Dissociation Diagnosis

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The following are the dissociation diagnosis for various forms of PTSD and dissociative conditions.

Post-Traumatic Stress Disorder (PTSD)

The development of characteristic symptoms following a psychologically distressing event that is outside the range of usual human experience. The characteristic symptoms involve re-experiencing the traumatic event, avoidance of stimuli associated with the event or numbing of general responsiveness and increased arousal. This group of symptoms was initially recognized in conjunction with other types of trauma. Professionals noticed that some survivors of car accidents had reactions similar to those of soldiers returning from combat. In the past this group of symptoms was alternately called shell shock, battle fatigue, or combat neurosis.

With PTSD, aspects of the traumatic event are dissociated, but the event is not forgotten. Treatment usually focuses on processing the unassimilated parts of the trauma by giving expression to it, thereby healing the aftereffects. The trauma may be re-experienced through dreams, behaviors, emotions, and bodily responses. Sometimes the trauma or aspects of it are re-experienced through flashbacks, nightmares, night terrors, and/or startle responses. Although symptoms of PTSD may feel frightening and are a cause of great distress, they are the body/mind's attempt to heal. The trauma is breaking through into conscious awareness, where it can be assimilated and healed. (DSM-IV)

PTSD is characterized by:

• recurrent or intrusive distressing recollections of an event( images, thoughts, perceptions)
• re-experiencing the trauma of the event through dreams or flashbacks
• feelings of emotional numbness and detachment from others
• irritability or exaggerated startle responses, or hyper-vigilance
• sleep difficulties
• anger or anxiety
• difficulty concentrating
• physiological responses to situations or events that symbolize or resemble the original stressful event or situation.

Symptoms of the disorder may occur within hours of the stressful event. Or they may not appear until months or years later.

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Depersonalization Disorder

A. Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream).

B. During the depersonalization experience, reality testing remains intact.

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

D. The depersonalization experience does not occur exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder, Acute Stress Disorder, or another Dissociative Disorder, and is not due to the direct physiological effects of a substance(e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy). (DSM-IV)

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Dissociative Fugue

A. The predominant disturbance is sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past.

B. Confusion about personal identity or assumption of a new identity (partial or complete).

C. The disturbance does not occur exclusively during the course of Dissociative Identity Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).

D. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (DSM-IV)

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Dissociative Amnesia

A. The predominant disturbance is one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.

B. The disturbance does not occur exclusively during the course of Dissociative Identity Disorder, Dissociative Fugue, Post traumatic Stress Disorder, Acute Stress Disorder, or Somatization Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a neurological or other general medical condition (e.g., Amnestic Disorder Due to Head Trauma).

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (DSM-IV)

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Dissociative Disorder - Not Otherwise Specified (DD-NOS)

This category is included for disorders in which the predominant feature is a Dissociative symptom (i.e., a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment) that does not meet the criteria for any specific Dissociative Disorder.

Examples include

1. Clinical presentations similar to Dissociative Identity Disorder that fail to meet full criteria for this Disorder. Examples include presentations in which
   a) there are not two or more distinct personality states, or
   b) amnesia for important personal information does not occur.

2. De-realization (A feeling of unreality or detachment from the environment, is frequently present in addition to the sense of estrangement from self.) unaccompanied by depersonalization in adults.

3. States of dissociation that occur in individuals who have been subjected to periods of prolonged and intense coercive persuasion (e.g., brainwashing, thought re-form, or indoctrination while captive).

4. Dissociative trance disorder: single or episodic disturbances in the state of consciousness, identity, or memory that are indigenous to particular locations and cultures. Dissociative trance involves narrowing of awareness of immediate surroundings or stereotyped behaviors or movements that are experienced as being beyond one's control. Possession trance involves replacement of the customary sense of personal identity by a new identity, attributed to the influence of a spirit, power, deity, or other person, and associated with stereotyped "involuntary" movements or amnesia. Examples include amok (Indonesia), bebainan (Indonesia), latab (Malaysia), pibloktoq (Arctic), ataque de nervios (Latin America), and possession (India). The Dissociative or trance disorder is not a normal part of a broadly accepted collective cultural or religious practice.

5. Loss of consciousness, stupor, or coma not attributable to a general medical condition.

6. Ganser syndrome: the giving of approximate answers to questions (e.g., "2 plus 2 equals 5") when not associated with Dissociative Amnesia or Dissociative Fugue. (DSM-IV)

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Dissociative Identity Disorder (DID)

A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).

B. At least two of these identities or personality states recurrently take control of the person's behaviour.

C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). In children, the symptoms are not attributable to imaginary playmates or other fantasy play. (DSM-IV)

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Catatonia/Catalepsy

Catatonia: An extreme form of withdrawal in which the individual retreats into a completely immobile state, showing a total lack of responsiveness to stimulation.

Catalepsy: a physical state in which muscles of the face, body, and limbs take on a condition of suspended animation; trancelike or unresponsive state of consciousness; also called anochlesia; may last for many hours; body position or expression does not alter and limbs remain in whatever position they are placed (known as flexibilitas cerea, or waxy flexibility); associated with hysteria, epilepsy, and schizophrenia in humans, and with organic nervous disease in animals; may also be caused by brain disease and some drugs.

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Excerpted from Compton's Interactive Encyclopedia - Current List of Specific Diagnosis (2003)

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