DID DSM-5 Criteria

What is dissociative identity disorder (DID)?

Dissociative identity disorder (DID), previously known as multiple personality disorder, is a mental health condition that presents the existence of two or more distinct identities or personality states that recurrently have power over an individual's behavior. In essence, a person with DID shifts between multiple identities that think, communicate, and behave in different ways in their own relatively enduring pattern.

The development of this mental disorder is often associated with severe traumatic memories and experiences, such as repeated childhood abuse. Dissociation, a defense mechanism to disconnect from overwhelming experiences, can lead to the formation of distinct identities as a coping strategy.

Diagnosing DID involves a comprehensive evaluation by mental health professionals, following the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Key criteria beyond the presence of two or more distinct personality states include recurrent memory gaps and significant distress or impairment in daily functioning (American Psychiatric Association, 2013).

Dissociative symptoms

Dissociative symptoms are key indicators of dissociative identity disorder and can manifest in various ways. These symptoms commonly include the following:

Amnesia or memory gaps

People with DID often experience amnesia, which goes beyond simple forgetfulness. There are notable gaps in their remembrance of routine personal information, activities, and traumatic events. These memory lapses can be fragmented, selective, or generalized, leading to a duality of memories corresponding to their different identities.

Depersonalization and derealization

Depersonalization refers to periods when individuals feel detached or disconnected from themselves, observing their own actions, feelings, and thoughts from an outsider's perspective. Derealization, another frequently noted symptom, is characterized by a perceived change or alteration in the external world, making it feel unreal or dreamlike.

Identity disruptions

At the core of DID lies disruptions in identity. This is described as two or more distinct personality states that each possess their perception, interaction, and thought process about themselves and the environment. These transitions between identities, often referred to as switching, can be triggered by stressors or be spontaneous. Each identity might have a unique name, personal history, and characteristics.

Trance-like states

Trance-like states or fugue states, marked by unresponsiveness and lack of interaction with the surroundings, can occur. They are often mistaken for daydreaming, but people with DID might become physically immobilized or lose touch with reality during these periods.

Posttraumatic symptoms

People with DID often exhibit posttraumatic symptoms and may display emotional constraint, hostility, and a hindered ability to engage in close relationships. Experiences of past traumatic events may resurface, leading to intense emotional distress and physical reactions.

Involuntary movements or sensations

In certain instances, individuals with DID may present involuntary movements or unexplained physical sensations. These are usually not under their control and may further support the diagnosis.

How to diagnose dissociative disorder?

Diagnosing dissociative identity disorder or other personality disorders involves a thorough assessment by mental health professionals. Proper diagnosis of DID is crucial for initiating the right therapeutic interventions. The following is an overview of how healthcare practitioners can approach the diagnostic process for DID:

Step 1: Initial evaluation

Start by thoroughly evaluating the patient's medical history and current symptoms. This step uncovers essential information about the individual and establishes a rapport that encourages open communication.

Step 2: Look for dissociative symptoms

Closely observe for signs of dissociative symptoms specific to DID, such as memory gaps, sense of depersonalization and derealization, identity disruptions, trance-like states, posttraumatic symptoms, and involuntary movements or sensations.

Step 3: Apply DSM-5 criteria

Once the presence of dissociative symptoms is confirmed, apply the diagnostic criteria outlined in the DSM-5 for DID:

• Disruption of identity: Characterized by the existence of two or more distinct identity states or personality modes leading to an individual's behavior
• Recurrent gaps in memory: Involving everyday events, personal information, or traumatic experiences not explained by ordinary forgetfulness
• The symptoms must cause considerable distress or problems in social, occupational, or other areas of functioning.
• The disturbance is not a normal part of broadly accepted cultural or religious practice and is not attributable to the physiological effects of a substance or another medical condition.

Step 4: Rule out other disorders

Ensure symptoms are not more readily attributed to another mental health disorder, cultural practice, effects of substance use, or a medical condition. This step helps to avoid misdiagnoses, which are not uncommon due to symptom overlaps with other mental health conditions.

Step 5: Psychological evaluation

Consider using standardized dissociative identity disorder tests and structured clinical interview tools like the Dissociative Disorders Interview Schedule (DDIS) or the Structured Clinical Interview for DSM (SCID-D) to help formulate a more accurate diagnosis. These evaluations serve as additional checks for DID and can uncover associated symptoms that may not be immediately obvious.

DID DSM-5 diagnostic criteria

Healthcare practitioners have at their disposal a detailed framework provided by the DSM-5 to guide them through the diagnosis process. Using this framework ensures that the diagnosis of DID is precise and accurate. The DSM-5 lays out the following criteria to diagnose DID:

A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in the sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

B. Recurrent gaps in the recall of everyday events, important personal information, and/ or traumatic events that are inconsistent with ordinary forgetting.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.

Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.

E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

How to use our DID criteria DSM-5 template?

The dissociative identity disorder criteria DSM-5 template is designed as a comprehensive checklist to streamline the diagnostic process for healthcare professionals. The following steps can help you effectively use this template:

Step 1: Review the criteria briefly

Before delving into the specifics with the patient, quickly review the DSM-5 criteria yourself. This step ensures you know what information you need to gather during the diagnostic process.

Step 2: Apply DSM-5 criteria

Once the presence of dissociative symptoms is confirmed, apply the diagnostic criteria outlined in the DSM-5 for DID by using the checklist in our template as a documentation tool.

Step 3: Rule out other causes

Ensure that the dissociative symptoms aren't due to the physiological effects of substance use, a medical condition, or part of a cultural or religious practice.

Step 4: Compile findings

After completing the checklist, review the gathered information to form an overall diagnostic picture.

Step 5: Decide on next steps

Based on your findings, consider the appropriate directions for patient care, whether developing a treatment plan, seeking a specialist, or conducting further evaluations.

Managing and treating dissociative identity disorder

Managing and treating dissociative identity disorder involves a comprehensive approach that focuses on integrating the different identities and addressing the underlying trauma that contributed to the disorder's development. Here are some key strategies healthcare practitioners can consider:

Stabilization

At the outset, focusing on stabilization is critical. This involves strategies like teaching emotional regulation skills, developing distress tolerance, and creating safety plans to manage the distress that may arise during therapy.

Psychotherapy

Psychotherapy forms the mainstay of DID treatment, particularly the following approaches:

• Psychodynamic therapy: This explores the unconscious processes and interrelationships between the different identities.
• Cognitive behavioral therapy (CBT): Adapted for DID, CBT can help reshape dysfunctional thoughts and integrate traumatic memories.

Addressing trauma

Trauma work is often central to DID therapy, allowing individuals to confront and reprocess traumatic experiences safely. Techniques such as eye movement desensitization and reprocessing (EMDR) may be utilized.

Medication

While no medications currently exist for DID itself, psychopharmacology can be beneficial for co-occurring symptoms such as depression, anxiety, or PTSD.

Coping strategies

Equipping individuals with coping strategies to manage acute dissociative episodes and reduce their frequency and intensity can enhance day-to-day functioning.

Family therapy

Involving family or close relationships can provide essential support and increase understanding of DID for those in the individual's support network.

Reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.