The unspecified trauma- or stressor-related disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific trauma- and stressor-related disorder, and includes presentations in which there is insuffi- cient information to make a more specific diagnosis (e.g., in emergency room settings).
«.5 M» fissociative
Dissociative d isorde rs are characterized by a disruption of and / or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. Dissociative symptoms can potentially dis- rupt every area of psychological functioning. This chapter includes dissociative identity disorder, dissociative amnesia, depersonalization/derealization disorder, other specified dissociative disorder, and unspecified dissociative disorder.
Dissociative symptoms are experienced as a) unbidden intrusions into awareness and behavior, with accompanying losses of continuity in subjective experience (i.e., “positive” dissociative symptoms such as fragmentation of identity, depersonalization, and dereal- ization) and / or b) inability to access information or to control mental functions that nor- mally are readily amenable to access or control (i.e., "negative” dissociative symptoms such as amnesia).
The dissociative disorders are frequently found in the aftermath of trauma, and many of the symptoms, including embarrassment and confusion about the symptoms or a desire to hide them, are inﬂuenced by the proximity to trauma. In DSM-5, the dissociative disor- ders are placed next to, but are not part of, the trauma- and stressor—related disorders, re- ﬂecting the close relationship between these diagnostic classes. Both acute stress disorder and posttraumatic stress disorder contain dissociative symptoms, such as amnesia, ﬂash- backs, numbing, and depersonalization/derealization.
Depersonalization/derealization disorder is characterized by clinically significant persis- tent or recurrent depersonalization (i.e., experiences of unreality or detachment from one’s mind, self, or body) and/ or derealization (i.e., experiences of unreality or detachment from one's surroundings). These alterations of experience are accompanied by intact reality testing. There is no evidence of any distinction between individuals with predominantly depersonalization versus derealization symptoms. Therefore, individuals with this disor- der can have depersonalization, derealization, or both.
Dissociative amnesia is characterized by an inability to recall autobiographical informa- tion. This amnesia may be localized (i.e., an event or period of time), selective (i.e., a specific aspect of an event), or generalized (i.e., identity and life history). Dissociative amnesia is fun- damentally an inability to recall autobiographical information that is inconsistent with nor- mal forgetting. It may or may not involve purposeful travel or bewildered wandering (i.e., fugue). Although some individuals with amnesia promptly notice that they have ”lost time” or that they have a gap in their memory, most individuals with dissociative disorders are ini- tially unaware of their amnesias. For them, awareness of amnesia occurs only when personal identity is lost or when circumstances make these individuals aware that autobiographical information is missing (e.g., when they discover evidence of events they cannot recall or when others tell them or ask them about events they cannot recall). Until and unless this hap- pens, these individuals have ”amnesia for their amnesia.” Amnesia is experienced as an es- sential feature of dissociative amnesia; individuals may experience localized or selective amnesia most commonly, or generalized amnesia rarely. Dissociative fugue is rare in per— sons with dissociative amnesia but common in dissociative identity disorder.