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Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

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The Diagnostic and Statistical Manual of Mental DisordersPublished 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. {{Rp|384}} (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. {{Rp|384}}) is the manual used by most psychiatrists and therapists, especially in the US and UK, to aid diagnosing mental disorders. [1] The DSM-5, was released at the American Psychiatric Association's (APA) 2013 Annual Meeting in San Francisco, CA, in May, 2013. The DSM-5 includes the following Dissociative Disorders (DD) and Trauma and stressor-related disorders. For specific diagnostic criteria see the individual 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."{{Rp|20}}.

Dissociative Disorders

Trauma and Stressor-Related Disorders

DSM-5 Criteria for dissociative identity disorderPrior to the DSM-IV, dissociative identity disorder was known as multiple personality disorder, which was from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, 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}}Dissociative 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. {{Rp|557-570,487-494,471-486}} {{See also| Dissociative Identity Disorder}}

Code 300.14

A The presentation of two or more distinct personality states/alters must present, and each must have their own way of being.

"Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity 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. {{Rp|160}} There is no unified sense of self. and sense of agency, accompanied by related alterations in 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. {{Rp| 6}}, behavior, consciousness, memory"Memory is not a static thing, but an active set of processes." {{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." {{Rp|11}}, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual." [2]:155

B AmnesiaMemory loss. {{See also| amnesia}} is a requirement, but the DSM-5 has altered the wording to be:

"Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting." [2]:155

Amnesia in dissociative identity disorder is understood to mean amnesiaMemory loss. {{See also| amnesia}} between two or more of the distinct identities; the host alter will experience "losing timeIs a period of time where either no state is present, such as the time it takes to switch or is the time where an ANP takes over for an EP or another ANP. This occurs often in otherwise specified dissociative disorder and dissociative identity disorder." in the present another alter takes the place of the one the host alter. Rarely is the host alter aware of their time lossIs a period of time where either no state is present, such as the time it takes to switch or is the time where an ANP takes over for an EP or another ANP. This occurs often in otherwise specified dissociative disorder and dissociative identity disorder.. Note that even though the DSM does not make it clear that they mean current [amnesia], 20% of the population who appear to not be traumatized do not remember their childhood.

C An individual must be distressed by the disorder or have an impaired ability to function in a major area of life as a result. This is described as follows:

"The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning." [2]:155

D Normal cultural or religious practice is excluded, and fantasy play in children are excluded.

The disturbance is not a normal part of a broadly accepted cultural or religious practice. [2]:155

E Dissociative identity disorderPrior to the DSM-IV, dissociative identity disorder was known as multiple personality disorder, which was from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, 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}}Dissociative 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. {{Rp|557-570,487-494,471-486}} {{See also| Dissociative Identity Disorder}} cannot be diagnosed if symptoms are attributable to substance useHarmful Use is a pattern of psychoactive substance use that results in damage to physical or mental health, e.g. hepatitis following injecting drugs or depression which is secondary to heavy alcohol intake. Adverse social consequences normally also occur. Previously known as "non-dependent use" in the ICD manual, referred to as "substance use" in the DSM manual. {{Rp|41}} or other medical conditions.

"The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures)." [2]:155

Diagnosis is normally performed by a clinically trained mental health professional through clinical evaluation, interviews with family and friends, and consideration of other ancillary material. Specially designed interviews and personality assessment tools may be used for evaluation. A diagnosis of dissociative identity disorder takes precedence over any other dissociative disorders.

The DSM-5 criteria references "experience of possession" and includes Pathological Possession Trance (PPT).

DSM-5 criteria for other specified dissociative disorder 300.15

This covers a variety of different presentation, including some symptoms similar to dissociative identity disorder but not matching the distinct criteria.

See also: OSDD

Unspecified dissociative disorder

This category is used in an emergency room setting where there is insufficient information to make a diagnosis.

