psychiatric disorders
Dissociative Identity Disorder
Diagnosis of Dissociative Identity Disorder
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria Detailed interviews, sometimes with hypnosis or facilitated by medications Diagnosis of dissociative identity disorder is clinical, based on presence of the following criteria in the DSM-5-TR: Patients have≥2 personality states or identities (disruption of identity), with substantial discontinuity in their sense of self and sense of agency. Patients have gaps in their memory for everyday events, important personal information, and traumatic events—information that would not typically be lost with ordinary forgetting. Symptoms cause significant distress or significantly impair social or occupational functioning. Also, the symptoms cannot be better accounted for by another disorder (eg, complex partial seizures, bipolar disorder, posttraumatic stress disorder, another dissociative disorder), by the effects of alcohol intoxication, by broadly accepted cultural or religious practices, or, in children, by fantasy play (eg, an imaginary friend). The diagnosis requires knowledge of and specific questions about dissociative phenomena. Prolonged interviews, Hypnotherapy , or medication-facilitated (barbiturate or benzodiazepine) interviews are sometimes used, and patients may be asked to keep a journal between visits. All of these measures involve an attempt to bring out a shift of identities during the evaluation. The clinician may over time attempt to map out the different identities and their interrelationships. Specially designed structured interviews and questionnaires may be used, especially for clinicians who have less experience with this disorder. The clinician may also attempt to directly contact other identities by asking to speak to the part of the mind involved in behaviors that patients cannot remember or that seem to be done by someone else. Hypnosis can help clinicians access the patient's dissociated states and other identities and help the patient better control the shifts among the dissociated states. Malingering (intentional feigning of physical or psychologic symptoms motivated by an external incentive) should be considered if gain could be a motive (eg, to escape accountability for actions or responsibilities). However, malingerers tend to overreport well-known symptoms of the disorder (eg, Dissociative Amnesia ) and underreport others. They also tend to create stereotypical alternate identities. In contrast to patients who have the disorder, malingerers usually seem to enjoy the idea of having the disorder; in contrast, patients with dissociative identity disorder often try to hide it. When clinicians suspect that the disorder is feigned, cross-checking information from multiple sources may detect inconsistencies that preclude the diagnosis. 