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DSM 5

Terms in this set (57)

In an effort to improve diagnosis and care to people of all backgrounds, the fifth edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM-5) incorporates a greater cultural sensitivity
throughout the manual. Rather than a simple list of culture-bound syndromes, DSM-5 updates criteria
to reflect cross-cultural variations in presentations, gives more detailed and structured information
about cultural concepts of distress, and includes a clinical interview tool to facilitate comprehensive,
person-centered assessments.
The Impact of Cultural Differences
Different cultures and communities exhibit or explain symptoms in various ways. Because of this, it is
important for clinicians to be aware of relevant contextual information stemming from a patient's culture,
race, ethnicity, religion or geographical origin. For example, uncontrollable crying and headaches
are symptoms of panic attacks in some cultures, while difficulty breathing may be the primary symptom
in other cultures. Understanding such distinctions will help clinicians more accurately diagnose problems
as well as more effectively treat them.
Cultural Considerations in Clinical Practice
Throughout the DSM-5 development process, the Work Groups made a concerted effort to modify
culturally determined criteria so they would be more equivalent across different cultures. In Section II,
specific diagnostic criteria were changed to better apply across diverse cultures. For example, the criteria
for social anxiety disorder now include the fear of "offending others" to reflect the Japanese concept
in which avoiding harm to others is emphasized rather than harm to oneself.
The new manual also addresses cultural concepts of distress, which detail ways in which different
cultures describe symptoms. In the Appendix, they are described through cultural syndromes, idioms
of distress, and explanations. These concepts assist clinicians in recognizing how people in different
cultures think and talk about psychological problems.
Finally, the cultural formulation interview guide will help clinicians to assess cultural factors influencing
patients' perspectives of their symptoms and treatment options. It includes questions about patients'
background in terms of their culture, race, ethnicity, religion or geographical origin. The interview provides
an opportunity for individuals to define their distress in their own words and then relate this to
how others, who may not share their culture, see their problems. This gives the clinician a more comprehensive
foundation on which to base both diagnosis and care.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) updates disorder
criteria to more precisely capture the experiences and symptoms of children. The book also features a
new lifespan approach to mental health. Rather than isolating childhood conditions, DSM-5's organization
underscores how they can continue to manifest at different stages of life and may be impacted by
the developmental continuum that influences many disorders.
Changes affecting children are evident before the manual's first page of text. Its table of contents reflects
a new framework that recognizes age-related aspects of disorders by arranging each diagnostic
chapter in a chronological fashion, with diagnoses most applicable to infancy and childhood listed first,
followed by diagnoses more common to adolescence and early adulthood, and ending with those relevant
to adulthood and later years. Thus, disorders previously addressed in a single "infancy, childhood
and adolescence" chapter are now integrated throughout the book.
Individual disorders, diagnostic categories and criteria were revised to better serve young patients. In
revising DSM-5, several factors motivated the Work Groups, including:
• Working with parents
• Defining a diagnostic home
• Developing more precise criteria
Parents' Integral Role
Throughout the development process for DSM-5, family and consumer advocacy organizations served
an important function in giving feedback on proposed changes and, in some cases, meeting with members
of the DSM-5 Work Groups. All revisions to the manual were made to more precisely describe and
diagnose the symptoms and behaviors of those seeking clinical help. Parents provided a particularly
valuable perspective on the framing around changes.
DSM-5 is a clinical guidebook for assessment and diagnosis of mental disorders and does not include
treatment guidelines or recommendations on services. That said, determining an accurate diagnosis
is the first step toward appropriate care. As with any medical issue, no child should ever be diagnosed
without a careful, comprehensive evaluation, and no medication should be prescribed without equal
vigilance. Parents play an integral role in this process as many of the DSM criteria require that symptoms
be observed by them or individuals who interact regularly with the child.
It is both appropriate and essential for parents to ask questions and provide information to clinicians
during a child's assessment. Parents' specific questions about their child's care should always be discussed
with the child's mental health clinician or pediatrician.
A Diagnostic Home
Clinicians and families often were frustrated that DSM-IV did not define or describe some of the clinically
significant behaviors and symptoms they observed in children. In an effort to improve diagnosis
and care, two new disorders are among the changes made to DSM-5 to provide children with an accurate
diagnostic home.
