Dissociative disorders in DSM‐5

The authors propose revisions to the diagnostic criteria for Dissociative Disorders in DSM-5 based on a review of clinical, phenomenological, epidemiological, cultural, and neurobiological data. They recommend that Depersonalization Disorder include derealization symptoms, that Dissociative Fugue become a subtype of Dissociative Amnesia, and that the criteria for Dissociative Identity Disorder emphasize disruptive dissociation and amnesia for everyday as well as traumatic events, with possession experiences included in identity disruption. They also suggest placing Dissociative Trance Disorder in the Unspecified Dissociative Disorder category.

Study at a glance

Abstract

Background: 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. Methods: 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. Results: We make 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. Should Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category.