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DiagnosisEdit

If symptoms seem to be present, the patient should first be evaluated by performing a complete medical history and physical examination. The various diagnostic tests, such as X-rays and blood tests are used to rule out physical illness or medication side effects as the cause of the symptoms. Certain conditions, including brain diseases, head injuries, drug and alcohol intoxication, and sleep deprivation, can lead to symptoms similar to those of dissociative disorders, including amnesia.

If no physical illness is found, the patient might be referred to a psychiatrist or psychologist. Psychiatrists and psychologists use specially designed interview and personality assessment tools to evaluate a person for a dissociative disorder.[1]

DiagnosisEdit

If symptoms seem to be present, the patient should first be evaluated by performing a complete medical history and physical examination. Diagnostic tests, such as X-rays and blood tests may be used to rule out physical illness or medication side effects as the cause of the symptoms. Certain conditions, including brain diseases, head injuries, drug and alcohol intoxication, and sleep deprivation, can lead to symptoms similar to those of Dissociative Disorders, including Dissociative Amnesia.

If no physical illness is found, the patient might be referred to a psychiatrist or psychologist who may use specially designed interviews and personality assessment tools to evaluate a person for a Dissociative Disorder.[1]

Diagnostic criteria (DSM-IV-TR)Edit

In summary, the diagnostic criteria in DSM-IV Dissociative Disorders[2] section 300.14[3] of the Diagnostic and Statistical Manual of Mental Disorders require the occurrence of two or more personalities within the same individual, each of which during some time in the person's life is able to take control. This must be combined with extensive areas of memory loss that cannot be explained as within normal limits. The symptoms must not be better explained by substance use or another medical condition.

The personalities are often very different in nature and may represent extremes of what is contained in a normal person. Memories may be asymmetrical with dominant identities remembering more than passive identities.

Screening and diagnostic instrumentsEdit

The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D)[4] may be used to make a diagnosis. This interview takes about 30 minutes to 1.5 hours, depending on the subject's experiences.

The Dissociative Disorders Interview Schedule (DDIS)[5] is a highly structured interview which discriminates between various DSM-IV diagnoses. The DDIS can usually be administered in 30-45 minutes.

The Dissociative Experiences Scale (DES)[6] is a simple, quick, and validated[7] questionnaire that has been widely used to screen for dissociative symptoms. Tests such as the DES provide a quick method of screening subjects so that the more time-consuming structured clinical interview can be used in the group with high DES scores. Depending on where the cutoff is set, people who would subsequently be diagnosed can be missed. An early recommended cutoff was 15-20[8] and in one study a DES with a cutoff of 30 missed 46% of the positive SCID-D[4] diagnoses and a cutoff of 20 missed 25%.[9] The reliability of the DES in non-clinical samples has been questioned.[10]

ReferencesEdit

  1. 1.0 1.1 Webmd.com
  2. Complete List of DSM-IV Codes ( PsychNet-UK.com)
  3. Dissociative Identity Disorder (formerly Multiple Personality Disorder) ( DSM-IV 300.14, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)
  4. 4.0 4.1 Steinberg M, Rounsaville B, Cicchetti DV (1990). The Structured Clinical Interview for DSM-III-R Dissociative Disorders: preliminary report on a new diagnostic instrument. The American journal of psychiatry 147 (1): 76-82.
  5. Ross CA, Ellason JW (2005). Discriminating among diagnostic categories using the Dissociative Disorders Interview Schedule. Psychological reports 96 (2): 445-53.
  6. Bernstein EM, Putnam FW (1986). Development, reliability, and validity of a dissociation scale. J. Nerv. Ment. Dis. 174 (12): 727-35.
  7. Carlson EB, Putnam FW, Ross CA, et al (1993). Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: a multicenter study. The American journal of psychiatry 150 (7): 1030-6.
  8. Steinberg M, Rounsaville B, Cicchetti D (1991). Detection of dissociative disorders in psychiatric patients by a screening instrument and a structured diagnostic interview. The American journal of psychiatry 148 (8): 1050-4.
  9. Foote B, Smolin Y, Kaplan M, Legatt ME, Lipschitz D (2006). Prevalence of dissociative disorders in psychiatric outpatients. The American journal of psychiatry 163 (4): 623-9. Full Text
  10. Wright DB, Loftus EF (1999). Measuring dissociation: comparison of alternative forms of the dissociative experiences scale. The American journal of psychology 112 (4): 497-519. Page 1

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