2 • DSM-5 and Diagnoses for Children
Social communication disorder (SCD) is characterized by a persistent difficulty with verbal and nonverbal
communication that cannot be explained by low cognitive ability. The child's acquisition and use
of spoken and written language is problematic, and responses in conversation are often difficult. Since
previous manuals did not provide an applicable diagnosis for individuals with such symptoms, there
was inconsistent treatment across clinics and treatment centers. SCD brings these children's social and
communication deficits out of the shadows of a "not otherwise specified" or similarly inexact diagnosis.
Also added to DSM-5 is disruptive mood dysregulation disorder (DMDD). It is characterized by severe
and recurrent temper outbursts that are grossly out of proportion to the situation in intensity or duration.
The outbursts occur, on average, three or more times each week for a year or more. The unique
features of DMDD necessitated a new diagnosis to ensure that children affected by this disorder get
appropriate clinical help.
More Precise Criteria
Existing criteria have been updated in DSM-5 to provide more precise descriptions and reflect the scientific
advances and clinical experience of the last two decades. Below are brief summaries of changes to
select disorders.
Autism spectrum disorder (ASD) incorporates four disorders from the previous manual: autistic disorder,
Asperger's disorder, childhood disintegrative disorder, and the catch-all diagnosis of pervasive
developmental disorder not otherwise specified. Researchers found that those four diagnoses were
inconsistently applied across clinics and treatment centers and, rather than distinct disorders, actually
represented symptoms and behaviors along a severity continuum. ASD reflects that continuum and is a
more accurate and medically and scientifically useful approach. People diagnosed with one of the separate
DSM-IV disorders should still meet the criteria for autism spectrum disorder or a different DSM-5
diagnosis.
Attention deficit/hyperactivity disorder (ADHD) now requires an individual's symptoms to be present
prior to age 12, compared to 7 as the age of onset in DSM-IV. Substantial research published since 1994
found no clinical differences between children with earlier versus later symptom onset in terms of their
disorder course, severity, outcome, or treatment response. Other criteria for diagnosing children with
ADHD remain unchanged.
Posttraumatic Stress Disorder (PTSD) includes a new subtype for children younger than 6. This change
is based on recent research detailing what PTSD looks like in young children. Adding the developmental
subtype should help clinicians tailor treatment in a more age-appropriate and age-effective way.
Specific Learning Disorder no longer limits learning disorders to reading, mathematics and written
expression. Rather, the DSM-5 criteria describe shortcomings in general academic skills and provide
detailed specifiers. Just as in DSM-IV, dyslexia is included in the descriptive text.
Eating disorders previously listed among Disorders Usually First Diagnosed in Infancy, Childhood, or
Adolescence are now listed in the Feeding and Eating Disorders chapter. They include pica, rumination
and avoidant/restrictive food intake disorder.
DSM-5 and Diagnoses for Children • 3
Section III of DSM-5 lists conditions warranting more scientific research and clinical experience before
they might be considered for inclusion in the main book as formal disorders. Two conditions listed here
are particularly relevant for children and adolescents; both are regarded as major problems and public
health issues that need to be better understood. Nonsuicidal self-injury defines self-harm without the
intention of suicide. Internet gaming disorder deals with the compulsive preoccupation some people
develop in playing online games, often to the exclusion of other needs and interests.
More information about children with these and other challenging behaviors is available from:
• American Academy of Child and Adolescent Psychiatry at www.aacap.org
• The Balanced Mind Foundation at www.thebalancedmind.org
• National Alliance on Mental Illness at www.nami.org
• Mental Health America at www.mentalhealthamerica.net.
The upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduces
an integration of a dimensional approach to diagnosis and classification with the current
categorical approach. Previous editions of DSM used a strictly categorical model requiring a clinician to
determine that a disorder was present or absent. The dimensional approach, which allows a clinician
more latitude to assess the severity of a condition and does not imply a concrete threshold between
"normality" and a disorder, is now incorporated via select diagnoses. Its inclusion will also provide
more utility in research contexts.
Disorders on a Spectrum
While all disorders in DSM-5 remain in specific categories, measures indicating degree of acuteness
have been added to several combined diagnoses.
For example, autism spectrum disorder (ASD) combines four different categorical disorders and conceptualizes
them as occurring along a single spectrum focused on dysfunctional social communication
and restricted, repetitive behaviors or interests. Under DSM-IV, patients with such symptoms could be
diagnosed with autistic disorder, Asperger's disorder, childhood disintegrative disorder, or the catch-all
diagnosis of pervasive developmental disorder not otherwise specified. But the diagnoses were not
consistently applied across practices and treatment centers, in large part because they shared such
similar characteristics. Researchers determined that these separate disorders are actually related conditions
along a single continuum of behavior. With ASD, some individuals show mild symptoms and others
have much more severe symptoms. This spectrum will allow clinicians to account for such variations
from person to person.
