Criterion A symptoms are related to discontinuities of experience that can affect any aspect of an individual’s functioning. Individuals with dissociative identity disorder may report the feeling that they have suddenly become depersonalized observers of their ”own" speech and actions, which they may feel powerless to stop (sense of self). Such in- dividuals may also report perceptions of voices (e.g., a child’s voice; crying; the voice of a spiritual being). In some cases, voices are experienced as multiple, perplexing, indepen- dent thought streams over which the individual experiences no control. Strong emotions, impulses, and even speech or other actions may suddenly emerge, without a sense of per— sonal ownership or control (sense of agency). These emotions and impulses are frequently reported as ego-dystonic and puzzling. Attitudes, outlooks, and personal preferences (e.g., about food, activities, dress) may suddenly shift and then shift back. Individuals may report that their bodies feel different (e.g., like a small child, like the opposite gender, huge and muscular). Alterations in sense of self and loss of personal agency may be accompa- nied by a feeling that these attitudes, emotions, and behaviors—even one’s body—are ”not mine" and / or are "not under my control." Although most Criterion A symptoms are subjective, many of these sudden discontinuities in speech, affect, and behavior can be wit- nessed by family, friends, or the clinician. Non—epileptic seizures and other conversion symptoms are prominent in some presentations of dissociative identity disorder, espe- cially in some non—Western settings.
The dissociative amnesia of individuals with dissociative identity disorder manifests in three primary ways: as 1) gaps in remote memory of personal life events (e.g., periods of childhood or adolescence; some important life events, such as the death of a grandparent, getting married, giving birth); 2) lapses in dependable memory (e.g., of what happened today, of well-leamed skills such as how to do their job, use a computer, read, drive); and 3) discovery of evidence of their everyday actions and tasks that they do not recollect do- ing (e.g., finding unexplained objects in their shopping bags or among their possessions; ”coming to” in the midst of doing something). Dissociative fugues, wherein the person discovers dissociated travel, are common. Thus, individuals with dissociative identity dis- order may report that they have suddenly found themselves at the beach, at work, in a night- club, or somewhere at home (e.g., in the closet, on a bed or sofa, in the corner) with no memory of how they came to be there. Amnesia in individuals with dissociative identity dis- order is not limited to stressful or traumatic events; these individuals often cannot recall everyday events as well.
Individuals with dissociative identity disorder vary in their awareness and attitude to- ward their amnesias. It is common for these individuals to minimize their amnestic symp- toms. Some of their amnestic behaviors may be apparent to others—as when these persons do not recall something they were witnessed to have done or said, when they cannot remember their own name, or when they do not recognize their spouse, children, or close friends.