel van der Kolk offers an interesting view when he argues that all trauma is harmful, and that trauma is either buried or accepted. [15] Other authors maintain that only "subjective trauma" causes problems. [18] Whichever view you take, there does not seem to be any genetic factor for this disorder since anyone can, with the right circumstances, develop other specified dissociative disorder. [5]

Cause of "other specified dissociative disorder" Criteria A.
Birth to age 6 or so
The child is consistently overwhelmed.
Adults in the child's life do not sooth the child.
A secure attachment has not been formed with any adult.
Trauma memories are not being processed.
Eventually the buildup of trauma memories results in Structural Dissociation of the child's personality.
Following Structural Dissociation the child will have one distinct and two or more less than distinct states making up their personality. Their personality is no longer normal and is damaged.
Integration of what were normal ego"the notion of a being who both thinks and acts". Feeling is also a characteristics of the ego. (van der Hart & Horst (1989){{Rp|2}}) Ego states is a term sometimes used to refer to several different identities within a person with Dissociative Identity Disorder, i.e., several different dissociative parts of the personality, each with his/her own sense of "me". states is no longer possible.
The synonym TRAUMA sums up DID 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/>
  • T rauma - overwhelmed resulting in Structural Dissociation
  • R ejected - feeling unloved, unwanted and alone
  • A ge - neglected between birth and prior to 6-years old
  • U nhappy - highly traumatized and overwhelmed
  • M emories - trauma memories are unprocessed
  • A ttachment - inability to form an attachment with an adult

Treatment

Medication does not aid in the treatment of other specified dissociative disorder. [19] Therapeutic work offers support and encouragement while the patient changes the way their mind and brainThe brain is a approximately a 1300-gram organ containing 100-billion neurons. It is the control center of the central nervous system. The mind and brain are not the same thing. (see mind) The mind emerges out of interactions between the brain and relationships during the earliest years of childhood. Different child-parent attachment relationships form differing physiological responses, patterns for interpersonal relationship and how an individual views the world. <ref name=Siegel2012/>{{Rp|9}} (see attachment) work through the hard work of trauma 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}} processing, reduction of fear, and acceptance of all self states. [20] [21] The only treatment that has ever been proven to aid in the integrationIntegration (state of unification) occurs in the minds of all individuals and is a process rather than an end product. "If integration is impaired, the result is chaos, rigidity, or both. Chaos and rigidity can then be seen as the red flags of blocked integration and impaired development of the mind." <ref name=Siegel2012/>{{Rp|9}} The natural process of the mind is to link differential parts (distinct modes of information processing) into a functional and unified self. No child has unified personality when born, in fact, they need years of sufficient nurturing for the parts of their personality to integrate. <ref name=Siegel2012/>{{Rp|394}} "Integration is more like making a fruit salad than like making a smoothie: It requires that elements retain their individual uniqueness while simultaneously linking to other components of the system. The key is balance of differentiation and linkage." <ref name=Siegel2012/>{{Rp|199}} Integration is the normal process that occurs in early childhood, but if interrupted by trauma, the child may not be able to integrate. <ref name=Howell2011/>{{Rp|143}} process of any individual with this disorder is talk therapy or self work that address integration concerns.

IntegrationIntegration (state of unification) occurs in the minds of all individuals and is a process rather than an end product. "If integration is impaired, the result is chaos, rigidity, or both. Chaos and rigidity can then be seen as the red flags of blocked integration and impaired development of the mind." <ref name=Siegel2012/>{{Rp|9}} The natural process of the mind is to link differential parts (distinct modes of information processing) into a functional and unified self. No child has unified personality when born, in fact, they need years of sufficient nurturing for the parts of their personality to integrate. <ref name=Siegel2012/>{{Rp|394}} "Integration is more like making a fruit salad than like making a smoothie: It requires that elements retain their individual uniqueness while simultaneously linking to other components of the system. The key is balance of differentiation and linkage." <ref name=Siegel2012/>{{Rp|199}} Integration is the normal process that occurs in early childhood, but if interrupted by trauma, the child may not be able to integrate. <ref name=Howell2011/>{{Rp|143}}