Another example of continuum-based assessment is evident in the new diagnosis of substance use
disorder. DSM-5 combines two separate diagnoses of abuse and dependence into a single spectrum of
eleven symptoms. In DSM-IV, the distinction between abuse and dependence was based on the concept
of abuse as a mild or early phase and dependence as the more severe manifestation. In practice,
that was an arbitrary dichotomy, as the abuse criteria were sometimes quite severe. The revised substance
use disorder better matches the symptoms that patients experience.
Building on Symptoms as the Foundation for Care
Using assessment models that also focus attention on the acuteness of symptoms helps clinicians
gather more information and thus more insight in creating a treatment plan. The narrow categorical
approach of previous DSM editions constricted the range of clinical information obtained, which often
could have significant implications for diagnosis, treatment planning, prognosis, and outcomes.
With greater depth of detail about symptoms—instead of simply marking them as present or absent—
DSM-5 will reduce the excess number of patients who would have been diagnosed under DSM-IV's
categorical approach as having a "not otherwise specified" diagnosis due to failure to meet thresholds
(e.g., patients with mild symptoms who might not fulfill threshold symptom counts but are in need of
treatment). Rather, the integrated approach moves these patients out of the "not otherwise specified"
2 • DSM-5's Integrated Approach to Diagnosis and Classification
category by tailoring their diagnosis to the particulars of each individual and providing a diagnosis that
is more informative and conducive to treatment planning than the residual diagnosis of "not otherwise
specified". Patients often do not fit precisely into one category or another, and the use of a spectrum in
DSM-5 mitigates that problem. Assessing on a spectrum also has benefits for research because the data
it produces is more reliable, stable and valid. Spectrum models are also preferred for hypothesis development
and testing.
To ensure DSM-5 is not overly disruptive to clinical practice, its spectrum measures are compatible with
categorical definitions. The new edition combines the best of both categorical and dimensional approaches
to provide better guidance to clinicians and, as a consequence better treatment to patients.
The upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will replace
the diagnosis of "mixed episode" with a mixed-features specifier that can be applied to episodes
of major depression, hypomania or mania. The change reflects ways these behaviors intersect and will
benefit diagnosis and care.
In DSM-IV, a diagnosis of mixed episode required an individual to simultaneously meet all criteria for
an episode of major depression and an episode of mania. During its review of the latest research, the
DSM-5 Mood Disorders Work Group recognized that individuals rarely meet full criteria for both episode
types at the same time. In order to be diagnosed with the new specifier in the case of major depression,
the new DSM-5 specifier will require the presence of at least three manic/hypomanic symptoms
that don't overlap with symptoms of major depression. In the case of mania or hypomania, the
specifier will require the presence of at least three symptoms of depression in concert with the episode
of mania/hypomania.
Using the Specifiers
If an individual is predominantly manic or hypomanic but also presents with depressive symptoms,
the mixed features specifier may be considered. Depressive symptoms may include depressed mood,
diminished interest or pleasure, slowed physical and emotional reaction, fatigue or loss of energy, and
recurrent thoughts of death. At least three of these symptoms must be present nearly every day during
the most recent week of a manic episode or during the most recent four days of a hypomanic episode.
Conversely, if an individual is predominantly depressed with some manic or hypomanic symptoms, the
mixed features specifier may also be considered. These manic or hypomanic symptoms may include elevated
mood, inflated self-esteem, decreased need for sleep and an increase in energy or goal-directed
activity. At least three of these symptoms must be present nearly every day during the most recent two
weeks of the major depressive episode.
Improving Diagnosis and Care
The specifier will allow clinicians to more accurately diagnose patients who may be suffering from
concurrent symptoms of depression and mania/hypomania, as well as better tailor treatment to their
behaviors. This is especially important since many patients with mixed features, depending on their
predominant symptoms, demonstrate poor response to lithium or become less stable when taking antidepressants.
Additionally, more accurately identifying these concurrent behaviors may allow clinicians
to recognize people with a unipolar disorder at increased risk of progression to bipolar disorder.
The upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) adds
a descriptive features specifier to the diagnosis of conduct disorder for individuals who meet the full
criteria for the disorder and who also present with limited prosocial emotions, such as limited empathy
and guilt. The addition of the specifier will help specialize care and spur additional treatment and
causal research.
Using the Specifier
Conduct disorder is characterized by behavior that violates either the rights of others or major societal
norms. These symptoms must be present for at least three months with one symptom having been
present in the past six months. To be diagnosed with conduct disorder, the symptoms must cause significant
impairment in social, academic or occupational functioning. The disorder is typically diagnosed
prior to adulthood.
In DSM-5, the criteria for conduct disorder are largely unchanged from DSM-IV, but the limited prosocial
specifier is new to DSM-5. The specifier applies to those individuals with a more serious pattern of
behavior characterized by a callous and unemotional interpersonal style across multiple settings and
relationships. The specifier goes beyond the presence of negative behavior and reflects an individual's
typical patterns in emotional and interpersonal functioning. People with conduct disorder who show
this specifier display limited empathy and little concern for the feelings, wishes, and well-being of others.
Specializing Care and Spurring Research
Individuals with conduct disorder who meet criteria for the specifier have a relatively more severe form
of the disorder and a different treatment response. Thus the specifier will allow clinicians to more accurately
identify and diagnosis individuals who need more intensive and individualized treatment. The
specifier attempts to avoid stigmatizing language and focuses on a limited display of prosocial emotions
such as empathy and guilt.
The specifier will also encourage treatment research to refine what does and does not work for this
group of individuals. In addition to treatment, the specifier will impact the research on persons with
conduct disorder by designating groups of patients with more similar causal factors.
Finding a Home in DSM
The road to mental health begins with an accurate diagnosis. Consider a recent Wall Street Journal
article describing nearly a decade of suffering for an 11-year-old boy who, although diagnosed with bipolar
disorder at age 4, has never been successfully treated for his extreme, explosive rages. Too many
severely impaired children like this are falling through the cracks because they suffer from a disorder
that has not yet been defined. A new diagnosis in the fifth edition of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) aims to give these children a diagnostic home and ensure they get
the care they need.
Characteristics of the Disorder
This disorder is called Disruptive Mood Dysregulation Disorder (DMDD), and its symptoms go beyond
describing temperamental children to those with a severe impairment that requires clinical attention.
Far beyond temper tantrums, DMDD is characterized by severe and recurrent temper outbursts that
are grossly out of proportion in intensity or duration to the situation. These occur, on average, three or
more times each week for one year or more.
Between outbursts, children with DMDD display a persistently irritable or angry mood, most of the day
and nearly every day, that is observable by parents, teachers, or peers. A diagnosis requires the above
symptoms to be present in at least two settings (at home, at school, or with peers) for 12 or more
months, and symptoms must be severe in at least one of these settings. During this period, the child
must not have gone three or more consecutive months without symptoms.
The onset of symptoms must be before age 10, and a DMDD diagnosis should not be made for the first
time before age 6 or after age 18.
Process for New Diagnosis
A new DSM diagnosis is included only after a comprehensive review of the scientific literature; full
discussion by Work Group members; review by the DSM-5 Task Force, Scientific Review Committee,
Clinical and Public Health Committee; and, finally, approval by the American Psychiatric Association's
Board of Trustees.
The DMDD diagnosis, like every other new disorder, also received review and feedback from other
mental health clinicians and advocacy organizations during three open-comment periods facilitated
through the DSM-5 website, www.DSM5.org.
Throughout this rigorous process, considerable discussion about DMDD focused on the need for developmentally
appropriate diagnostic criteria for severe irritability in children and adolescents. DSM-IV
provided no guidance on an appropriate diagnosis for children with such severely impairing symptoms.
2 • Disruptive Mood Disregulation Disorder
Improving Diagnosis and Care
While DSM does include two diagnoses with related symptoms to DMDD, oppositional defiant disorder
(ODD) and Bipolar Disorder (BD), the symptoms described in DMDD are significantly different than
these two diagnoses.
ODD is an ongoing pattern of anger-guided disobedience, hostilely defiant behavior toward authority
figures that goes beyond the bounds of normal childhood behavior. While some of its symptoms may
overlap with the criteria for DMDD, the symptom threshold for DMDD is higher since the condition is
considered more severe. To avoid any artificial comorbidity of the two disorders, it is recommended
that children who meet criteria for both ODD and DMDD should only be diagnosed with DMDD.
