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Dissociative Disorders in the DSM-5

The DSM-5 was updated May 2013. It continues to include the following in the category of Dissociative Disorders: Dissociative Identity Disorder, Dissociative Amnesia, Other Specified Dissociative Disorder and Unspecified Dissociative Disorder.

Personality

In the DSM-5 the personality is one entity but with different characteristics that show up on fMRI and are referred to as personality states ranging from slightly distinct to highly distinct. The various lighting technique used on scans shows marked differences between Posttraumatic Stress Disorder, Dissociative Amnesia, Other Specified Dissociative Disorder and Dissociative Identity Disorder, but there is no visible evidence of what the DSM-5 calls Depersonalization/Derealization Disorder.

Personality can be defined as a biopsychosocial system that determines an individual's characteristic mental and behavioral actions. This definition highlights the fact that personality includes perception and emotion; that perception, emotion, and thought involve mental actions, including decision making; and that behavior involves combined mental and motor action. Personality constitutes a whole system that has an ongoing tendency toward integration, that is, binding and differentiation of different components of experiences as well as different experiences across time. In dissociation in trauma, personality as a system includes two or more insufficiently integrated subsystems.

Distinct personality state (DPS)

The DSM-5 uses the terminology distinct personality state (DPS) to define the different mental disorders classified within the category referred to as Dissociative Disorders.

Less-distinct personality state

The DSM-5 avoids using the term DPS[4][9] to describe anything other than Dissociative Identity Disorder. When terminology is absolute then this version refers to the most innate of all types of disorders and reflects the very essence of each independent disorder refereeing to each as a unique part of a make up and class of disorders.[3][5][7][11]

Dissociation

Dissociation is defined as a state of being that is pathological to the adult human, but innate to a child because fantasy, dream states and other forms of magical play are part of a child's world, but adults don't fall into the category of play because while they dream and even day dream they don't habituate in the avenue of making it a daily life habit. Onno van der Hart and Ellert Nijenhuis further define dissociation, and while they have a set goal the populous of the ISSTD falls behind them lacking the understanding they have of the subject, but none-the-less, these two researchers are the foremost experts on the subject and have a large following consisting of the top researching in the field.

Dissociation in trauma entails a division of an individual’s personality, i.e., of the dynamic, biopsychosocial system as a whole that determines his or her characteristic mental and behavioral actions. This division of personality constitutes a core feature of trauma. It evolves when the individual lacks the capacity to integrate adverse experiences in part or in full, can support adaptation in this context, but commonly also implies adaptive limitations. The division involves two or more insufficiently integrated dynamic, that is changeable, but excessively rigid subsystems. These subsystems exert functions, and can encompass any number of different dynamic configurations of brain, body, and environment. These different configurations manifest as dynamic actions and implied dynamic states. The dissociative subsystems can be latent, or activated in a sequence or in parallel. Each dissociative subsystem, i.e., dissociative part of the personality includes its own, at least rudimentary person perspectives, that is, its own epistemic pluralism and epistemic dependency. As each dissociative part, the individual can interact with other dissociative parts and other individuals, at least in principle. Dissociative parts maintain permeable biopsychosocial boundaries that keep them divided, but that they can in principle dissolve. Phenomenologically, this division of the personality manifest in dissociative symptoms that can be categorized as negative or positive, and cognitive-emotional or sensorimotor.

Category 300.14 (F44.81)

Dissociative Identity Disorder is diagnosed by the following criteria, which like all mental disorders in the DSM-5, the minimum criteria needed to diagnose a disorder is all that is needed and so that is all that is used. As shown below it only takes three criteria to diagnosis the most complex of any mental disorder,[5] but a diagnostician must be able to identify True Amnesia from Dissociative Amnesia and it is essential they understand how to recognize a Distinct Personality State from a Less-Distinct Personality State.

   #Two distinct personality states (DPS) switch with disruption in identity.
   #True amnesia, (not to be confused with Dissociative Amnesia) is present between two or more Distinct Personality States.
   #Significant impairment due to symptoms.
   #Lacking a "temporary state" created purposefully by cultural practice, which is a common addition to any DSM category like this.
   #The defined symptoms are not attributed to other factors, which again is a common addition to any DSM category like this.

Category 300.12 (F44.0)

Dissociative Amnesia is diagnosed by four criteria in the DSM-5.

   #Amnesia, which is not to be confused with True Amnesia which is only found in Dissociative Identity Disorder.
   #Significant impairment due to symptoms.
   #Lacking drug affects, direct trauma to the skull or other neurological condition.
   #Lacking a "temporary state" created purposefully by cultural practice, which is a common addition to any DSM category like this.
   #The defined symptoms are not attributed to Dissociative Identity Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder, Somatic Symptoms Disorder or any other neurological disorder.

International Society for the Study of Trauma and Dissociation (ISSTD)

The International Society for the Study of Trauma and Dissociation is considered to be the foremost expert on the subject of Dissociative Disorders, psychological trauma and they are by default the organization that should be referenced in bulk.

History

Twice upon a time there were references that pointed people to disasters of blame; within the psychiatry section of the sciences there was the idea that therapists caused the dissociative disorders, but there is no doubt now, that suggestion cannot make a person do anything! This point was drilled in by the foremost expert in the field of dissociation today, Ellert R.S. Nijenhuis, in The Trinity of Trauma: Ignorance, Fragility and Control. The Evolving Concepts of Trauma.

The studies that have been considered so far do not provide convincing empirical evidence for the various hypotheses of the SC- and F-models of dissociative symptoms and disorders. To the extent that the involved hypotheses of these models differ from the hypotheses of trauma models of dissociative sympotms and disorders, they have not been confirmed by studies with general population and clinical samples. A most serious problem of SC- and F-models of DID is that supports of these persuasions did not test the hypotheses in samples with DID patients.