The DSM-5 replaced the now defunct category known as “dissociative disorder not otherwise described” (DDNOS) with other specified dissociative disorder (OSDD) and unspecified dissociative disorder. Ignoring the vagueness of the category that begins with “other specified,” which at first glance seems to be a catch all for anything that does not fit into the other categories (dissociative identity disorder, dissociative amnesia, and depersonalization – derealization disorder) this mental illness is the most common, pervasive and conceptually difficult to understand, and for the afflicted to live with. It is a disorder of uncommon dissociative states that influence one another to the point they cause unfounded mental confusion, emotional conflict and disappointment among the selves. The selves are said to possess a magical way of being, but in reality they are nothing more than normal states that have been altered to the point they cannot communicate well with each other. (Giuseppe et al., 2014)
One way that the etiology of OSDD differs from dissociative identity disorder is that the factors required to cause the disorder need only consume one childhood developmental stage, rather than the two needed to cause dissociative identity disorder. While research has not pinpointed the exact time-frame “abuse” occurs in order to cause OSDD, they have with dissociative identity disorder. It only makes sense that since this is a mental disorder caused by structural dissociation, that the factors must occur prior to the age in which structural dissociation would no longer define the disorder. That means that a child must live in an environment prior to the age of four where they were unable to form a secure attachment with a primary caregiver, and their brain was terrorized on a consistent basis for at least one childhood developmental period. These children are unable to bring their partially developed personality states together in what is known as an integrated state. The states are not as distinct, or as elaborate as those seen in dissociative identity disorder, and the dissociative boundaries are not as intense (phobic of trauma), but the lack of those characteristics is exactly what makes this mental disorder so difficult to live with. They are not afforded the extreme protection of state isolation seen in dissociative identity disorder, but they have enough isolation that they are highly distressed in many ways. (Lanius et al.,2014) Triggers are important to individuals with OSDD since they cause the less than distinct states to react. In dissociative identity disorder, the states are too protected by thick dissociative boundaries to react by triggers unless they are directly from childhood. A word or phase is not going to affect someone with dissociative identity disorder, like it does an individual with OSDD.
In adults, the presentation of other specified dissociative disorder is this. Dissociative states switch freely, and often, and although some may become quite elaborated, they never reach the level seen in the other complex Dissociative Disorder – dissociative identity disorder. Evidence has been gained through fMRI scans that shows clearly how these states behave, and there is one, and only one, distinct state, which is the part of the personality in those with structural dissociation that attends to daily life activities. All other states are less than distinct states, which are the type that are associated with unprocessed trauma. In Dissociative identity disorder, no state will associate with another state while in the conscious mind, which has been verified repeatedly by fMRI scans. Meanwhile, in OSDD, all states can actually be in the conscious mind at one time. As you can see, these two complex Dissociative Disorders are highly differentiated and are not “like” each other, which is an all too common misconception. (Lanius et al., 2014)
The differences begin in early infancy, which is where dissociative identity disorder is born. It is “abuse” in this childhood period that is required to cause dissociative identity disorder, and lack of certain criteria that allows others to escape the more complex of the Dissociative Disorders. The mental illness known as OSDD is, without a doubt, more common, more intrusive and is what is actually written about instead of dissociative identity disorder,, foolishly, when authors don’t know one illness from the other. (Lanius et al., 2014)
For a therapist to distinguish OSDD from dissociative identity disorder, they need to do some detective work. The easiest way to identity OSDD is to rule out other disorders. Both PTSD and the complex version of PTSD would quickly be ruled out after states identify themselves with elaboration. Borderline personality disorder, although this disorder can be complicated by structural dissociation occurring after the disorder has already formed, is still distinct in his characteristics. The individual with borderline personality disorder will act a certain way. They cannot help themselves. It can be tricky because states in both complex Dissociative Disorders can behave as if they have borderline personality disorder, due to introjected behavior of an adult they were influenced by in childhood, but to have a personality disorder, every single state must have that personality disorder, otherwise it’s just introjected behavior which can be changed – unlike personality disorders which cannot be “cured.” (Lanius et al., 2014)
The only other disorder to then distinguish from is dissociative identity disorder. In this presentation there will be switches between distinct states. A therapist will ignore switches between child-like states because they will be the less than distinct states, and both disorders have this same presentation. The diagnostician will look for switches between states that are adult-like and address daily life tasks. In addition, the states will not know they have switched. While dissociative amnesia is seen in all the Dissociative Disorders, and even in PTSD, it is true amnesia,which only only exists between distinct states, that is seen in dissociative identity disorder. (Lanius et al.,2014)
The DSM-5 category unspecified dissociative disorder is used when it’s clear an individual has a Dissociative Disorder, but it’s unclear which one. This is meant to be a temporary category only, while the actual disorder is found.