BD also has similar symptoms. And while clinicians may have been assigning a BD diagnosis to these
severely irritable youth to ensure their access to treatment resources and services, these children's
behaviors may not present in an episodic way as is the case with BD. In an effort to address this issue,
research was conducted comparing youth with severe non-episodic symptoms to those with the classic
presentations of BD as defined in DSM-IV.
Results of that extensive research showed that children diagnosed with BD who experience constant,
rather than episodic, irritability often are at risk for major depressive disorder or generalized anxiety
disorder later in life, but not life-long BD. This finding pointed to the need for a new diagnosis for children
suffering from constant, debilitating irritability. The hope is that by defining this condition more
accurately, clinicians will be able to improve diagnosis and care.
Defining this disorder as a distinct condition will likely have a considerable impact on clinical practice
and thus treatment. For example, the medication and psychotherapy treatment recommended for BD is
entirely different from that of other disorders, such as depressive and anxiety disorders.
The unique features of DMDD necessitated a new diagnosis to ensure that children affected by this
disorder get the clinical help they need.
The chapter on Feeding and Eating Disorders in the fifth edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM-5) includes several changes to better represent the symptoms and behaviors
of patients dealing with these conditions across the lifespan. Among the most substantial changes
are recognition of binge eating disorder, revisions to the diagnostic criteria for anorexia nervosa and
bulimia nervosa, and inclusion of pica, rumination and avoidant/restrictive food intake disorder. DSM-IV
listed the latter three among Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence, a
chapter that will not exist in DSM-5.
In recent years, clinicians and researchers have realized that a significant number of individuals with
eating disorders did not fit into the DSM-IV categories of anorexia nervosa and bulimia nervosa. By
default, many received a diagnosis of "eating disorder not otherwise specified." Studies have suggested
that a significant portion of individuals in that "not otherwise specified" category may actually have
binge eating disorder.
Binge Eating Disorder
Binge eating disorder was approved for inclusion in DSM-5 as its own category of eating disorder. In
DSM-IV, binge-eating disorder was not recognized as a disorder but rather described in Appendix B:
Criteria Sets and Axes Provided for Further Study and was diagnosable using only the catch-all category
of "eating disorder not otherwise specified."
Binge eating disorder is defined as recurring episodes of eating significantly more food in a short period
of time than most people would eat under similar circumstances, with episodes marked by feelings of
lack of control. Someone with binge eating disorder may eat too quickly, even when he or she is not
hungry. The person may have feelings of guilt, embarrassment, or disgust and may binge eat alone
to hide the behavior. This disorder is associated with marked distress and occurs, on average, at least
once a week over three months.
This change is intended to increase awareness of the substantial differences between binge eating
disorder and the common phenomenon of overeating. While overeating is a challenge for many Americans,
recurrent binge eating is much less common, far more severe, and is associated with significant
physical and psychological problems.
Anorexia Nervosa
Anorexia nervosa, which primarily affects adolescent girls and young women, is characterized by distorted
body image and excessive dieting that leads to severe weight loss with a pathological fear of
becoming fat. The criteria have several minor but important changes:
• Criterion A focuses on behaviors, like restricting calorie intake, and no longer includes the word
"refusal" in terms of weight maintenance since that implies intention on the part of the patient and
can be difficult to assess. The DSM-IV Criterion D requiring amenorrhea, or the absence of at least
three menstrual cycles, will be deleted. This criterion cannot be applied to males, pre-menarchal
females, females taking oral contraceptives and post-menopausal females. In some cases, individuals
exhibit all other symptoms and signs of anorexia nervosa but still report some menstrual activity.
2 • Feeding and Eating Disorders
Bulimia Nervosa
Bulimia nervosa is characterized by frequent episodes of binge eating followed by inappropriate behaviors
such as self-induced vomiting to avoid weight gain. DSM-5 criteria reduce the frequency of binge
eating and compensatory behaviors that people with bulimia nervosa must exhibit, to once a week
from twice weekly as specified in DSM-IV.
Overall Changes
The Eating Disorders Work Group intended for DSM-5 changes to minimize use of the catch-all diagnoses
of Other Specified Feeding and Eating Disorder and Unspecified Feeding and Eating Disorder.
A primary goal is for more people experiencing eating disorders to have a diagnosis that accurately
describes their symptoms and behaviors. Determining an accurate diagnosis is a first step for clinicians
and patients in defining a treatment plan.