See also: Unspecified Dissociative Disorder

DSM History

The DSM is a product of the American Psychiatric Association and it is the standard classification of mental disorders used by United States mental health professionals. It includes the diagnostic classification, the diagnostic criteria sets, and the descriptive text. [3] The DSM I was published in 1952, the DSM II in 1968, the DSM III on 1980, the DSM-IV in 1994, and the DSM-5 was released in May 2013. [3] An alternative diagnostic manual is the ICD-10 manual which classifies mental and physical health problems.

The DSM-II (1968) listed multiple personalities in the description of hysterical neurosisThe prejudicial term "hysterical" came from the myth that hysteria is a specific disorder of women.{{Rp|218}}Hysteria is an historic term which refers to several different disorders. The DSM-II (1968) listed "multiple personality" as a symptom of "Hysterical Neurosis, dissociative type". This later become Multiple Personality Disorder before being renamed to Dissociative Identity Disorder, retaining code 300.14, and becoming part of the Dissociative Disorders category along with Depersonzaliation Disorder (formerly Depersonzaliation Neuroses)."Hysterical Neurosis, conversion type" was listed under "Neuroses" in the DSM-II (code 300.13), and later became "Somatoform Disorder", but is now known as Somatization Disorder in the DSM manual, and Conversion Disorders in the ICD manual.{{Rp|612}} This represents physical symptoms which are common in dissociative disorders.Hysteria also refers to physical symptoms which are believed to have an unconscious psychological cause, for example Conversion Disorder. "Hysteria is still stigmatized and frequently associated with lying or malingering." However, symptoms are not under the person's voluntary control. Cottencin (2013)Hysterical Personality Disorder was renamed to Histronic Personality Disorder. The prejudicial term "hysterical" came from the myth that hysteria is a specific disorder of women.{{Rp|218}}, dissociative type. It described the possible occurrence of alterations in the patient's state of consciousness or identity, and included the symptoms of "amnesia, somnambulismHistorically somnambulism was described as a dissociative symptom. Taylor (2000){{Rp|106}} states that the term "dissociation" was first coined in psychology by William James, who used the term to explain alterations of consciousness, including somnambulism, dissociative fugue and "conditions of double consciousness". Personality was considered a "plurality of states" of which waking consciousness was only one such state, meaning performing actions apparently without conscious awareness of those actions."Artificial somnambulism" refers to deep hypnosis. {{Rp|2}} (van der Hart and Horst (1989)), fugue, and multiple personalities."

The DSM-III (1980) changed multiple personality from a symptom to it's own diagnosis and grouped the diagnosis with the other four major dissociative disorders using the term "multiple personality disorder".

The DSM-IV (1994) made more changes to this category than any other dissociative disorder, and renamed it dissociative identity disorder. The name was changed for two reasons. First, to emphasize the main problem was not a multitude of personalities, but rather a lack of a single, unified identity and an emphasis on the identities as centers of information processing. Second, the term personality is used to refer to characteristic patterns of thoughts, feelings, moods and behaviors of the whole individual, while for a patient with dissociative identity disorder, the switches between identities and behavior patterns is the personality.

It is for this reason the DSM-IV-TR referred to distinct identities or personality states instead of personalities. The diagnostic criteria also changed to indicate that while the patient may name and personalize alters, they lack an independent, objective existence. The changes also included the addition of amnesia as a symptom, which was not included in the DSM-III-R, because despite being a coreThe terms "core" and "original" were used back in history to mean the part that body was born with, but today we know there is no such part. Many also incorrectly assume the host or ANP is what they call the core. {{Rp|59}} {{Rp|80, 87-88}} (see personality and alters) (see personality)Note: Outside of the dissociative disorders the term core is used by some to mean an individuals "suchness;" a part that is "beneath narrative and memory, emotional reactivity and habit." {{Rp|208-209}} symptom of the condition, patients may experience "amnesia for the amnesia" and so of course it is not reported. Amnesia was replaced when it became clear that the risk of false negative diagnoses was low because amnesia was central to dissociative identity disorder.

