The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released May 18, 2013. The DSM criteria and explanations listed here are not meant to self-diagnose, but instead are listed to help improve public understanding of dissociative identity disorder. Trauma specialists with experience in the dissociative disorders should be contacted if you suspect you have any dissociative disorder. Many mental health professionals lack the training needed to recognize and treat this class of disorders.
II. Diagnostic and Statistical Manual of Mental Disorders
DSM-5 (300.14) criteria for Dissociative Identity Disorder
Disruption of identity characterized by two or more distinct personality states.
This involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and sensory-motor functioning.
B. Amnesia is defined in the DSM-5 as recurrent gaps in the recall of current, everyday events that go beyond ordinary forgetting.
C. The symptoms cause clinically significant distress or impairment in important areas of functioning.
D. Religious practice is omitted, as is normal fantasy play in children.
E. Physiological effects from a substance are omitted. (DSM-5 2013)
Discussion of Diagnostic and Statistical Manual of Mental Disorders
DSM-5 criteria for Dissociative Identity Disorder
To receive a diagnosis of dissociative identity disorder, an individual must meet all five DSM-5 criteria.
Distinct personality state
The first criterion refers to the most distinguishable aspect of dissociative identity disorder: the distinct personality states. There is a lot of misconception and confusion about what these states are even among mental health professionals. Separate personalities or people are of course not carried around inside an individual with dissociative identity disorder. So what does the DSM-5 mean when it refers to a distinct personality state? There are other terms used in the literature that might confuse readers, so here is a list of labels often used other than distinct personality state: alternate personality, alternate identity (alter), dissociated identity (identity) dissociated part (part), dissociated state (state), dissociated personalities (personalities), personality state, self-state, dissociated part of the personality, part of the self, part of the mind, disaggregate self-state, and so on, but the idea is that this is a part of a person's personality is distinct and has been dissociated due to severe trauma and abuse experienced during their early years of childhood. (Chu, 2011)
(Howell, 2011, p. 6,55,58)
It's important to understand that the distinct personality states seen in dissociative identity disorder are contained within dissociative boundaries, with the degree of dissociation experienced between them as defining the dissociative disorder. (Howell, 2011, p. 8) In other words, when the dissociative boundary between two distinct personality states is so great that those distinct personality states are unable to communicate with each other, then an individual meets the first criteria for dissociative identity disorder.
This is often referred to as an amnesic boundary.
Normal personality states
Most mental health professionals and neurologists agree that the personality of all individuals is made up of personality states which are not distinct or Dissociative. Mentally healthy people are less aware of these states because their mind personality states work together to a far greater extent than does someone with dissociative identity disorder. (Howell, 2011, p. 8,88-89)
The two types of alters
The parts of the personality that did not integrate due to early childhood abuse are called Apparently Normal Parts (ANP) in one of the three accepted models of etiology called Structural Dissociation. (van der Hart, 2006, p 83-88) The two other accepted models would identify these alters as hosts. ANP's (hosts) are not the only alters that act as hosts however. In the model of Structural Dissociation the alters that hold trauma memories are called Emotional Parts (EP). (van der Hart, 2006, p 83-88) (Howell, 2011, p. 59,109-114, 87-88,133-144)
(Note: The ANP also have emotion, but the ANP are not triggered by unprocessed trauma memories like the EP are. The emotion from the EP can seem irrational and out of place.)
There are many types of amnesia, but that found in dissociative identity disorder is unique in that it occurs when an alter takes the place of the alter that is usually in executive control (host/ANP) of the individual. (Howell, 2011p. 6,58-59) Amnesia is not clearly defined in the DSM-5, it but it does not make sense that it would inability to recall childhood since studies show that 20% of the population who don't appear to have ever suffered any trauma cannot recall their childhood. (Siegel 2012 p 67-90)
Switching & amnesia
In dissociative identity disorder the amnesia criteria means that one of two things happen on a daily basis. The ANP (who are often the host during times when the individual is not in danger) switches with another ANP, that they lack the ability to share memory with.
An EP (alter that holds trauma memories) switches with the ANP (alter that does not hold trauma memories) that is usually in executive control of the individual who the EP does not share memory with.
Amnesia for amnesia
Individuals with undiagnosed dissociative identity disorder often do not noticed switching, amnesia, or even partial dissociation (intrusions). This is one reason why
dissociative identity disorder is often unidentified. If an individual comes to a mental health professional for help it is usually for other problem such as PTSD, depression, eating disorders, or relationship problems. Some individuals with dissociative identity disorder are so dissociated, then can be in a car one moment, and their house the next, and are so use to this that they don't even acknowledge it. This can go for a lifetime on until it is caught by someone other than the individual with dissociative identity disorder. (Howell, 2011, p. 148)
Last 3 Criteria
The last 3 criteria are common to most mental health diagnosis
and simply means that the symptoms are severe enough to be disrupting life, the symptoms are not due to religious or cultural practice, and the symptomsa are not due to any type of drug.
IV. Beyond the DSM-5 Criteria
Pseudoseizures (convulsive PNES)
PNES was a specifier that was seriously considered for the DSM-5, but did not make the final cut, and is included here so that those who have what they might describe as shaking, seizures, convulsions, body memory, etc... can identify them. They are involuntary manifestations of psychological distress that when lying down on ones back are visualized and felt as a bicycle type of seizure, with the heels of the feet alternating as they hit the underlying surface . They can be isolated in one part of the body, or involve all parts. Convulsive PNES are also called pseudoseizures, psychogenic non-epileptic seizures, and non-epileptic attack disorder (NEAD). Convulsive PNES appear to be related to childhood abuse. They superficially resemble an epileptic seizure but have no neurologic origin. Medscape offers a clip of this type of involuntary movement as well as excellent information on the subject.
V. Changes from the DSM-IV to the DSM-5
The following changes to the DSM-IV were suggested by the DSM-5 work committee.
- Clarification of language.
- Different states can be reported or observed. Including Trance and Possession
- Mention of experience of possession increases global utility.
- Amnesia for everyday events is a common feature.
- Differentiate normative cultural experiences from psychopathology. (Siegel 2011)