Dissociative identity disorder is characterized by a) the presence of two or more distinct personality states or an experience of possession and b) recurrent episodes of amnesia. The fragmentation of identity may vary with culture (e.g., possession-form presentations) and cir- cumstance. Thus, individuals may experience discontinuities in identity and memory that may not be immediately evident to others or are obscured by attempts to hide dysfunction. In- dividuals with dissociative identity disorder experience a) recurrent, inexplicable intrusions into their conscious functioning and sense of self (e.g., voices; dissociated actions and speech; intrusive thoughts, emotions, and impulses), b) alterations of sense of self (e.g., attitudes, pref- erences, and feeling like one’s body or actions are not one’s own), c) odd changes of perception (e.g., depersonalization or derealization, such as feeling detached from one’s body while cut- ting), and d) intermittent functional neurological symptoms. Stress often produces transient exacerbation of dissociative symptoms that makes them more evident.
The residual category of other specified dissociative disorder has seven examples: chronic or recurrent mixed dissociative symptoms that approach, but fall short of, the diagnostic cri- teria for dissociative identity disorder; dissociative states secondary to brainwashing or thought reform; two acute presentations, of less than 1 month’s duration, of mixed dissociative symptoms, one of which is also marked by the presence of psychotic symptoms; and three sin- gle-symptom dissociative presentations—dissociative trance, dissociative stupor or coma, and
Ganser’s syndrome (the giving of approximate and vague answers).
Diagnostic Criteria 300.14 (F44.81)
A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompa- nied by related alterations in attect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be ob- served by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, important personal information, and/ or traumatic events that are inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.
Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.
E. The symptoms are not attributable to the physiological el'Iects of a substance (e.g., (e.g., complex partial seizures).
The defining feature of dissociative identity disorder is the presence of two or more dis- tinct personality states or an experience of possession (Criterion A). The overtness or covertness of these personality states, however, varies as a function of psychological motivation, current level of stress, culture, internal conﬂicts and dynamics, and emotional resilience. Sustained periods of identity disruption may occur when psychosocial pres- sures are severe and / or prolonged. In many possession-form cases of dissociative identity disorder, and in a small proportion of non—possession-form cases, manifestations of alter- nate identities are highly overt. Most individuals with non-possession—form dissociative identity disorder do not overtly display their discontinuity of identity for long periods of time; only a small minority present to clinical attention with observable alternation of identities. When alternate personality states are not directly observed, the disorder can be identified by two clusters of symptoms: 1) sudden alterations or discontinuities in sense of self and sense ofagency (Criterion A), and 2) recurrent dissociative amnesias (Criterion B).