diagnosis
The official diagnostic criteria according to the “The Diagnostic and Statistical Manual, 4 th Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000a)” are:
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
B. At least two of these identities or personality states recurrently take control of the person's behavior.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
However, few patients with DID display distinct identities early within therapy, and many deny, or are unaware of, amnesic episodes (time loss).
Because this condition is frequently missed or misdiagnosed, the interviewing clinician must have a high index of suspicion when patients complain of symptoms that are frequently encountered in DID/PTSD.
Useful questions cover the following areas:
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
B. At least two of these identities or personality states recurrently take control of the person's behavior.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
However, few patients with DID display distinct identities early within therapy, and many deny, or are unaware of, amnesic episodes (time loss).
Because this condition is frequently missed or misdiagnosed, the interviewing clinician must have a high index of suspicion when patients complain of symptoms that are frequently encountered in DID/PTSD.
Useful questions cover the following areas:
Sense of gaps within childhood memories – many patients have extensive periods without memories, and are initially acquainted with little of their personal history.
Having been told often that he/she has done or said something that is not recalled within a reasonable timeframe.
Awareness of losing periods of time – most often noticed in relation to watching television programs. Vague complaints of “difficulty with time” are common.
Sense of saying or doing something outside volitional control.
Sense of having feelings or thoughts that do not belong to his/herself.
Sense of buzzing or ringing in the ears, often accompanied by headache, or hearing voices.
These questions ought to be repeated from time to time as patients may initially deny symptoms out of lack of trust, or may not yet be aware of the symptoms as being unusual.
The clinician’s awareness of the ways in which patients describe their symptoms usually quickly unmasks the rare case of factitious “DID”.
posted 11:56 p.m.
<< Home