The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) outlines specific criteria for diagnosing dissociative disorders, which involve disruptions or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. Below are the key diagnostic criteria for the most common dissociative disorders:

1. Dissociative Identity Disorder (DID)

• Disruption of identity characterized by two or more distinct personality states (which may be described in some cultures as possession). This disruption involves marked discontinuity in sense of self and agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.
• Recurrent gaps in the recall of everyday events, personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
• Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance is not a normal part of a broadly accepted cultural or religious practice.
• Not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

2. Dissociative Amnesia

• Inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. The amnesia may be:
  • Localized (failure to recall events during a specific period),
  • Selective (inability to recall some, but not all, events within a specific period), or
  • Generalized (complete loss of memory for one’s life history, which is rare).
• Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance is not attributable to the effects of a substance (e.g., alcohol or drugs) or a neurological or other medical condition (e.g., head injury, epilepsy).
• The disturbance is not better explained by another mental disorder, such as DID, PTSD, somatic symptom disorder, or major or mild neurocognitive disorder.
• Specifier: With dissociative fugue: A subtype of dissociative amnesia where the individual experiences sudden, unexpected travel away from home or one’s customary place of work, with an inability to recall their past.

3. Depersonalization/Derealization Disorder

• Depersonalization: Experiences of unreality, detachment, or being an outside observer of one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).
• Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
• During the depersonalization or derealization experiences, reality testing remains intact (i.e., the individual is aware that the experiences are not real).
• Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance is not attributable to the effects of a substance (e.g., drugs, alcohol) or another medical condition (e.g., seizures).
• The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, PTSD, or another dissociative disorder.

4. Other Specified Dissociative Disorder

• This category applies to presentations in which symptoms characteristic of a dissociative disorder cause significant distress or impairment but do not meet the full criteria for any of the specific dissociative disorders.
• Examples include:
  • Chronic and recurrent syndromes of mixed dissociative symptoms: Individuals experience dissociative symptoms that do not fully fit the criteria for DID or another dissociative disorder.
  • Identity disturbance due to prolonged and intense coercive persuasion: Individuals subjected to brainwashing, indoctrination while captive, torture, etc.
  • Acute dissociative reactions to stressful events: Short-term dissociative episodes (lasting hours to weeks) occurring in response to trauma or extreme stress.
  • Dissociative trance: Acute narrowing of awareness of immediate surroundings or profound detachment from the surroundings, with a trance-like state.

5. Unspecified Dissociative Disorder

• This diagnosis is used in situations where the clinician chooses not to specify the reason that the criteria for a specific dissociative disorder are not met, or where there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).

Reference:

American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc.. https://doi.org/10.1176/appi.books.9780890425596

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