DID
DSM-5 300.14: Dissociative Identity Disorder

I. Dissociative Disorders

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 given to help improve public understanding of dissociative identity disorder. A trauma specialist 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. See the symptoms page for more.

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 parts. This disruption may be observed by others, or reported by the patient.

Amnesia between parts of the personality.

The disturbance is not a normal part of broadly accepted cultural, religious practice, or part of the normal fantasy play of children.

The last two points are commonly stressed with any mental illness.

Causes clinically significant distress and impairment in social, occupational, or other important areas of functioning.

The disturbance is not due to the direct physiological effects of a substance.
(APA, DSM-5)

See our page on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

III. 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.

Criteria 1


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) 

Dissociative boundaries
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 states which are not distinct or dissociative. Mentally healthy people are less aware of these states because their states work together to a far greater extent than does someone with dissociative identity disorder.  (Howell, 2011, p. 8,88-89) 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.

Criteria 2

 
Amnesia
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 can refer to different types of amnesia. One important type means that one of two things happen often.  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 or until it is caught by someone other than the individual with the problem. (Howell, 2011, p. 148)

Last 3 Criteria

Distruption in life  
The last 3 criteria are common to most mental health diagnosis
and simply mean that the symptoms are severe enough to be disrupting life, the symptoms are not due to religious or cultural practice, and the symptoms are not due to any type of drug. (Siegel 2011)

 

More information on how to interpret the DSM-5


Reviewed by Sara Staggs, LICSW, MSW, MPH

 
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