Magazine article Clinical Psychiatry News

Dissociative Disorders Definition Criticized

Magazine article Clinical Psychiatry News

Dissociative Disorders Definition Criticized

Article excerpt

PHILADELPHIA -- The current official definition of dissociative disorders is too limited and hard for clinicians to use in practice, experts said at the annual conference of the International Society for the Study of Trauma and Dissociation.

"The diagnostic criteria for dissociative disorders in DSM-IV [the Diagnostic and Statistical Manual of Mental Disorders, 4th edition] are in significant need of revision, primarily because they're vague and abstract," Paul F. Dell, Ph.D., said at the meeting. "You're in deep trouble trying to diagnose dissociative disorders on the basis of what's in DSM-IV The idea is to have diagnostic criteria that are as concrete and user friendly as possible."

A task force assembled in 2005 by the ISSTD has been assessing the problems with the way dissociative disorders are handled in DSM-IV and has plans to propose changes for DSM-V, due out in 2012.

"DSM-IV does not present an adequate picture of dissociative disorders, and the diagnostic criteria are substandard, compared with [criteria for] other disorders in DSM," said Dr. Dell, clinical director of the Trauma Recovery Center in Norfolk, Va. But it is unclear what role the ISSTD or its task force will have in influencing what goes into DSM-V "We'll have a much better idea a year from now," he said.

"This is the [ISSTD's] major project. If we can achieve [refining the definitions], the field will progress," said Dr. Vedat Sar, professor of psychiatry at Istanbul (Turkey) University and president of the ISSTD.

DSM-IV defines dissociative identity disorder (DID) as a condition in which a patient has two or more identities that recurrently take control, accompanied by amnesia, Dr. Dell said. The definition fails to explain how to determine if these identities are present and if they ever take control. It also gives an "incomplete, one-sided picture" of DID.

A major problem is that personality switching is usually visible only during stress or crisis. DSM-IV misleads clinicians into thinking that they should be able to see visible switching, said Dr. Dell, who chairs the ISSTD task force. According to him, clinicians then say, "This patient has dissociative symptoms but doesn't have DID because I don't see switching." There needs to be a way to diagnose DID when patients are not switching, he said.

One factor that has limited the diagnostic criteria of DSM-III and DSM-IV is a lack of good information from large-cohort studies. These data have become available only since the last revision of DSM, in the early 1990s. "There has been tremendous skepticism about dissociative disorders," said Dr. …

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