Memory sharing is primary to this disorder. During most of the integration work there will be overlapping phase work until an individual reaches the point they want to discontinue work, which many report a desire to do before full unificationAlso known as final fusion. See 'integration'.Integration (state of unification) occurs in the minds of all individuals and is a process rather than an end product. "If integration is impaired, the result is chaos, rigidity, or both. Chaos and rigidity can then be seen as the red flags of blocked integration and impaired development of the mind." <ref name=Siegel2012/>{{Rp|9}} The natural process of the mind is to link differential parts (distinct modes of information processing) into a functional and unified self. No child has unified personality when born, in fact, they need years of sufficient nurturing for the parts of their personality to integrate. <ref name=Siegel2012/>{{Rp|394}} "Integration is more like making a fruit salad than like making a smoothie: It requires that elements retain their individual uniqueness while simultaneously linking to other components of the system. The key is balance of differentiation and linkage." <ref name=Siegel2012/>{{Rp|199}} Integration is the normal process that occurs in early childhood, but if interrupted by trauma, the child may not be able to integrate. <ref name=Howell2011/>{{Rp|143}} takes place. [14]:599-652 [22] [23] There are no medications to cure or manage the disorder; the best results are obtained when trauma memories integrate. [24] See our detailed section on integration for more.

Prognosis

When untreated there is chronic and recurrent symptoms varying overtime. [25] [14]:637-652 Around four-years of psychotherapy are usually needed for adults (less for children) to allow time for trauma memory processing, and to obtain a unified sense of self. [1] [14]:637-652

History

Paul F. Dell led a drive to understand PTSD, the Dissociative Disorders and dissociation in his multi-authored, 864 page book titled: Dissociation and the Dissociative Disorders: DSM-V and Beyond. The massive book was an attempt made in 2009 to bring to the forefront the main ideas of the research community, [26] [5] but there was little agreement at that time and the book strongly reflected that fact. More recently, Ellert R.S. Nijenhuis and Onno van der Hart have led the field with an unearthing of knowledge that was influenced by the French genius, Pierre Marie Félix Janet. [13] [27] Janet, amid an onslaught of naysayers, determined that the mind's ability to dissociate, a term he coined, was influenced by what he called "dissociative determinations," which are referred to today as subjective trauma. [27] Janet insisted that the mind is made up of a network of neurons that when healthy, work together in harmony, but when "infected" by a trauma memory the mind has no choice but to react to and interact with stimulus. [20] [27] Janet pointed out that while the process had purpose in human evolution it is counter-productive in modern man. [5] [28] Janet's work was stifled by influential researchers that took another path after Janet died. [27] There was a media circus in response to movies, books and other public information sharing including "Sybil," "Three Faces of Eve," and the Billy Milligan story. The symptoms and presentation were mixed portrayals of dissociative identity disorder, and other specified dissociative disorder and maybe even other comorbidComorbid means the the presence of more than one psychiatric diagnosis at once, with substance use this is often referred to as "dual diagnosis" Also see [[Cormobid]]. disorders. All this confusion created a Frankenstein effect that was more fantasy than reality and it continues in the media today. [13]

Rational began to take over when Ellert R. S. Nijenhuis and Onno van der Hart dug into the original writings of Janet and brought them to light. They demanded that Janet's work be heard and understood. Later, Kathy Steele joined the two men and the three researching clinicians published the landmark book: The Haunted Self: Structural dissociation|Structural Dissociation and the Treatment of Chronic Traumatization. [4] There were earlier journal articles by the three authors, but it was the book that fully introduced the concept of what today is called Structural Dissociation of the Personality. [14]:3-26 Now in 2014, fMRI scans exist that support Janet's ideas, and most neurologists that write about Dissociative Disorders share similar views, even if they don't use the same terminology.

DSM history and OSDD

There was nothing about "multiple personalities" in the DSM-I, but the DSM-II did mention the term as a symptom of neurosisNeurosis is an emotional disorder. Neurotic refers to a person displaying a symptom of emotional distress, which could range from anxiety, panic attacks depression, and lying, to promiscuity. <ref name=Hook2004/>{{Rp|97}} This historical term referred to a very large group of conditions, which were later divided between Mood Disorders, Dissociative Disorders, Anxiety Disorders, Somatization Disorder and Personality Disorder. Neurosis was removed from the DSM completely because it suggested a "cause" common to the categories under that term, and to "reduce confusion" <ref name=Decker2013/>{{Rp|272}}. The DSM-III was the first time that "multiple personality 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}}" was listed in a DSM as a diagnosis of its own, and other specified dissociative disorder was never included in a DSM until the DSM-IV.

