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Tests and diagnosis
By Mayo Clinic staffDoctors diagnose dissociative disorders based on a review of your symptoms and your personal history. As part of your evaluation, your doctor may perform tests to rule out physical conditions — including head injuries, certain brain diseases, sleep deprivation and intoxication — that can cause symptoms such as memory loss and a sense of unreality. If your doctor rules out physical causes, he or she will likely refer you to a mental health for an in-depth interview.
To help diagnose dissociative identity disorder, some doctors use medication or hypnosis. These may help your doctor identify alternate personalities or may help you describe repressed memories that played a role in the development of dissociative patterns.
To be diagnosed with a dissociative identity disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DMS), published by the American Psychiatric Association.
Criteria for dissociative amnesia to be diagnosed include:
- You have had one or more episodes in which you couldn't remember important personal information, usually something traumatic or stressful. This memory loss is too extensive to be explained by ordinary forgetfulness.
- Your episodes of memory loss do not occur only during the course of another disorder, such as dissociative identity disorder, dissociative fugue, posttraumatic stress disorder, acute stress disorder, or somatization disorder (a condition in which affected people have many recurring physical symptoms that cannot be fully explained by a physical disorder). Your symptoms also are not explained by the direct effects of a substance, such as a prescription medication or recreational drug, or by a neurological or other general medical condition, such as amnesia related to head trauma.
- Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life.
Criteria for dissociative identity disorder to be diagnosed include:
- You display the presence of two or more distinct identities or personalities, each with its own relatively stable pattern of perceiving, relating to, and thinking about yourself and the world.
- At least two of these identities or personality states recurrently take control of your behavior.
- You can't recall important personal information that is too extensive to be explained by ordinary forgetfulness.
- Your symptoms are not due to the direct effects of a substance, such as alcohol, or a general medical condition, such as complex partial seizures. In children, symptoms are not due to imaginary playmates or other fantasy play.
Criteria for dissociative fugue to be diagnosed include:
- You experience sudden, unexpected travel away from your home or place of work, and can't remember your past.
- During fugue episodes, you are confused about your personal identity or you assume a partially or completely new identity.
- Your episodes of fugue do not occur only during the course of dissociative identity disorder. Your symptoms also are not explained by the direct effects of a substance, such as a prescription medication or recreational drug, or a general medical condition, such as temporal lobe epilepsy.
- Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life
Criteria for depersonalization disorder to be diagnosed include:
- You have persistent or recurrent experiences of feeling detached from yourself, as if you are an outside observer of your mental processes or your body — you feel as though you are in a dream.
- While you are experiencing an episode of depersonalization, you are aware that your feeling of being outside yourself isn't reality.
- Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life.
- Your depersonalization symptoms do not occur only during the course of another mental disorder, such as schizophrenia, panic disorder, acute stress disorder, or another dissociative disorder. Your symptoms also are not explained by the direct effects of a substance, such as a prescription medication or recreational drug, or a general medical condition, such as temporal lobe epilepsy.
- Dissociative disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Jan. 20, 2009.
- Maldonado JR, et al. Dissociative disorders. In: Hales RE, et al., eds. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Arlington, Va.: American Psychiatric Publishing; 2008:665.
- Dissociation and dissociative disorders. National Mental Health Association. http://www.nmha.org/index.cfm?objectId=C7DF8D4E-1372-4D20-C86C22067E838DF0&CFID=306278&CFTOKEN=696f1d08c4d6ecd2-823F75DC-1372-4D20-C8B94665B1F8DBE7. Accessed Jan. 20, 2009.
- Frequently asked questions: Dissociation and dissociative disorders. International Society for the Study of Trauma and Dissociation. http://www.isst-d.org/education/faq-dissociation.htm. Accessed Jan. 20, 2009.
- Turkus JA, et al. Therapeutic interventions in the treatment of dissociative disorders. Psychiatric Clinics of North America. 2006;29:245.
- Chu JA, et al. Guidelines for treating dissociative identity disorder in adults. Journal of Trauma & Dissociation. 2005;6:69.
- Silberg J, et al. Guidelines for treating dissociative identity disorder in children and adolescents. Journal of Trauma & Dissociation. 2004;5:119.
- Berkowitz CD. Child maltreatment. In: Marx JA, et al., eds. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo.: Mosby; 2006:968.
- Sar V, et al. Dissociative disorders in the psychiatric emergency ward. General Hospital Psychiatry. 2007;29:45.
