Dissociative Disorders and Trauma- and Stressor-Related Disorders

There have been some important changes in the dissociative disorders diagnostic class from DSM-IV to DSM-5 that affect treatment as well as diagnosis. The definition of dissociative identity disorder has been altered to emphasize the intrusive nature of the dissociative symptoms as disruptions in consciousness, including an experience of possession as an alteration of identity, and to specify, also, that amnesia for everyday, as well as traumatic, events is typical. Dissociative fugue has been included as a specifier of dissociative amnesia, so it is no longer a separate diagnosis. Derealization has been added to depersonalization disorder. Dissociative symptoms are among those in acute stress disorder but are not required for the diagnosis. Finally, a dissociative subtype has been added to posttraumatic stress disorder (PTSD), which, along with acute stress disorder, has been moved from the anxiety disorders to the trauma- and stressor-related disorders. For this subtype to be applicable, all of the DSM-5 PTSD symptoms must be present, in addition to depersonalization or derealization. There is evidence that individuals with these dissociative symptoms benefit from psychotherapies that emphasize stabilization, mood regulation, and relapse prevention, in addition to working through trauma-related memories.