Evolution
OSDD was officially adopted in the DSM-V, which was published in 2013, alongside Unspecified Dissociative Disorder to replace DDNOS. [7]
Other specified dissociative disorder (OSDD) is a mental health diagnosis for pathological dissociation that matches the DSM-5 criteria for a dissociative disorder, but does not fit the full criteria for any of the specifically identified subtypes, which include dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder, and the reasons why the previous diagnoses were not met are specified. "Unspecified dissociative disorder" is given when the clinician does not give a reason. [1] The International Statistical Classification of Diseases and Related Health Problems (ICD-10) refers to the diagnosis as "Other dissociative and conversion disorders". [2] Under the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), it was known as "Dissociative disorder not otherwise specified" (DDNOS).
Examples of OSDD include chronic and recurrent syndromes of mixed dissociative symptoms, identity disturbance due to prolonged and intense coercive persuasion, disorders similar to dissociative identity disorder, acute dissociative reactions to stressful events, and dissociative trance. [1]
OSDD is the most common dissociative disorder and is diagnosed in 40% of dissociative disorder cases. [3] It is often co-morbid with other mental illnesses such as complex posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, personality disorders, substance use disorders, and eating disorders. [4]
There are currently no available drugs that treat dissociative symptoms directly; however, dissociative conditions appear to respond well to psychotherapy. [5] [6]
OSDD was officially adopted in the DSM-V, which was published in 2013, alongside Unspecified Dissociative Disorder to replace DDNOS. [7]
There are currently four examples of OSDD given in the DSM. OSDD is a "catch-all" category for any presentation that is abnormal but does not meet the diagnostic criteria for any of the dissociative disorders, and therefore the examples given are not the only presentations of OSDD possible. OSDD is only diagnosed when it is known that another dissociative disorder is not present; if the diagnosis is still being clarified, or if there is not enough time to make an informed diagnosis (such as in an emergency room setting), a diagnosis of unspecified dissociative disorder may be given.
It is worth noting that a person will not be diagnosed with "OSDD type 4" (for example); instead they will simply be diagnosed with OSDD. The diagnosing clinician may specify in the client's file that the diagnosis is "OSDD (dissociative trance)", but in general the simple diagnosis of OSDD will be given.
OSDD-1 is diagnosed when a person is experiencing sub-threshold dissociative identity disorder (DID).
The DSM states that "This category includes identity disturbance associated with less-than-marked discontinuities in sense of self and agency, or alterations of identity or episodes of possession in an individual who reports no dissociative amnesia". [1]
OSDD type 1 is often split up into 2 major types, OSDD-1a and OSDD-1b. OSDD-1a is usually described as DID however with less distinct alters. Alters in this type are often different versions of the host. OSDD-1b is described as DID but without blackouts. However, people with OSDD-1b may experience greyouts or emotional amnesia. These are not diagnosable terms, and are only used to clarify the symptoms involved. [ citation needed ]
The ICD-11 describes OSDD-1 as "Partial dissociative identity disorder". [8]
OSDD-2 describes a dissociative identity disturbance caused by "prolonged and intense coercive persuasion". [1] The DSM gives the examples of "brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, recruitment by sects/cults or by terror organizations." People with OSDD-2, as a result, experience distressing changes to and/or questioning of their identity. [1]
OSDD-3 is diagnosed when a person experiences acute dissociative reactions to stressful events. These reactions last anywhere from a few hours to weeks, but typically less than a month. The dissociative conditions are characterised by "constriction of consciousness", including "depersonalization; derealization; perceptual disturbances (e.g., time slowing, macropsia); micro-amnesias; transient stupor; and/or alterations in sensory-motor functioning (e.g., analgesia, paralysis)." [1]
OSDD-4 is characterised by a dissociative trance; "an acute narrowing or complete loss of awareness of immediate surroundings that manifests as profound unresponsiveness or insensitivity to environmental stimuli." [1] The DSM specifies that "The dissociative trance is not a normal part of a broadly accepted collective cultural or religious practice".