Despite the lengthy history of the psychopathology of dissociative disorders, and the intense study by Pierre Janet and Morton Prince in the first part of the last century, and by Jean-Martin Charcot before, dissociative disorders have had only limited research since Sigmund Freud and did not received serious attention again until after the 1980s. Prior versions of the DSM have avoided discussing the 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. (cause) of dissociative disorders in an effort to create distance from Freudian psychology. The DSM-5 is reintroducing etiology; and the development of a pathophysiologically based classification system. This has been advocated as investigation of the neuroevolution of stress-induced and fear circuitry disorders and related amygdala-driven, species-atypical fear behaviors of clinical severity in adult humans.

The DSM-IV-TR criteria for dissociative identity disorder has been criticized for failing to capture the clinical complexity of the mental disorder, and lacking usefulness in diagnosing individuals with it. For instance, it focuses on the two least frequently occurring subtle symptoms, producing a high rate of false negatives and an excessive number of OSDD diagnoses. Also it includes only two "core" symptoms of Dissociative Identity Disorder: amnesia and self-alteration, while failing to discuss 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. {{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). {{Rp|45}}Visual hallucinations are the most common type of hallucination and are often in geometric forms and figures {{Rp|127}} Illusions are similar to visual hallucinations but are based on real images or sensations., trance"periods of absence-like staring and unresponsiveness; well documented in severely dissociative people for over 100 years"{{Rp|229}}-like states, somatoformSomatoform Dissociation - refers to dissociative symptoms that involve the body; these symptoms are characteristic of dissociative disorders. {{Rp| 9}}Somatoform or somatic symptoms are physical symptoms that resemble, but cannot be explained by, a medical symptom or the direct effects of a substance. {{Rp| 9}} These include bodily sensations such as numbness/loss of sensation, inability to feel pain and dizziness. They are strongly linked to past trauma. {{See also | Somatoform Disorders}}, depersonalization and derealization symptoms. Arguments have been made prior to the printing of the DSM-5 to allow diagnosis through the presence of some, but not all of the characteristics of Dissociative Identity Disorder rather than the current exclusive focus on the two least common and noticeable features.

The diagnostic criteria for Dissociative Identity Disorder changed only slightly. Changes included = instead of someone who is qualified to diagnose an individual having to witness a switch of control between identities with time loss (amnesia), now the client or another person can report this. This self reporting is consistent with other psychiatric diagnoses in the DSM-5. [2]

Dissociative disorder not otherwise specified was renamed to other specified dissociative disorder (OSSD). There are minor wording changes to the criteria for dissociative identity disorder that should result in more people being diagnosed with dissociative identity disorder rather than OSDD. Unspecified Dissociative Disorder was also introduced.

Trauma and Stressor-related Disorder changes

Posttraumatic stress disorder and acute stress disorder were moved from the anxiety disorders section to the Trauma and Stressor-related Disorders section. Changes were also made to reactive attachment disorder, including the addition of disinhibited social engagement disorder.

Other chapters listed in the DSM-5

DSM-II-multiple-personality.jpg

The chapters in the DSM-5 are:


See also: Dissociative disorders
See also: Dissociative Identity Disorder
See also: Other Specified Dissociative Disorder
See also: History of DID
See also: PTSD

References

  1. ^ Spiegel, David; Lewis-Fernández, Roberto; Lanius, Ruth; Vermetten, Eric; Simeon, Daphne; Friedman, Matthew (2013). Dissociative Disorders in DSM-5. Annual Review of Clinical Psychology, volume 9, issue 1, 28 March 2013, page 299–326. (doi:10.1146/annurev-clinpsy-050212-185531)
  2. ^ a b c d e f American Psychiatric Association, (2013). Desk Reference to the Diagnostic Criteria from DSM-5. APA.
  3. ^ a b Diagnostic and Statistical Manual of Mental Disorders-5 Development.
  4. ^ Varley, Christopher K.. Overview of DSM-5 Changes. retrieved on 26 January 2014
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