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Dissociative disorders in DSM-5

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Spiegel, David, Loewenstein, Richard J., Lewis-Fernández, Roberto, Sar, Vedat, Simeon, Daphne, Vermetten, Eric, Cardeña, Etzel, Dell, Paul F.·2011·Depression and Anxiety
DOI 10.1002/da.20874
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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. CONCLUSIONS: There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms.

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  • DID is both a successful survival strategy in the context of childhood maltreatment and a cause of significant distress and impairment in other contexts.

    “In this way, DID represents a paradoxical condition: it is both a successful survival strategy in the context of childhood maltreatment as well as a cause of significant distress and impairment in other contexts [14,19,36,42].”

    From Treatment of dissociative identity disorder: leveraging neurobiology to optimize success (2024) · cites this paper as [42]

    In “Dissociative Symptoms and the Subjective Experience of Dissociation” (page not specified), the paper hypothesizes that dissociation may help children cope with traumatizing circumstances; it does not establish DID as a successful survival strategy. That section describes distressing DID symptoms, and the proposed DID criteria specify clinically significant distress and impairment. (LLM, conf=0.86)

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  • People with DID experience amnesia, or gaps in memory, for important personal information, aspects of traumatic experiences, and day-to-day events.

    “People with DID also experience amnesia, or gaps in their memory, for important personal information, aspects of traumatic experiences, and day-to-day events [1,43].”

    From Treatment of dissociative identity disorder: leveraging neurobiology to optimize success (2024) · cites this paper as [43]

  • PTSD + DS is highly associated with early life traumatization, where dissociation acts as an adaptive response to inescapable threat.

    “PTSD + DS is highly associated with early life traumatization, where dissociation acts as an adaptive response to inescapable threat ( Nijenhuis et al., 1998a ; Chu et al., 1999 ; Spiegel et al., 2011 ; Wolf et al., 2012a ; Stein et al., 2013 ; Lowenstein, 2018 ).”

    From The brain-body disconnect: A somatic sensory basis for trauma-related disorders (2022) · cites this paper as Spiegel et al., 2011

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Research works printed but not linked: 13

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. 4th ed. Washington, DC: American Psychiatric Press; 2000.
  2. Braude SE. The coneptual unity of dissociation: a philosophical argument. In: Dell PF, O'Neil JA, editors. Dissociation and the Dissociative Disorders: DSM-V and Beyond. New York: Routledge; 2009:27-36.
  3. Dell PF. Understanding dissociation. In: Dell PF, O'Neil JA, editors. Dissociation and the Dissociative Disorders: DSM-V and Beyond. New York: Routledge; 2009:709-825.
  4. Dalenberg CJ. The case for the study of ''normal'' dissociation. In: Dell PF, O'Neil JA, editors. Dissociation and the Dissociative Disorders: DSM-V and Beyond. New York: Routledge; 2009:145-154.
  5. Butler LD, Duran RE, Jasiukaitis P, et al. Hypnotizability and traumatic experience: a diathesis-stress model of dissociative symptomatology. Am J Psychiatry 1996;153:42-63.
  6. Loewenstein RJ, Putnam FW. The dissociative disorders. In: Sadock BJ, Sadock VA, editors. Comprehensive Textbook of Psychiatry VIII. Vol. 1. 8th ed. Baltimore: Williams & Wilkins; 2004:1844-1901.
  7. Carlson EB, Putnam FW, Ross C, et al. A discriminant validity analysis of the Dissociative Experiences Scale: a multicenter study. Paper presented at 7th International Conference on Multiple Personality and Dissociative States, Chicago; 1990.
  8. Steinberg M. The Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D). Washington, DC: American Psychiatric Press; 1993.
  9. Steinberg M. The Structured Clinical Interview for DSM-IV Dissociative Disorders-revised (SCID-D-R). Washington, DC: American Psychiatric Press; 1994.
  10. Boon S, Draijer N. The differentiation of patients with MPD or DDNOS from patients with Cluster B personality disorder. Dissociation 1993;6:126-135.
  11. Braun BG. The BASK (behavior, affect, sensation, knowledge) model of dissociation. Dissociation 1988;1:4-23.
  12. Spiegel H, Spiegel D. Trance and Treatment. 2nd ed. Washington: American Psychiatric Press; 2004.
  13. Putnam FW. Dissociative phenomena. In: Spiegel D, editor. American Psychiatric Press Annual Review of Psychiatry. Vol. 10. Washington, DC: American Psychiatric Press; 1991; 145-160.

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Authors
Spiegel, D., Loewenstein, R. J., Lewis-Fernández, R., Sar, V., Simeon, D., Vermetten, E., Cardeña, E., & Dell, P. F.
Affiliations
  • Stanford University (US)
  • Sheppard Pratt Health System (US)
  • Albert Einstein College of Medicine (US)
  • University Medical Center Utrecht (NL)
  • Lund University (SE)
Corresponding author
Spiegel, David
ORCID
Venue
Depression and Anxiety
Publisher
Wiley
Published
2011-09
Volume
28
Issue
9
Pages
824-852
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.20874
OpenAlex
W2095692557
Cited by
330
References
369
Citations by year
2026: 19 · 2025: 16 · 2024: 20 · 2023: 24 · 2022: 23 · 2021: 14 · 2020: 15 · 2019: 14 · 2018: 18 · 2017: 25 · 2016: 24 · 2015: 24 · 2014: 46 · 2013: 28 · 2012: 16
FWCI
3.90
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 1461 d)
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords
dissociative disorders, DSM-5, diagnostic criteria, dissociation, depersonalization disorder, derealization, dissociative fugue, dissociative amnesia, dissociative identity disorder, identity disruption, possession, trauma history
MeSH terms
Conversion Disorder, Depersonalization, Diagnosis, Differential, Dissociative Disorders, Humans, Life Change Events, Psychotic Disorders, Risk Factors, Comorbidity, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, Evidence-Based Practice

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