OSDD, BPD, PTSD, Schizophrenia

Mental health professionals with inadequate training have misdiagnosed other specified dissociative disorder throughout history, [29] but with today's knowledge this should soon be a thing of the past. Below are common disorders that use to be confused with other specified dissociative disorder.

  • Dissociative identity disorder is eliminated from consideration when there is a switch between two distinct personality states, because only one distinct state exists in other specified dissociative disorder. [14]:429-434
  • Borderline personality disorder would be removed from consideration since the presenting distinct state would be unable to attend to daily life without the immediate influence of vehement emotion from the less than distinct state. [6] [7]
  • PTSD would be eliminated for the same reason as borderline personality disorder, and the less than distinct state seen in PTSD is far less elaborate than in other specified dissociative disorder. The less than distinct state can take over in PTSD, but it's limited to re-experiencing trauma. It cannot take over enough to act on its own. [14]:447-470 [14]:495-510
  • Schizophrenia has been confused with other specified dissociative disorder, but in schizophrenia there are no states. What is seen in schizophrenia is a delusionalA delusion is a "false belief, based on incorrect inference about external reality, that is firmly held despite objective and obvious contradictory proof or evidence and despite the fact that other members of the culture do not share the belief." <ref name=Sadock2008/>{{Rp|24}}Delusional perception is a "perception that has a unique and idiosyncratic meaning for a person, which leads to an immediate delusional interpretation". A Schniederian first-rank symptom often associated with schizophrenia <ref name=Sadock2009/>{{Rp|1434}} but not associated with dissociative identity disorder. <ref name=Dell2009/>{{Rp|391}} pattern of "state shifting." [14]:557-570

    Edit this site

We encourage those with knowledge of the trauma-stressor and dissociative disorders to join our project and help to create an accurate and helpful information based wiki. To do so, simply make an account and review our editor guidelines.
New Editor Information

Other branches of the Trauma and DissociationDissociation is a compartmentalization of experience, where elements of a trauma are not integrated into a unified sense of the self. <ref name=Dell2009/>{{Rp|4-810, 127}}The lay persons idea of [[dissociation]], that which exists in the normal mind, is not what is referred to in this document. <ref name=Dell2009/>{{Rp|233-234}} Project

Dissociative Identity Disorder.org is a multi-authored peer written site, reviewed by a health care professional.

