Dissociative Disorders in DSM-5

Abstract

The rationale, research literature, and proposed changes to the dissociative disorders and conversion disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are presented. Dissociative identity disorder will include reference to possession as well as identity fragmentation, to make the disorder more applicable to culturally diverse situations. Dissociative amnesia will include dissociative fugue as a subtype, since fugue is a rare disorder that always involves amnesia but does not always include confused wandering or loss of personality identity. Depersonalization disorder will include derealization as well, since the two often co-occur. A dissociative subtype of posttraumatic stress disorder (PTSD), defined by the presence of depersonalization or derealization in addition to other PTSD symptoms, is being recommended, based upon new epidemiological and neuroimaging evidence linking it to an early life history of adversity and a combination of frontal activation and limbic inhibition. Conversion disorder (functional neurological symptom disorder) will likely remain with the somatic symptom disorders, despite considerable dissociative comorbidity.

Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD

“…hypervigilance, increased startle response; American Psychiatric Association, 2013). DSM-5 also introduced the dissociative subtype of PTSD (PTSD+DS), reflecting approximately 15–30% of individuals with PTSD who experience significant dissociative symptoms of depersonalization (feeling as though one is separated from one’s own body) and derealization (feeling as though things around you are strange or unfamiliar) (Armour, Karstoft, & Richardson, 2014; Bennett, Modrowski, Kerig, & Chaplo, 2015; Blevins, Weathers, & Witte, 2014; Bremner & Brett, 1997; Bremner et al, 1992; Frewen, Brown, Steuwe, & Lanius, 2015; Hansen, Ross, & Armour, 2017; Lanius, Brand, Vermetten, Frewen, & Spiegel, 2012; Lanius et al, 2010; Spiegel et al, 2013; Steuwe, Lanius, & Frewen, 2012; Tsai, Armour, Southwick, & Pietrzak, 2015; Waelde, Silvern, & Fairbank, 2005; Wolf et al, 2012, 2012). Among military members and veterans, recent studies indicate that 8–32% of veterans and active duty military personnel meet criteria for the dissociative subtype (Armour et al, 2014; Tsai et al, 2015; Waelde et al, 2005; Wolf et al, 2012, 2012).…”

Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis

“…Dissociation also refers to a dichotomy between conscious and unconscious processes dating back to the ideas of Janet in the late 19th century, which probably inspired Freud's conception of conversion, but this implies distinct psychodynamic mechanisms [89]. In addition, the role of dissociation in conversion disorders also remains hypothetical.…”

“…Uncertainties regarding the definition and cause(s) of conversion disorders are also reflected by the fact that they are classified in distinct diagnostic families in the DSM framework put forward by the American Psychiatry Association [2] and the ICD taxonomy established by the World Health Organization [65], being listed among somatoform disorders in the former but among dissociative disorders in the latter. Dissociation also refers to a dichotomy between conscious and unconscious processes dating back to the ideas of Janet in the late 19th century, which probably inspired Freud's conception of conversion, but this implies distinct psychodynamic mechanisms [89]. In addition, the role of dissociation in conversion disorders also remains hypothetical.…”

Experiências Religiosas/Espirituais: dissociação saudável ou patológica?

“…A dissociação patológica se expressa na amnésia, na fuga dissociativa, na despersonalização-desrealização, no transtorno de identidade dissociativa e no transtorno de transe de possessão (SPIEGEL et al, 2011;WALLER;CARLSON, 1996). A amnésia dissociativa compreende basicamente a perda de memória, sobretudo de eventos recentes e de informações pessoais importantes, que não pode ser atribuída a um esquecimento habitual, à fadiga ou a um sintoma de origem orgânica.…”