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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Available from: Richard J Loewenstein
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    • "The dissociative subtype is characterized by blunted affect and symptoms of depersonalization/derealization (persistent distortions in one's perception of the self or compelling experiences of the unreality of one's environment) in response to trauma cues, higher levels of re-experiencing and amnestic symptoms , earlier onset of PTSD symptomatology, higher comorbidity with other psychiatric conditions, and higher suicidality. In contrast, the more frequent, non-dissociative subtype experiences greater hyperarousal in response to trauma cues (Spiegel et al., 2013). Multiple studies using epidemiological data or finite mixture modeling, a method for partitioning cases into homogeneous classes, have provided convergent evidence for the dissociative subtype (Blevins, Weathers, & Witte, 2014; Frewen, Brown, Steuwe, & Lanius, 2015; Stein et al., 2013; Wolf et al., 2012). "
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    ABSTRACT: Converging evidence suggests that heterogeneity in posttraumatic stress disorder (PTSD) arises from the presence of discrete subtypes of patients, one of which is characterized by elevated dissociative symptoms. A similar dissociative subtype has been observed among individuals displaying high hypnotic suggestibility. Here we highlight important parallels between these subtypes, drawing from research on a history of exposure to stressful life events and pathological symptomatology, cognitive functioning, hypnotic suggestibility, and functional neuroimaging and electrophysiology. Further clarification of these parallels can help elucidate the developmental paths and neurocognitive basis of heterogeneity in PTSD and high hypnotic suggestibility and refine the understanding and treatment of different subtypes of PTSD.
    Full-text · Article · Dec 2015 · Current Directions in Psychological Science
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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). "

    Full-text · Article · Jul 2015 · Psychological Inquiry
    • "Rather than employing experimental methods, the literature which examined possible associations with hearing voices has employed a range of self-report instruments to measure dissociation, in particular (but not exclusively) the Dissociative Experiences Scale (DES;Bernstein & Putnam, 1986), the most commonly employed questionnaire to measure dissociation across different clinical and non-clinical populations (Holmes et al., 2005;van IJzendoorn & Schuengel, 1996). The DES assesses three distinct areas of dissociation including absorption (i.e., the experience of losing contact with one's present moment experience and becoming immersed in internal events such as thoughts and imagery;Waller, Putman, & Carlson, 1996;Waller & Ross, 1997), depersonalisation/derealisation (i.e., experiencing a sense of unreality, detachment or disconnection in relation to one's body and surroundings;Hunter, Sierra, & David, 2004) and dissociative amnesia (i.e., the inability , distinct from ordinary forgetfulness, to consciously retrieve autobiographical , personal information that would ordinarily be readily accessible to recall;Spiegel et al., 2011). At present, empirical studies have not been systematically reviewed and synthesised, and an assessment of the quality of evidence to support the proposed association has not been carried out. "
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    ABSTRACT: There are an increasing number of studies exploring the association between voice-hearing (auditory verbal hallucinations) and dissociative experiences. The current study provides a systematic literature review and meta-analytic synthesis of quantitative studies investigating the relationship between voice-hearing and dissociation. A systematic search identified and included 19 clinical studies, comprising 1620 participants, and 12 non-clinical studies, comprising 2137 participants, published between 1986 and 2014. Nineteen of these studies provided sufficient data to be included within the meta-analysis. The narrative review findings suggested that dissociative experiences may be implicated in voice-hearing, and may potentially be a mediating factor within the well-established trauma and voice-hearing relationship. Similarly, the meta-analytic findings suggested that the majority of the identified studies showed a significant positive relationship between dissociative experiences and voice-hearing. The magnitude of the summary effect was large and significant (r=.52), indicating a robust relationship between these two phenomena. However, considerable heterogeneity within the meta-analytic results and methodological limitations of the identified studies were evident, highlighting areas for future investigation. As the majority of the studies were cross-sectional by design, we recommended future research to include longitudinal designs with a view to exploring directional effects. Additionally, future studies should control for potential confounding factors. Clinical implications of the findings were also considered. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Jun 2015 · Clinical psychology review
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