References

  1. ^ a b Bethany L. Brand (2012): What We Know and What We Need to Learn About the Treatment of Dissociative Disorders, Journal of Trauma and Dissociation, 13:4, 387-396
  2. ^ 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)
  3. ^ a b 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.
  4. ^ a b c d e f g h i j k l 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.
  5. ^ a b c d e Siegel, Daniel (2012). The Developing Mind, Second Edition: How Relationships and the Brain Interact to Shape Who We Are. Guilford press.ISBN 978-1462503902.
  6. ^ a b c d e f 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)
  7. ^ a b Fernando, Silvia Carvalho; Beblo, Thomas, Schlosser, Nicole, Terfehr, Kirsten, Otte, Christian, Löwe, Bernd, Wolf, Oliver Tobias, Spitzer, Carsten, Driessen, Martin, Wingenfeld,Katja (2014). The Impact of Self-Reported Childhood Trauma on Emotion Regulation in Borderline Personality Disorder and Major Depression. Journal of Trauma & Dissociation, volume 15, issue 4, 2014, page 384-401. (doi:10.1080/15299732.2013.863262)
  8. ^ a b c Dorahy, Martin; Bethany L Brand, Vedat Şar, Christa Krüger, Pam Stavropoulos, Alfonso Martínez-Taboas, Roberto Lewis-Fernández, Warwick Middleton (2014). Dissociative identity disorder: An empirical overview. Aust N Z J Psychiatry, volume 48, issue 5. (doi:doi: 10.1177/0004867414527523)
  9. ^ a b DSM5, APA (2013). Diagnostic and Statistical Manual of Mental Disorders. ISBN 978-0890425558.
  10. ^ Obsuth, Ingrid; Hennighausen, Laura E. Brumariu and Karlen Lyons-Ruth (2014). Disorganized Behavior in Adolescent–Parent Interaction: Relations to Attachment State of Mind, Partner Abuse, and Psychopathology. Child Development, volume 85, issue 1. (doi:10.1111/cdev.12113)
  11. ^ a b c d 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)
  12. ^ a b Fisher, Sebern (2014). Neurofeedback in the Treatment of Developmental Trauma: Calming the Fear-Driven Brain. Norton.ISBN 978-0393707861.
  13. ^ a b c d Chu, James A. (2011). Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders. Hoboken, N.J.:John Wiley & Sons.ISBN 0470768746.
  14. ^ a b c d e f g h i j k 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.
  15. ^ a b vanderKolk, Bessel (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking Adult.ISBN 10: 0670785938.
  16. ^ Sar, Vedat. Epidemiology of Dissociative Disorders: An Overview. Epidemiology Research International. (doi:doi:10.1155/2011/404538)
  17. ^ Reinders, Antje A.T.S.; Antoon T.M. Willemsen, Johan A. den Boer, Herry P.J. Vos, Dick J. Veltman, Richard J. Loewenstein (2014). Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: A PET study and neurobiological model. Psychiatry Research: Neuroimaging, volume 223, issue 3. (doi:10.1016/j.pscychresns.2014.05.005)
  18. ^ Frewen, Paul; Lanius, Ruth (2014). Trauma-Related Altered States of Consciousness: Exploring the 4-D Model. Journal of Trauma & Dissociation, volume 15, issue 4. (doi:DOI: 10.1080/15299732.2013.873377)
  19. ^ Gentile, JP; Dillon, KS; Gillig, PM (2013). Psychotherapy and Pharmacotherapy for Patients with Dissociative Identity Disorder.. Innovations in clinical neuroscience, volume 10, issue 2, 2013 Feb, page 22-29.
  20. ^ a b Loewenstein, R. J.; Brand, B. (2014). Does phasic trauma treatment make patients with dissociative identity disorder treatment more dissociative?. J Trauma Dissociation, volume 15, issue 1, 2014, page 52-65. (doi:10.1080/15299732.2013.828150)
  21. ^ Loewenstein, R. J.; Brand, B.L., Spiegel, D. (2014). Dispelling myths about dissociative identity disorder treatment: an empirically based approach. Psychiatry, volume 77, issue 2, 2014. (doi:10.1521/psyc.2014.77.2.169)
  22. ^ Vermetten, Eric; Spiegel, Eric (2014). Trauma and Dissociation: Implications for Borderline Personality Disorder. Current Psychiatry Reports, volume 16, issue 2. (doi:10.1007/s11920-013-0434-8)
  23. ^ Solomon, Roger; Nijenhuis, Ellert R. S.; van der Hart, Onno (2010). Dissociation of the Personality in Complex Trauma-Related Disorders and EMDR: Theoretical Considerations. Journal of EMDR Practice and Research, volume 4, issue 2, 2010, page 76-92. (doi:10.1891/1933-3196.4.2.76)
  24. ^ Siegel, Daniel (2010). Mindsight: The New Science of Personal Transformation. Bantam.ISBN 10.1521/ijgp.2010.60.4.605.
  25. ^ Brand, Bethany; Dorahy, Martin, Sar, Vedat, Krüger, Christa, Stavropoulos, Pam, Martínez-Taboas, Alfonso, Lewis-Fernández,Roberto, Middleton,Warwick (2014). Psychiatry Australian and New Zealand Journal of http://anp.sagepub.com/content/48/5/402 Dissociative identity disorder: An empirical overview. Aust N Z J Psychiatry, volume 48, issue 402, 2014. (doi:10.1177/0004867414527523)
  26. ^ Kluemper, Nicole; Dalenberg, Constance (2014). Is the Dissociative Adult Suggestible? A Test of the Trauma and Fantasy Models of Dissociation. Journal of Trauma and Dissociation, volume 15, issue 4, 2014, page 457-476. (doi:10.1080/15299732.2014.880772)
  27. ^ a b c d Whitfield, Charles (1995). Memory and Abuse: Remembering and Healing the Effects of Trauma. HCI.ISBN 10: 1558743200.
  28. ^ Steele, Kathy; van der Hart, Onno; Nijenhuis, Ellert R. S. (2001). Dependency in the Treatment of Complex Posttraumatic Stress Disorder and Dissociative Disorders. Trauma & dissociation, volume 4, issue 1, page 79-116. (doi:10.1300/J229v02n04_05)
  29. ^ Brand, B.; Loewenstein, Richard J. (2010). Dissociative disorders: An overview of assessment, phenomenology, and treatment. Psychiatric Times.