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Diagnosis of Dissociative Disorders

Dissociative Disorders are diagnosed based on a clinical assessment performed by a mental health professional.  This assessment includes an interview with the individual, a review of any previous medical records, and can also include an interview with the individual's family members or close friends.  The goal of this assessment is to determine whether the individual meets the clinical criteria for any of the Dissociative Disorders based on the information obtained. 

Diagnosing these conditions can be challenging even for experienced clinicians because the symptoms can be very vague and also difficult to differentiate from other psychiatric disorders. For this reason, a period of observation either in hospital or as an out-patient is often required.

There are no laboratory tests or imaging tests (such as CT scans or MRI scans) that can help make a diagnosis of a Dissociative Disorder, but these tests are often important in order to rule-out the presence of other general medical conditions or substance use that can be contributing to the symptoms.

Differentiating Dissociative States and Disorders from other Conditions (Differential Diagnosis)

There are various medical and psychiatric conditions that should be distinguished from true Dissociative Disorders:

Medical causes of dissociation

Any medical condition that can cause states of confusion, altered levels of consciousness or memory impairment can be mistaken for a dissociative state. Most commonly this will involve neurological conditions. Two such conditions that can be particularly difficult to tell apart from a Dissociative Disorder are:

Substances that can cause dissociation

Various medications and street drugs can cause dissociative symptoms, including:

Psychiatric conditions that can be mistaken for Dissociative Disorders

It can be difficult to tell apart Dissociative Identity Disorder from Psychotic Disorders like Schizophrenia, especially when the individual experiences hallucinations. Clear-cut sudden shifts in identity states, reversible memory loss, and high scores on measures of dissociation are factors that support a diagnosis of Dissociative Identity Disorder.

Dissociative Identity Disorder has many qualities of a Personality Disorder, and these individuals can often be diagnosed with various other Personality Disorders.

The dramatic shifts in mood that can occur in Rapid Cycling Bipolar Disorder can sometimes be mistaken for changes in identity or personality, and people in the grips of a Manic or Mixed Episode can sometimes be confused or unclear about recent events. However, a careful assessment should help to reveal the various other symptoms typical of a Manic or Mixed Episode and help to make the proper diagnosis.

Some people may feign having a Dissociative Disorder, either for legal or financial reasons, or because they are hoping to receive care and attention from others. For this reason, taking some time to make this diagnosis after a period of observation may be prudent.

Diagnostic Tools for Dissociative Symptoms and Disorders

There are several scales that clinicians can use to help them in detecting Dissociative Disorders and measure the severity of these conditions.

The Dissociative Experiences Scale (DES) is probably the most commonly used and well validated instrument to measure dissociative symptoms [ref]. It is a self-report questionnaire completed by the patient, usually in 5-10 minutes. Most people without significant dissociative symptoms will have a score below 15. Scores above 20 are thought to represent a clinically significant amount of dissociative symptoms, and scores above 30 are in line with having a Dissociative Disorder [ref, ref]. This scale can be used as a screening instrument to detect dissociative symptoms in people.

Other scales with similar properties include the Perceptual Alterations Scale, the Questionnaire on Experiences of Dissociation, the Dissociation Questionnaire (DIS-Q), and the Dissociative Processes Scale [ref].

 

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Dissociative Disorder (NOS)

Causes