Other specified dissociative disorder

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What you are looking at is an 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. The image on the left shows two distinct state caught in the act of 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 each other as is only seen in dissociative identity disorder. In other specified dissociative disorder you will only ever see one distinct state, but there can be several less than distinct states which is what the smaller dot represents. [1]

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

This diagnosis is given when an individual has an identity disturbance and symptoms that causes clinically significant distress and/or 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. The clinician must specify a reason for this giving diagnosis. If none can be specified then a diagnosis of unspecified dissociative disorder is appropriate instead. [2]:306-307 An individual only needs to fit into one of the following criteria to be given a diagnosis of other specified dissociative disorder. Other specified dissociative disorder broadly replaced "dissociative disorder not otherwise specified" from the older DSM-IV.

  • A. Identity disturbance associated with "less than marked discontinuities in sense of self and agency," in which there will be no overt amnesiaMemory loss. {{See also| 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 conversely.
  • 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. [2]: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 and/or that he or she cannot control, as well as transient paralysis or loss of consciousness.

Differences between OSDD and 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}}

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 (DID) will always have two or more "distinct states", while other specified dissociative disorder has only one, [3] [4] [5] a fact which has been shown repeatedly on fMRI scans. [1] [6] Criteria A uses the terminology "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," but the term "less than distinct state" is also often used. The less than distinct states are more often than not states that are full of emotion and which act child-like. [3] [7] [4] The less than distinct states in other specified dissociative disorder are usually less elaborate than the less than distinct states in dissociative identity disorder, [8] [9]:337-366 [4] [10] [5] If a less than distinct state is worked with a great deal then it can mature, but that still does not change it's chemical and neurological makeup, and so it is still a less than distinct state. If comparing the two complex Dissociative Disorders, it's important to note 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}}, [3] [5] but with other specified dissociative disorder the symptoms are usually so overwhelming that they are hard for the individual and others to ignore. [5]

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}}. [3] [5]

DSM-5 mentions other specified disorder disorder outside its category

  • Section: Sleep-Wake Disorders
  • Disorder: nightmare disorder

Under differential diagnosis it mentions "sleep-related dissociative disorder where individuals may recall actual physical or emotional trauma and a dream during electroencephalography documented awakenings. [2]:407

  • Section: Sleep-Wake Disorders
  • Disorder: rapid eye moment sleep behavior disorder

Under differential diagnosis it mentions that other specified dissociative disorder (sleep-related psychogenic dissociative disorder is unlike other parasomnias, which arise precipitously from NREM or REM sleep, psychogenic dissociative behaviors arise from a period of well defined wakefulness during the sleep period. [2]:410

  • Section: Other Mental Disorders
  • Disorder: other specified 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}} due to another medical condition
It mentions that dissociative symptoms due to complex partial seizures would be coded and recorded as 345.40, and 294.8 for complex partial seizures with dissociative symptoms. [2]:707

References

  1. ^ a b 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)
  2. ^ a b c d e DSM5, APA (2013). Diagnostic and Statistical Manual of Mental Disorders. ISBN 978-0890425558.
  3. ^ 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)
  4. ^ a b c 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. ^ 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.
  6. ^ 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.