In the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
people whose gender at birth is contrary to the one they identify with will be diagnosed with gender
dysphoria. This diagnosis is a revision of DSM-IV's criteria for gender identity disorder and is intended
to better characterize the experiences of affected children, adolescents, and adults.
Respecting the Patient, Ensuring Access to Care
DSM not only determines how mental disorders are defined and diagnosed, it also impacts how people
see themselves and how we see each other. While diagnostic terms facilitate clinical care and access to
insurance coverage that supports mental health, these terms can also have a stigmatizing effect.
DSM-5 aims to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a
different gender than their assigned gender. It replaces the diagnostic name "gender identity disorder"
with "gender dysphoria," as well as makes other important clarifications in the criteria. It is important
to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria
is the presence of clinically significant distress associated with the condition.
Characteristics of the Condition
For a person to be diagnosed with gender dysphoria, there must be a marked difference between the
individual's expressed/experienced gender and the gender others would assign him or her, and it must
continue for at least six months. In children, the desire to be of the other gender must be present and
verbalized. This condition causes clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
Gender dysphoria is manifested in a variety of ways, including strong desires to be treated as the other
gender or to be rid of one's sex characteristics, or a strong conviction that one has feelings and reactions
typical of the other gender.
The DSM-5 diagnosis adds a post-transition specifier for people who are living full-time as the desired
gender (with or without legal sanction of the gender change). This ensures treatment access for individuals
who continue to undergo hormone therapy, related surgery, or psychotherapy or counseling to
support their gender transition.
Gender dysphoria will have its own chapter in DSM-5 and will be separated from Sexual Dysfunctions
and Paraphilic Disorders.
Need for Change
Persons experiencing gender dysphoria need a diagnostic term that protects their access to care and
won't be used against them in social, occupational, or legal areas.
When it comes to access to care, many of the treatment options for this condition include counseling,
cross-sex hormones, gender reassignment surgery, and social and legal transition to the desired
2 • Gender Dysphoria
gender. To get insurance coverage for the medical treatments, individuals need a diagnosis. The Sexual
and Gender Identity Disorders Work Group was concerned that removing the condition as a psychiatric
diagnosis—as some had suggested—would jeopardize access to care.
Part of removing stigma is about choosing the right words. Replacing "disorder" with "dysphoria" in the
diagnostic label is not only more appropriate and consistent with familiar clinical sexology terminology,
it also removes the connotation that the patient is "disordered."
Ultimately, the changes regarding gender dysphoria in DSM-5 respect the individuals identified by offering
a diagnostic name that is more appropriate to the symptoms and behaviors they experience without
jeopardizing their access to effective treatment options.
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Internet Gaming
Disorder is identified in Section III as a condition warranting more clinical research and experience
before it might be considered for inclusion in the main book as a formal disorder.
A New Phenomenon
The Internet is now an integral, even inescapable part of many people's daily lives; they turn to it to
send messages, read news, conduct business and much more. But recent scientific reports have begun
to focus on the preoccupation some people develop with certain aspects of the Internet, particularly
online games. The "gamers" play compulsively, to the exclusion of other interests, and their persistent
and recurrent online activity results in clinically significant impairment or distress. People with this condition
endanger their academic or job functioning because of the amount of time they spend playing.
They experience symptoms of withdrawal when kept from gaming.
Much of this literature stems from evidence from Asian countries and centers on young males. The
studies suggest that when these individuals are engrossed in Internet games, certain pathways in their
brains are triggered in the same direct and intense way that a drug addict's brain is affected by a particular
substance. The gaming prompts a neurological response that influences feelings of pleasure and
reward, and the result, in the extreme, is manifested as addictive behavior.
Further research will determine if the same patterns of excessive online gaming are detected using the
proposed criteria. At this time, the criteria for this condition are limited to Internet gaming and do not
include general use of the Internet, online gambling or social media.
By listing Internet Gaming Disorder in DSM'5 Section III, APA hopes to encourage research to determine
whether the condition should be added to the manual as a disorder.
In the Diagnostic and Statistical Manual of Mental Disorders (DSM), paraphilic disorders are often
misunderstood as a catch-all definition for any unusual sexual behavior. In the upcoming fifth edition of
the book, DSM-5, the Sexual and Gender Identity Disorders Work Group sought to draw a line between
atypical human behavior and behavior that causes mental distress to a person or makes the person a
serious threat to the psychological and physical well-being of other individuals. While legal implications
of paraphilic disorders were considered seriously in revising diagnostic criteria, the goal was to update
the disorders in this category based on the latest science and effective clinical practice.
