Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Dissociative Disorders

TABLE 16-7. Differential Diagnosis of Dissociative Identity Disorder Affective disorders Psychotic disorders Anxiety disorders Posttraumatic stress disorder Personality disorders Neurocognitive disorders Seizure disorders Somatic symptom disorders Factitious disorders Malingering Other dissociative disorders Deep-trance phenomena

involve a disruption of identity, whereas the latter do. Additionally, patients with DID will attribute dissociative experiences to alters rather than relying on delu sional explanations. Other specific dissociative disorder The existence of alters, disruptions in single identity narrative, and recurrent am nesia are core features of DID. Patients with other specific dissociative disorders may have similar symptoms, but their condition may not meet full criteria for DID. Posttraumatic stress disorder Patients can be diagnosed with both DID and PTSD. The dual diagnosis is rel atively common, as both conditions can oftentimes be traced back to trauma. A key distinction between the two is that dissociative symptoms may be present in PTSD (ie, dissociative flashbacks or dissociative amnesia based around the traumatic event), but patients with DID experience not only disruptions but also changes in identity states. Amnesias and intrusions are recurrent and not con nected to the traumatic events. Bipolar disorders Patients with DID may often be diagnosed with bipolar disorder, particularly bipolar II disorder, which involves cycling between hypomanic and depressive moods. The changes in personality can be mistaken for mood cycling. If patient displays changes in mood in conjunction with overt changes in identity, diagno sis of DID may be warranted. Major depressive disorder Patients with DID may experience comorbid depressive disorders in some per sonality states, but not all, thereby creating a complicated diagnostic situation. In this scenario, other specified depressive disorder with DID can be used to recognize the fluctuations in mood. Substance-/medication-induced disorders Patients with severe substance use disorders may seem to exhibit changes in person ality when under the influence of substances or experience blackouts, while patients with DID will experience dissociative experiences without the use of substances.

Dissociative Disorders

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