In the ICD-11, this condition warrants a separate diagnosis of Trance disorder. [8]
Dissociative fugue, formerly called a fugue state or psychogenic fugue, is a rare psychiatric phenomenon characterized by reversible amnesia for one's identity in conjunction with unexpected wandering or travel. This is sometimes accompanied by the establishment of a new identity and the inability to recall personal information prior to the presentation of symptoms. Dissociative fugue is a mental and behavioral disorder that is classified variously as a dissociative disorder, a conversion disorder, and a somatic symptom disorder. It is a facet of dissociative amnesia, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Dissociative identity disorder (DID), also known as multiple personality disorder, split personality disorder, or dissociative personality disorder, is a member of the family of dissociative disorders classified by the DSM-5, DSM-5-TR, ICD-10, ICD-11, and Merck Manual for diagnosis. It remains a controversial diagnosis.
Depersonalization is a dissociative phenomenon characterized by a subjective feeling of detachment from oneself, manifesting as a sense of disconnection from one's thoughts, emotions, sensations, or actions, and often accompanied by a feeling of observing oneself from an external perspective. Subjects perceive that the world has become vague, dreamlike, surreal, or strange, leading to a diminished sense of individuality or identity. Sufferers often feel as though they are observing the world from a distance, as if separated by a barrier "behind glass". They maintain insight into the subjective nature of their experience, recognizing that it pertains to their own perception rather than altering objective reality. This distinction between subjective experience and objective reality distinguishes depersonalization from delusions, where individuals firmly believe in false perceptions as genuine truths. Depersonalization is also distinct from derealization, which involves a sense of detachment from the external world rather than from oneself.
Dissociation is a concept that has been developed over time and which concerns a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a false perception of reality as in psychosis.
Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.
Ganser syndrome is a rare dissociative disorder characterized by nonsensical or wrong answers to questions and other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness. The syndrome has also been called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, hysterical pseudodementia or prison psychosis.
Depersonalization-derealization disorder is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached from one's self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike, surreal, and/or visually distorted.
Acute stress reaction and acute stress disorder (ASD) is a psychological response to a terrifying, traumatic or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).
Dissociative disorders (DDs) are a range of conditions characterized by significant disruptions or fragmentation "in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior." Dissociative disorders involve involuntary dissociation as an unconscious defense mechanism, wherein the individual with a dissociative disorder experiences separation in these areas as a means to protect against traumatic stress. Some dissociative disorders are caused by major psychological trauma, though the onset of depersonalization-derealization disorder may be preceded by less severe stress, by the influence of psychoactive substances, or occur without any discernible trigger.
Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.
Depressive disorder not otherwise specified (DD-NOS) is designated by the code 311 in the DSM-IV for depressive disorders that are impairing but do not fit any of the officially specified diagnoses. According to the DSM-IV, DD-NOS encompasses "any depressive disorder that does not meet the criteria for a specific disorder." In the DSM-5, it is called unspecified depressive disorder.
A spectrum disorder is a disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism. In either case, a spectrum approach is taken because there appears to be "not a unitary disorder but rather a syndrome composed of subgroups". The spectrum may represent a range of severity, comprising relatively "severe" mental disorders through to relatively "mild and nonclinical deficits".
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In 2022, a revised version (DSM-5-TR) was published. In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has practical importance. However, not all providers rely on the DSM-5 for planning treatment as the ICD's mental disorder diagnoses are used around the world and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. The DSM-5 is the only DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the only living document version of a DSM.
Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. It is a dissociative symptom that may appear in moments of severe stress.
Personality disorder not otherwise specified (PD-NOS) is a subclinical diagnostic classification for some DSM-IV Axis II personality disorders not listed in DSM-IV.
Dissociative disorder not otherwise specified (DDNOS) was a mental health diagnosis for pathological dissociation that matched the DSM-IV criteria for a dissociative disorder, but did not fit the full criteria for any of the specifically identified subtypes, and the reasons why the previous diagnoses were not met are specified. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) refers to the diagnosis as "Other dissociative and conversion disorders". Under the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), it is known as "Other specified dissociative disorder" (OSDD).
Bouffée délirante (BD) is an acute and transient psychotic disorder. It is a uniquely French psychiatric diagnostic term with a long history in France and various French speaking nations: Caribbean, e.g., Haiti, Guadeloupe, Antilles and Francophone Africa. The term BD was originally coined and described by Valentin Magnan (1835–1916), fell into relative disuse and was later revived by Henri Ey (1900–1977).
The Multiscale Dissociation Inventory (MDI) is a comprehensive, self-administered, multiscale instrument developed by Paul F. Dell. It is designed to assess the entire domain of dissociative identity disorder phenomena. The MDI measures 14 major facets of pathological dissociation and uses 23 scales to diagnose dissociative disorders.