Other Specified Dissociative Disorder

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Dissociative Disorders that do not fit into other categories in the DSM-5 include both dissociative disorder not otherwise specified (DDNOS, now known as other specified dissociative disorder (OSDD), and unspecified dissociative disorder meant to be used in emergency situations. Other specified dissociative disorder is a Dissociative Disorder that has been present for some time, where an individual reports distress impaired functioning due to symptoms. [2]

Other Specified Dissociative Disorder (OSDD)

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}} is caused by environmental stressors which is signified by the knife piercing the heart. By Kameal Leon-Ish
This was formally the DDNOS (dissociative disorder not otherwise specified) category, and many who had this diagnosis now have a diagnosis of dissociative identity disorder if they do experience time-loss (amnesiaMemory loss. {{See also| amnesia}}) and report this to their therapistPyschotherapists are often called a 'therapists'. These professionals may be a psychiatrist, psychologist or other mental health professional who have specialist training in psychotherapy. They are qualified to work with patients in a clinical setting.{{cn}}. [3]:158

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 Criteria

As with all dissociative disorders, the condition must cause "clinically significant distress" and/or "impaired functioning in social, occupational, or other significant areas of life must predominate". The clinician must record a reason for this giving diagnosis. [3]:158

Example presentations include:

  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 identity 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 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.

ICD-10 Criteria

All dissociative [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." Kaplan and 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}}] disorders must involve

  1. No evidence of a physical disorder that can explain the symptoms that characterize the disorder (but physical disorders may be present that give rise to other symptoms).
  2. Convincing associations in time between the symptoms of the disorder and stressful events, problems or needs. [4]

The ICD-10 describes a range of dissociative disorders which are all classified as DDNOS in the DSM-5 manual.

Dissociative Stupor

F44.2

  • Profound diminution or absence of voluntary movements and speech, and of normal responsiveness to light, noise and touch.
  • Maintenance of normal muscle tone, static posture, and breathing (and often limited coordinated eye movements).

Trance"periods of absence-like staring and unresponsiveness; well documented in severely dissociative people for over 100 years"<ref name=Dell2009/>{{Rp|229}} and Possession Disorders

F44.3 Either (1) or (2):

  1. Possession disorder: Conviction that the individual has been taken over by a spirit, power, deity or other person.
  2. Trance: Temporary alteration of the state of consciousness, shown by any two of:
  • Loss of the usual sense of personal identity.
  • Narrowing of awareness of immediate surroundings, or unusually narrow and selective focusing on environmental stimuli.
  • Limitation of movements, postures, and speech to repetition of a small repertoire.

In addition both criterion 1. and 2. must be unwanted and troublesome, occurring outside or being a prolongation of similar states in religious or other culturally accepted situations. This must not occur at the same time as schizophrenia or related disorders, or mood"Pervasive and sustained emotion" which affects a person's perception of the world.<ref name=Sadock2008/>{{Rp|6}} [affective] disorders with 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. or delusionsA 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}}.

Dissociative motor disorders

F44.4 The commonest varieties of dissociative motor disorder are loss of ability to move the whole or a part of a limb or limbs. Paralysis may be partial, with movements being weak or slow, or complete. Various forms and variable degrees of in coordination (ataxialack of coordination, physical or mental. Intrapsychic ataxia refers to lack of coordination between feelings and thoughts; seen in schizophrenia and severe OCD. <ref name=Sadock2008/>{{Rp|22}}) may be evident, particularly in the legs, resulting in bizarre gait or inability to stand unaided (astasia-abasia). There may also be exaggerated trembling or shaking of one or more extremities or the whole body.

Either (1) or (2):

  1. Complete of partial loss of the ability to perform movements that are normally under voluntary control (including speech).
  2. Various or variable degrees of in coordination or ataxia or inability to stand unaided.

Dissociative convulsions

F44.5 These are pseudoseizures, they may mimic epileptic seizures but with some differences. Diagnostic criteria:

  • Sudden and unexpected spasmodic movements, closely resembling any of the varieties of epileptic seizures, but not followed by loss of consciousness.
  • this must not be accompanied by tongue-biting, serious bruising or laceration due to falling, or incontinence of urine.

