The Trauma-Stressor and Dissociative Disorders Project

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This site reflects the most current information on the Dissociative Disorders and the Trauma and Stressor-Related Disorders.

Dissociative Disorders

The Dissociative Disorders (DD) in the DSM-5 include 300.14 dissociative identity disorder (DID), 300.12 dissociative amnesia (DA), 300.6 depersonalization disorder (including derealization) (DPD), 300.15 other specified dissociative disorder (OSDD), 300.15 and unspecified dissociative disorder (UDD).

Trauma and Stressor-Related Disorders

The Trauma and Stressor-Related Disorders in the DSM-5 include 313.89 reactive attachment disorder (RADOriginally the only attachment disorder listed in the [[DSM]]. A stressor-related disorder, disinhibited social engagement disorder was originally a subtype of RAD.), 313.89 disinhibited social engagement disorder, 309.81 posttraumatic stress disorder (PTSD), 308.3 acute stress disorder (ASD). The adjustment disorders include 309.89 other specified trauma and stressor-related disorder and 309.9 unspecified trauma and stressor-related disorder.

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. 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}}

Structural Dissociation of the Personality occurs at the point when unprocessed trauma that has not been fully integrated into narrative memory has overwhelmed an individual. The following are disorders that fall within the boundaries of Structural Dissociation of the Personality: acute stress disorder (ASD), posttraumatic stress disorder with, and without the dissociative aspects of depersonalization and derealization. In addition, there are the complex Dissociative Disorders: other specified dissociative disorder (OSDD) and dissociative identity disorder (DID). All of these disorders, acute stress disorder, posttraumatic stress disorder, other specified dissociative disorder, and dissociative identity disorder are caused by Structural Dissociation of the Personality. Borderline personality disorder does not share this etiology, but its dissociative presentation is the reason it's included under the umbrella of Structural Dissociation.

See the page on Structural Dissociation for referenced and more detailed information.

Differences between MPDPrior 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}} and DID and between DDNOS and OSDD are important

Other specified dissociative disorder (OSDD) is not the same thing as the now defunct description of dissociative disorder not otherwise specified (DDNOS) which was in the DSM-IV. The DSM-5, published late in 2013, offers criteria that simplify the diagnosis of other specified dissociative disorder and dissociative identity disorder. Note that in dissociative identity disorder distinct states can switch with one another, but since there is only one distinct state in other specified dissociative disorder it does not meet the criteria for dissociative identity disorder. Both disorders have two or more "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" which can be described as "less than distinct states." Note that the criteria for other specified dissociative disorder clearly addresses two very different types of disorders under this one name. The first is a disorder that acts like dissociative identity disorder and the second describes the act of creating a temporary state, which when it no longer has a purpose fades away almost as quickly as it was created.

See the categories on Structural Dissociation, dissociative identity disorder, other specified dissociative disorder and the DSM for referenced and more detailed information.

DID is not a more severe form of OSDD

Dissociative identity disorder is not a form of other specified dissociative disorder where a child was abused more, which is a common misinterpretation. Both disorders are distinct disorders unto themselves.

See the categories on Structural Dissociation, dissociative identity disorder, other specified dissociative disorder and the DSM for referenced and more detailed information.

OSDD etiology

Other specified dissociative disorder (OSDD) is associated with disorganized attachment, and is often related to child abuse. If there is 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/> it can be by someone outside the home as long as that individual has isolated access to the child several hours each week. Other specified dissociative disorder can occur even if a child does not have symptoms of dissociation during their first years of life.

See the categories on Structural Dissociation, dissociative identity disorder, other specified dissociative disorder and the DSM for referenced and more detailed information.

DID Etiology

Dissociative identity disorder must develop prior to any significant memory 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}}, and therefore the basis for its creation is exceptionally early in life. The child will have had a background of being neglected and traumatized. The individual will have a disorganized attachment style and they will show signs of their disorder early in life.

See the categories on Structural Dissociation, dissociative identity disorder, other specified dissociative disorder and the DSM for referenced and more detailed information.

OSDD can mimic DID

Other specified dissociative disorder mimics dissociative identity disorder if the "less than distinct parts" are elaborated. Distinct states attend to the daily activities of life and are typically not child-like, nor do they display vehement emotion, but a less than distinct state can intrude vehement emotion onto a distinct state making the differentiation confusing.

