In-Depth: Understanding Dissociative Disorders
Advances in the Diagnosis of Dissociative Disorders
Over the past twenty five years, there has been an increase in scientific research on the diagnosis and treatment of dissociative disorders.
Screening tools such as the Dissociative Experience Scale and diagnostic tools such as the Structured Clinical Interview for Dissociative Disorders (or SCID-D) have helped advance work in the identification and treatment of these disorders. Screening tests cannot diagnose people with a dissociative disorder but can help identify people who have dissociative symptoms and need to be evaluated further. Diagnostic tests require the time of a knowledgeable mental health professional and allow for the definitive diagnosis of dissociative symptoms and disorders.
Raising the Standard of Care: The Structured Clinical Interview for DSM-IV Dissociative Disorders
Before the development of specialized diagnostic tests, people suffering from dissociative disorders were misdiagnosed for many years preventing the start of effective treatment. Some mental health professionals are still unfamiliar with or skeptical of recent specialized screening and diagnostic tests for dissociation. As more mental health professionals become familiar with advances in detecting dissociative symptoms, there will be less of a delay in accurate diagnosis and treatment.
The use of specialized diagnostic interviews allows for early detection of dissociative symptoms preventing years of ineffective treatments. The Structured Clinical Interview for DSM-IV Dissociative Disorders (The SCID-D) is a diagnostic test that has been proven to be reliable and effective in identifying dissociative symptoms and disorders. The SCID-D is the only diagnostic test in the field of dissociation whose scientific testing has been evaluated and funded by the National Institute of Mental Health. Endorsed by experts in the field, this diagnostic tool is considered the ‘gold standard’ to which all other tests of this type should be compared.
Over a hundred scientific publications by researchers in the United States and abroad have documented this tests ability to accurately diagnose dissociative symptoms and disorders. In fact, research with the SCID-D indicates that the features of dissociation are virtually identical world wide.
People suffering from dissociative disorders can now be identified with the same degree of accuracy as people suffering from other psychiatric or medical disorders. Just like an electrocardiogram can diagnose heart rhythm abnormalities worldwide, individuals who are suffering from a dissociative disorder can now be accurately identified with the SCID-D. Since dissociation is a universal response to overwhelming trauma, it should not be surprising that dissociative symptoms are the same in cultures that may be very different.
A trained therapist can administer the Structured Clinical Interview for Dissociative Disorders (or SCID-D) in order to detect whether a person is experiencing dissociative symptoms and/or a dissociative disorder. Evaluation with the SCID-D can take three to five hours. Since accurate identification of dissociative symptoms can prevent many years of missed diagnosis and ineffective treatments with medications that can cause potentially serious side effects, it is recommended that one seek out a specialized evaluation with a trained mental health professional as soon as possible.
Five Specific Symptoms of Dissociation
The SCID-D can evaluate whether a person is experiencing specific dissociative symptoms and whether these symptoms are interfering with one’s relationships or work and whether the symptoms are causing distress. The five symptoms of dissociation include:
- Amnesia or memory problems involving difficulty recalling personal information
- Depersonalization or a sense of detachment of disconnection from one’s self. A common feeling associated with depersonalization is feeling like a stranger to one’s self.
- Derealization or a sense of disconnection from familiar people or one’s surroundings
- Identity confusion or inner struggle about one’s sense of self/identity
- Identity alteration or a sense of acting like a different person
These five symptoms of dissociation are often hidden and cause much inner turmoil and suffering. Often the person experiences a lot of other symptoms such as anxiety, depression and mood swings. The figure titled “Obvious and Hidden Signs of DID” depicts the inner symptoms of dissociation and the more external symptoms a person might describe to a therapist.
For a more detailed description of these five symptoms, see Steinberg M, Schnall M: The Stranger in the Mirror: Dissociation-The Hidden Epidemic, HarperCollins, 2001.
Steinberg, M. (2013). In-Depth: Understanding Dissociative Disorders. Psych Central. Retrieved on November 25, 2015, from http://psychcentral.com/lib/in-depth-understanding-dissociative-disorders/