Dissociative anesthesialoss of sensory awareness; all sensory modalities, touch, kinesthesia, smell, taste, hearing, vision. <ref name=Dell2009/>{{Rp|261-262}} A negative symptom of somatoform dissociation (loss of a physical ability) and sensory loss

F44.6 Either (1) or (2):

  1. Partial or complete loss of any or all of the normal cutaneous sensations over part or all of the body (specify: touch, pin prick, vibration, heat, cold).
  2. Partial or complete loss of vision, hearing or smell (specify).

Anesthetic areas of skin often have boundaries which make it clear that they are associated more with the patient's ideas about bodily functions than with medical knowledge. There may also be differential loss between the sensory modalities which cannot be due to a neurological lesion. Sensory loss may be accompanied by complaints of paraesthesia.

Loss of vision is rarely total in Dissociative Disorders, and visual disturbances are more often a loss of acuity, general blurring of vision, or "tunnel vision". In spite of complaints of visual loss, the patient's general mobility and motor performance are often surprisingly well preserved. Dissociative deafness and anosmia (loss of smell) are far less common than loss of sensation or vision.

Mixed dissociative [conversion] disorders

F44.7 Any mix of the Dissociative Disorders, possibly including Dissociative Amnesia and Dissociative Fugue.

Ganser's syndrome

F44.80 Giving approximate answers to questions, for example 2+2 equals 5.

Transient dissociative [conversion] disorders occurring in childhood and adolescence

F44.82 No description is given for this in the ICD-10 manual.

Other specified dissociative [conversion] disorders

F44.88 Specific research criteria are not given for all disorders mentioned above, since these other dissociative states are rare and not well described. Research workers studying these conditions in detail will wish to specify their own criteria according to the purposes of their study. This includes psychogenic confusion and twilight state.

Dissociative [conversion] disorder, unspecified

F44.9 This has no description but must meet the two dissociative disorder criteria described at the top.[5]

Common examples of other specified dissociative disorder

A person with Other Specified Dissociative Disorder may experience different parts of their personality which are not distinct and separate identities and do not physically take over their body. This is similar to Dissociative Identity Disorder but without the identity alterationDefined 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}}. [2]

A person with Other Specified Dissociative Disorder may experience different parts of their personality, and those parts may physically take over their body but there is no amnesia for the past or present, so the full criteria for dissociative identity disorder is not met. [2] [1]

Other specified dissociative disorder and dissociative identity disorder both develop from early 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}}. dissociative identity disorder may initially present as other specified dissociative disorder, but cannot develop into dissociative identity disorder.

Other specified dissociative disorder is often a diagnosis made when the amnesia prevents full awareness of the symptoms, or before past amnesia is recognized (for example a person may initially believe that most people do not remember most of their childhood). [2] Dr. Dan Siegel reports that 20% of the population who do not seem to have suffered trauma do not remember their childhood. [6]:7

Diagnosis and treatment

The ISSTD treatment guidelines for dissociative identity disorder also apply to other specified dissociative disorder and the same diagnostic tests should be used. [7] See the dissociative identity disorder page for further details.

Dr. Alison Miller (2012) describes a few differences in treatment and states between [dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder in the DSM manual 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 and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}] and OSDD, stating that OSDD is often the intended result of ritual abuse, rather than dissociative identity disorder. [1]

References

  1. ^ a b c Miller, Alison (2012). Healing the Unimaginable: Treating Ritual Abuse and Mind Control. Karnac Books.ISBN 9781855758827.
  2. ^ a b c d Spiegel, David; Loewenstein, Richard J. Lewis-Fernández, Roberto, Sar, Vedat, Simeon, Daphne, Vermetten, Eric, Cardeña, Etzel, Dell, Paul F. (2011). Dissociative disorders in DSM‐5. Depression and anxiety, volume 28, issue 9, page 824-852 also cited as Depression and Anxiety 28(12) E17-E45. (doi:10.1002/da.20874)
  3. ^ a b Diagnostic and Statistical Manual of Mental Disorders-5.
  4. ^ ICD-10 Classification of Mental and Behavioural Disorders" (PDF). World Health Organization
  5. ^ ISSTD International Society for the Study of Trauma and Dissociation.
  6. ^ Siegel, Daniel J. (2008). The neurobiology of "we" [how relationships, the mind, and the brain interact to shape who we are]. [Boulder, CO]:Sounds True.ISBN 159179949X.
  7. ^ International Society for the Study. Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation, volume 12, issue 2, 28 February 2011, page 115–187. (doi:10.1080/15299732.2011.537247)