See the categories on Structural Dissociation, dissociative identity disorder, other specified dissociative disorder and the DSM for referenced and more detailed information.

OSDD and DID can be identified using fMRI scans

Other specified dissociative disorder is identified when one distinct part has control, with two or more less than distinct states switching in the background. An fMRI scan in other specified dissociative disorder is seen as one constant light with other lights flashing on and off behind it like a musical symphony. This symphony of lights indicates the minds ability to move rapidly from one less than distinct part to another. In dissociative identity disorder distinct states can be seen on an fMRI scan as a lit up area that swaps places with each other, and switching behind the distinct state are the less than distinct states.

See the categories on Structural Dissociation, dissociative identity disorder, other specified dissociative disorder and the DSM for referenced and more detailed information.

Dissociative boundariesA dissociative boundary separates dissociated states. <ref name=Spiegel2011/> <ref name=DSMIV/> <ref name=DSM5Deskref/> {{See also | Amnesia}}

All Dissociative Disorders have dissociative boundaries associated with the states that are highly responsible for how states act and react. The boundaries associated with the distinct states in dissociative identity disorder are highly complex including the chemical, neurological and the solid makeup of them. They contain, replicate, and isolate most things including memory. They are unyielding in their phobia of each other until a great deal of therapeutic work has been done. Overtime many individuals with dissociative identity disorder process their trauma memories and break down the dissociative boundaries, and increase communication between states. This is called the integration process. When all parts can freely communicate with each other then the term unification is more appropriate. This process of integration is what all the Dissociative Disorders have in common. The dissociative boundaries of the less than distinct states in other specified dissociative disorder and dissociative identity disorder differ in their chemistry, neuronal and physical makeup. Although they are both considered to be less than distinct states they are not the same.

OSDD and DID are not like disorders that exist on a spectrum

To repeat the point which has been stressed many times on this page, the two complex Dissociative Disorders are decidedly different from each other. The common misconception is that one is a more severe form of the other or one was due to more abuse, but the fact is that these are two very different disorders.

See the categories on Structural Dissociation, dissociative identity disorder, other specified dissociative disorder and the DSM for referenced and more detailed information.

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DSM-5 Category: Dissociative Disorders

The DSM-5, was released May, 2013 and the DSM-5 committees have settled on the following categories:

  • Dissociative identity disorder (DID)
  • Dissociative amnesia (DA), with or without dissociative fuguepsychogenic fugueA temporary loss of personal identity due to trauma, reclassified as dissociative amnesia within the DSM-5. Dissociative amnesia includes dissociative fugue as a subtype, since fugue is a rare disorder that always involves amnesia, but does not always include confused wandering or loss of personality identity. <ref name=DSMIV/> <ref name=DSM5Deskref/> <ref name=Spiegel2013/>Dissociative amnesia (DA) was previously called psychogenic amnesia is a form of temporary amnesia that presents often in traumatic situations; for example in car accidents or victim or witness of a violent crime. Dissociative Amnesia is described in the DSM as a disorder that causes significant distress or impairment in functioning, such as when a person cannot remember significant events that happened to them. <ref name=ISSTD.org/> (DF)
  • Depersonalization/derealization disorder
  • Other specified dissociative disorder (OSDD)
  • Unspecified dissociative disorder (UDD)

DSM-5 Category: Trauma and Stressor-Related Disorders

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The Trauma and Stressor-Related Disorders are:

Note: Complex posttraumatic stress disorder is a term not included in the DSM-5, but the DSM-5 PTSD category does have a couple of "dissociative" specifiers. The term complex-PTSD implies an etiology of childhood trauma and is being considered for inclusion in the ICD-11 manual.

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Peer to peer tips for living with dissociative identity disorder

Child abuse and the Trauma and Dissociation Project

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Child abusers can go to great length to hide emotional, physical and sexual abuse which they enact upon the young and innocent, but the fact remains that child abuse is common, and is a hidden epidemic. Abused individuals suffer shame, and often blame themselves for the acts perpetuated upon them. Abusers can go to great lengths to prevent their victims from recalling abuse.

This page is an introduction, see the following pages for more information: Structural Dissociation, other specified dissociative disorder, and dissociative identity disorder.

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