Dissociative disorders in DSM-V

Department of Psychiatry, Stanford University, Palo Alto, California, USA.
Depression and Anxiety (Impact Factor: 4.41). 03/2011; 28(12):E17-45. DOI: 10.1002/da.20923
Source: PubMed


We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria.
This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding dissociative symptoms and disorders.
We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should include derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category.
There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms.

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    • "Proposals from all of the work groups were posted on the DSM-5 website in 2010. Many of the DSM-5 literature reviews did appear to meet the spirit of the Kendler et al. (2009) guidelines, such as the reviews for hoarding (Frost, Steketee, & Tolin, 2012), hypersexual disorder (Kafka, 2010), dissociative disorders (Spiegel et al., 2013), and the proposal to subtype conduct disorder for callous-unemotional traits (Frick, Ray, Thornton, & Than, in press). However, many others did not (Frances & Widiger, 2012; Widiger & Crego, 2015). "

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    • ") as well as the awareness of the significant amount of psychiatric patients resistant to available treatment options (Bondolfi et al., 1998; Dunlop, Kaye, Youngner, & Rothbaum, 2014; Zarate et al., 2004) stimulated psychological and biological subtyping of psychiatric disorders. In PTSD research, these efforts resulted inter alia in proposals of symptomatically (Flood et al., 2010; Spiegel et al., 2013; Weston, 2014) and biologically (Mehta et al., 2011; Zaba et al., 2015) distinct PTSD endophenotypes. The PTSD dissociative subtype has reached the level of a diagnosis in DSM-5 (American Psychiatric Association, 2013). "
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    • "It is claimed that hypnosis is easier with people who have PTSD or DID [46], and this suggests that the backup becomes easier to trigger with repetition. Whether this is a factor in AD might again be hard to assess because of the atrophy and deterioration, as the consequent loss of ability will make the cut-out easier to trigger. "
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