“As an undergraduate student in psychology, I was taught that multiple personalities were a very rare and bizarre disorder. That is all that I was taught on ... It soon became apparent that what I had been taught was simply not true. Not only was I meeting people with multiplicity; these individuals entering my life were normal human beings with much to offer. They were simply people who had endured more than their share of pain in this life and were struggling to make sense of it.”
― Deborah Bray Haddock, The Dissociative Identity Disorder Sourcebook
Other Specified Dissociative Disorder
The DSM-5 gives the following criteria for a diagnosis of other specified dissociative disorder:
This category applies to presentations in which symptoms characteristic of a dissociative disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the dissociative disorders diagnostic class. The other specified dissociative disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific dissociative disorder. This is done by recording “other specified dissociative disorder” followed by the specific reason (e.g., “dissociative trance”).
Examples of presentations that can be specified using the “other specified” designation include the following:
1. Chronic and recurrent syndromes of mixed dissociative symptoms: This category includes identity disturbance associated with less-than-marked discontinuities in sense of self and agency, or alterations of identity or episodes of possession in an individual who reports no dissociative amnesia.
2. Identity disturbance due to prolonged and intense coercive persuasion: Individuals who have been subjected to intense coercive persuasion (e.g., brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, recruitment by sects/cults or by terror organizations) may present with prolonged changes in, or conscious questioning of, their identity.
3. Acute dissociative reactions to stressful events: This category is for acute, transient conditions that typically last less than 1 month, and sometimes only a few hours or days. These conditions are characterized by constriction of consciousness; depersonalization; derealization; perceptual disturbances (e.g., time slowing, macropsia); micro-amnesias; transient stupor; and/or alterations in sensory-motor functioning (e.g., analgesia, paralysis).
4. Dissociative trance: This condition is characterized by an acute narrowing or complete loss of awareness of immediate surroundings that manifests as profound unresponsiveness or insensitivity to environmental stimuli. The unresponsiveness may be accompanied by minor stereotyped behaviors (e.g., finger movements) of which the individual is unaware and/or that he or she cannot control, as well as transient paralysis or loss of consciousness. The dissociative trance is not a normal part of a broadly accepted collective cultural or religious practice (American Psychiatric Association, 2013)1.
Other specified dissociative disorder is a category used for symptom clusters that are clearly dissociative in nature but that don't meet the criteria for another dissociative disorder. This category is used when it is known that another dissociative disorder is not present and what the symptoms are.
Examples of other specified dissociative disorder include presentations similar to DID with either no fully differentiated alters or with no amnesia between alters; dissociative symptoms such as identity confusion or assuming a new identity due to brainwashing, torture, political imprisonment, etc; dissociative symptoms that occur in reaction to trauma but do not last longer than a month; dissociative trance in which an individual loses awareness of their surroundings and so becomes under-responsive.
Before the DSM-5 was released, OSDD was known as dissociative disorder not otherwise specified (DDNOS). In addition to the above, it contained derealization unaccompanied by depersonalization in adults (which is now covered by depersonalization/derealization disorder) and ganser syndrome, a condition in which approximate answers are given to questions (this is not covered by the DSM-5 and may in fact be a factitious disorder)(4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000)2.
Unspecified Dissociative Disorder
The DSM-5 gives the following criteria for a diagnosis of unspecified dissociative disorder:
This category applies to presentations in which symptoms characteristic of a dissociative disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the dissociative disorders diagnostic class. The unspecified dissociative 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 dissociative disorder, and includes presentations for which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings) (American Psychiatric Association, 2013)1.
Unspecified dissociative disorder is similar to other specified dissociative disorder, but this diagnosis is only made when the exact diagnosis is unknown or when it cannot be said that or why the symptoms present do not qualify for another dissociative disorder. This diagnosis is usually made when there is not time or opportunity for a more specific diagnosis to be made.
1 American Psychiatric Association. (2013). Dissociative Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). http://dx.doi.org/10.1176/appi.books.9780890425596.dsm08
2 American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). doi:10.1176/appi.books.9780890423349.