Dissociative disorders in DSM-5

The DSM and ICD formulations originate in Janet’s conceptualization of dissociation, which he termed ‘‘de´sagre´gation mentale’’. Janet postulated that a failure of integration of mental elements was the fundamental aspect of hysterical (i.e. dissociative and conversion) disorders. In DSM-5, possession experiences are included in the diagnostic criteria of dissociative identity disorder (DID) as well as in related types of other specified dissociative disorders possibly, non-dissociative psychiatric disorders with an onset in adulthood compensate Downloaded by this difference by possession experiences accompanying the primary disorder. Dissociative subtypes of schizophrenia, depression, and PTSD may be among them Experiences of possession seem to be a common final pathway of adaptation to traumatic stress in the spectrum extending from normality to pathological. Last but not least, future studies may lead to development of revised diagnostic criteria (e.g. requirements for a minimum of severity and chronicity) for adolescent DID and allied dissociative disorders in updated versions of the DSM-5 to exclude dissociative phenomena possibly normative or rather acute or transient for this age group. DSM-IV-TR portrays DID by means of two dissociative phenomena: amnesia and the presence of alter personalities. DSM-IV-TR also notes that DID patients may manifest şashbacks, voices, and conversion symptoms. Dell proposed a revised concept of DID that he called “major dissociative disorder.” He organized the previously replicated findings about DID into three diagnostic criteria: a) pervasive dissociation (i.e., memory problems, depersonalization, derealization, şashbacks, somatoform dissociation, and trance); b) partially dissociated manifestations of an alter personality (i.e., child voices; internal struggle; persecutory voices; partially dissociated speech, thoughts, emotions, impulses, and actions; temporarily dissociated knowledge/skills; disconcerting experiences of self-alteration; and self-puzzlement); and c) fully dissociated manifestations of an alter personality (i.e., time loss, “coming to,” fugues, being told of forgotten behavior, finding unexplainable objects among one’s possessions, and finding evidence of one’s previous unknown actions).Research on DID has repeatedly reported that DID patients manifest memory problems; depersonalization; derealization; identity confusion; trance; ego-alien, passive inşuence experiences such as the Schneiderian first-rank symptoms of “made” feelings, “made” impulses, “made” actions, inşuences playing on the body, thought insertion, and thought withdrawal; child voices; persecutory voices; voices commenting; voices arguing or conversing; somatoform/ conversion symptoms; time loss; fugues; finding evidence of one’s previously unknown actions; and şashbacks. Spiegel et al. made the following recommendations for DSM-5: 1.Depersonalization Disorder (DPD) should 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.