DDNOS1 and Dissociative Identity Disorder – Do you know the differences?

Dissociative Disorder Not Otherwise Specified (DDNOS) and Other Specified Dissociative Disorder (OSDD)

Dissociative Disorder Not Otherwise Specified was the most commonly diagnosed Dissociative Disorder in the DSM-IV diagnostic manual.[1] DDNOS is a complex dissociative disorder which includes many different groups of dissociative symptoms. The most common presentations of DDNOS are numbered, for example DDNOS1, DDNOS2, etc. The DSM-5 changed the name of DDNOS to Other Specified Dissociative Disorder (OSDD); DDNOS-1 was renamed to OSDD-1.

DDNOS-1 and Other Specified Dissociative Disorder

Dissociative Disorder Not Otherwise Specified (DDNOS) and DID. DDNOS is any significant mix of dissociative symptoms that don't fully fit another Dissociative Disorder - It was renamed to Other Specified Dissociative Disorder in the DSM-5 - DDNOS-1 (DDNOS presentation 1) is very similar to DID. DDNOS 1 is either DDNOS-1a - identity disturbance with less distinct parts than in DID (alter personalities may exist but can't physically take control of the person's body, but strongly influence the person's thoughts and actions and amnesia is present), or DDNOS-1b - distinct dissociative parts (alters identities) exist and can take executive control, but without amnesia, less common - DDNOS may be diagnosed if symptoms are not quite clear enough for DID criteria but are similar - the amnesia needed for DID in the DSM5 has been broadened to "recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting", meaning amnesia for past trauma alone is enough - symptoms (including alters and amnesia) can be self-reported in the DSM5. height=

DDNOS1 and Dissociative Identity Disorder differences explained and DSM-5 changes to DID.
Information taken from DSM-5 (APA, 2013) and Dissociative Disorders: The DSM-V and beyond (2011).

DDNOS-1 is the most common form of DDNOS, and can be thought of as “partial DID”. [1] The improved wording of the Dissociative Identity Disorder criteria in the DSM-5 will help those incorrectly diagnosed as DDNOS, for instance because of not obviously switching to an alter identity in front of the psychiatrist, be correctly classed as Dissociative Identity Disorder. [1, 2]

References

  1. Dell, P. F., & O’Neil, J. A. (Eds.). (2010).Dissociation and the dissociative disorders: DSM-V and beyond. Routledge. ISBN 1135906033.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association. ISBN 0890425574.

Related links

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Depersonalization Disorder – a personal experience of treatment

This blog was inspired by an excellent blog post describing elements of living with chronic Depersonalization, which is now known as Depersonalization/Derealization disorder. Read Sandy’s blog to find her experiences of treatment Dreamchild – Therapy and Medication.

Diagnostic Criteria

Depersonalization/Derealization Disorder description

Depersonalization disorder is a Dissociative Disorder. Depersonalization is an experience that can occur within a schizophrenic, depressive, phobic, or obsessive-compulsive disorder, or Dissociative Identity Disorder, as well as being a separate disorder.

Certain substances can also cause these effects, so these are excluded in the diagnostic criteria. Depersonalization often includes Derealization experiences (DR); they are now considered a single disorder.

The Stranger In The Mirror

Art from http://mermann87.deviantart.com/art/Mirror-Transgender-Self-90629564 Known as DP or DPD, Depersonalization Disorder can be difficult to treat. One example of depersonalization is being unable to recognize yourself in a mirror. Dissociation expert Dr Marlene Steinberg’s reflected this in the name of her classic book, The Stranger in the Mirror, Dissociation – The Hidden Epidemic, and the art work here.

Artwork from http://mermann87.deviantart.com/art/Mirror-Transgender-Self-90629564

What is it like to be suffering from something that isn’t adequately recognized?

Today I stumbled across an excellent article by UK psychotherapist Valerie Sinason about Dissociative Identity Disorder and the difficulties in both diagnosis and treatment which exist within the very traditional British public health care system.

Sinason writes:

Without early specialist training on the consequences of abuse, professionals are attacking each other’s contradictory diagnoses without realising the aptness of Walt Whitman’s words “I am large. I contain multitudes”.

 

truth hidden attachment John Bowlby

We cannot see what we cannot bear – John Bowlby, psychoanalyst

Compared with Freud’s ability to recognise the traumatic aetiology of hysteria one hundred years ago (Freud, 1896), contemporary clinicians have found it extremely hard to bear the horrors of patients’ objective lives. Sometimes (Hale & Sinason 1994) psychotherapists’focus on the internal narrative is a defence against the historic external reality.

However, as de Zulueta (1995) comments: “a refusal on the part of psychiatrists and therapists to validate the horrors of their patients’ tortured past implies a refusal to take seriously the unconscious psychological mechanisms that individuals need to use to protect themselves from the unspeakable.

Both quotes come from the revised edition of Attachment, Trauma and Multiplicity by Valerie Sinason (Editor), which contains contributions by both survivors of trauma with Dissociative Identity Disorder and professionals working with psychological trauma.

Does the NHS have (undiagnosed) Dissociative Identity Disorder?

Recently I heard a therapist who does a great deal of trauma work in the UK refer humourusly to the British NHS health care as having a so many separate states that do not communicate with each other, and typically have different and opposing ideas, that it felt as if the NHS system itself was in fact suffering from dissociative identity disorder… Sinason writes about “Fragmentation within professional teams” as well as between them:

“the psychiatrist who meets a frozen DID patient who shows only one state (as a result of correctly assessing their psychiatrist’s inability to deal with the subject) then attacks the other psychiatrist/social worker/psychologist/psychotherapist who points out the fragmentation into states. We are then witnessing the trauma-organised systems… that systemically mirror the DID experience.”

Read more (Details may trigger.)

 

Dissociation within PTSD – evidence

Dissociation in Posttraumatic Stress Disorder: Evidence from the World Mental Health Surveys

The DSM-5 added a new dissociative subtype of Posttraumatic Stress Disorder (PTSD) last year, but before this was finalized there were concerns that the majority of the evidence for the dissociative subtype of PTSD came from Western counties. The research described here consisted of interviews with over 25,000 respondents across 16 countries in the World Health Organization World Mental Health Surveys in order to assess whether this differed between low/middle and high income countries, and whether this was consistent across a diverse set of countries.

The results showed that dissociative symptoms within PTSD did not differ between high and low/middle income countries after 12 months. Dissociative symptoms were present in over 14% of those with PTSD, and were associated with a number of different factors including more re-experiencing symptoms (for example, flashbacks), high exposure to prior trauma, suicidality and childhood onset of PTSD.

Full abstract of findings: http://www.biologicalpsychiatryjournal.com/…/abstract

Published in Biological Psychiatry, Volume 73, Issue 4, Pages 302-312. 15 February 2013

Related articlesKeep Calm PTSD awareness

Co-occurance of borderline personality disorder & DID – new research

The Journal of Trauma and Dissociation has just published new research into the link between borderline personality disorder and dissociative identity disorder. Dr Colin A. Ross, founder of the Ross Institute, L. Ferrell L and E. Schroeder used the dissociative disorders interview schedule to assess inpatients in a trauma unit for BPD, DID and levels of trauma.

The researches hypothesized that dissociative identity disorder commonly co-occurs with borderline personality disorder and vice versa, and people with both disorders would have more co-occurring psychiatric disorders and more trauma than those with only one disorder, or neither disorder.