In the DSM-5, the criteria for DID is to be broadened in criteria A and B and adding a new diagnostic criterion: "C.
Criterion C - Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning." This phrase, which occurs in several other diagnostic criteria, is proposed for inclusion in 300.14 as part of a proposed merger of dissociative trance disorder with DID. Criterion C would be included to "help differentiate normative cultural experiences from psychopathology". For example, professionals would be able to take shamanism, which involves voluntary possession trance states, into consideration, rather than diagnosing those who report it as having a mental disorder.
The DSM-5, was released May, 2013. It includes the following categories for the dissociative disorders. Notice that DDNOS is now split into two categories.
- Dissociative Identity Disorder (DID)
- Dissociative Amnesia (DA) with or without Dissociative Fugue
- Depersonalization/Derealization Disorder
- Other Specified Dissociative Disorder (OSDD)
- Unspecified Dissociative Disorder (UDD)
A. "Disruption of identity characterized by two or more distinct personality states." Most refer to these states as alters, and DID is the only mental disorder with alters. This involves "marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning." The big change from the DSM-IV to the DSM-5 is that an individual can now report their experience or the observations of someone else to their therapist, rather than the therapist having to observe it themselves.
B. Amnesia. This criteria does now say the amnesia is for everyday occurrence. A large percentage of the population that has not experienced trauma as a child does not remember their childhood, so that is not what they are looking for. Instead we look for something unique to DID, and that is the amnesia that occurs when one alter takes the place of the part that is usually the host. The amnesia requirement is for the host alter and in present day. Anything else simply does not make sense, but the criteria simply states "recurrent gaps in the recall of everyday events, important personal information and/or traumatic events...."
C. "The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning."
D. Religious practice is of course not included, and with children the behavior is not just normal fantasy play.
E. Finally none of the symptoms are due to drugs or alcohol
The Rationale given for changes from the DSM-IV to the DSM-5:
A. Clarification of language. Different states can be reported or observed. Including Trance and Possession Disorder by mentioning “experience of possession” increases global utility.
B. Amnesia for everyday events is a common feature.
C. Attempt to differentiate normative cultural experiences from psychopathology.
D. Dissociative Trance Disorder to increase cross-cultural applicability
Specifier that did not make the final cut: A substantial proportion of patients with Dissociative Identity Disorder have conversion symptoms, which are related to their dissociative disorder and require special clinical attention and treatment. b) Some Dissociative Identity Disorder patients have dissociative variations in somatic symptoms that require clarification for differential medical diagnosis and treatment.
Reference: Spiegel D et al: Dissociative Disorders in DSM-5.
Dissociative Identity Disorder (formerly Multiple Personality Disorder)
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
B. At least two of these identities or personality states recurrently take control of the person's behavior.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
As you can see there has been some important changes in the criteria when comparing what is in the DSM-IV TR and the DSM-5. Many that did have the diagnosis of DDNOS will now have a DID diagnosis. Nothing has changed, it is just that the therapist no longer has to be the one to observe what is happening. More information on the DSM.