Through careful consideration of the research as well as of the collective clinical knowledge of experts
in the field, several important changes were made to the criteria of paraphilic disorders, or paraphilias
as they have been called in previous editions of the manual.
Characteristics of Paraphilic Disorders
Most people with atypical sexual interests do not have a mental disorder. To be diagnosed with a paraphilic
disorder, DSM-5 requires that people with these interests:
• feel personal distress about their interest, not merely distress resulting from society's disapproval;
or
• have a sexual desire or behavior that involves another person's psychological distress, injury, or
death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal
consent.
To further define the line between an atypical sexual interest and disorder, the Work Group revised the
names of these disorders to differentiate between the behavior itself and the disorder stemming from
that behavior (i.e., Sexual Masochism in DSM-IV will be titled Sexual Masochism Disorder in DSM-5).
It is a subtle but crucial difference that makes it possible for an individual to engage in consensual atypical
sexual behavior without inappropriately being labeled with a mental disorder. With this revision,
DSM-5 clearly distinguishes between atypical sexual interests and mental disorders involving these
desires or behaviors.
The chapter on paraphilic disorders includes eight conditions: exhibitionistic disorder, fetishistic disorder,
frotteuristic disorder, pedophilic disorder, sexual masochism disorder, sexual sadism disorder,
transvestic disorder, and voyeuristic disorder.
Additional Changes to Paraphilic Disorders
Other changes to diagnostic criteria for two DSM-5 paraphilic disorders also should be noted.
The first concerns transvestic disorder, which identifies people who are sexually aroused by dressing as
the opposite sex but who experience significant distress or impairment in their lives—socially or occupationally—because
of their behavior. DSM-IV limited this behavior to heterosexual males; DSM-5 has
no such restriction, opening the diagnosis to women or gay men who have this sexual interest. While
2 • Paraphilic Disorders
the change could increase the number of people diagnosed with transvestic disorder, the requirement
remains that individuals must experience significant distress or impairment because of their behavior.
In the case of pedophilic disorder, the notable detail is what wasn't revised in the new manual. Although
proposals were discussed throughout the DSM-5 development process, diagnostic criteria ultimately
remained the same as in DSM-IV TR. Only the disorder name will be changed from pedophilia
to pedophilic disorder to maintain consistency with the chapter's other listings.
Personality disorders are associated with ways of thinking and feeling about oneself and others that
significantly and adversely affect how an individual functions in many aspects of life. They fall within
10 distinct types: paranoid personality disorder, schizoid personality disorder, schizotypal personality
disorder, antisocial personality disorder, borderline personality disorder, histrionic personality, narcissistic
personality disorder, avoidant personality disorder, dependent personality disorder and obsessivecompulsive
personality disorder.
During the development process of the fifth edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), several proposed revisions were drafted that would have significantly changed the
method by which individuals with these disorders are diagnosed. Based on feedback from a multilevel
review of proposed revisions, the American Psychiatric Association Board of Trustees ultimately decided
to retain the DSM-IV categorical approach with the same 10 personality disorders.
The proposed revisions that were not accepted for the main body of the manual were approved as an
alternative hybrid dimensional-categorical model that will be included in a separate chapter in Section
III of DSM-5. This alternative model is included to encourage further study on how this new methodology
could be used to assess personality and diagnose personality disorders in clinical practice.
DSM-5 moves from the multiaxial system to a new assessment that removes the arbitrary boundaries
between personality disorders and other mental disorders.
Assessing on a Single Axis
Until now, DSM has organized clinical assessment into five areas, or axes, addressing the different
aspects and impact of disorders. This multiaxial system was introduced in part to solve a problem that
no longer exists: Certain disorders, like personality disorders, received inadequate clinical and research
focus. As a consequence, these disorders were designated to Axis II to ensure they received greater
attention. However, the axis system was seen by some clinicians as burdensome and time consuming.
Given that there is no fundamental difference between disorders described on DSM-IV's Axis I and Axis
II, DSM-5 has shifted to a single axis system.
This system combines the first three axes outlined in past editions of DSM into one axis with all mental
and other medical diagnoses. Doing so removes artificial distinctions among conditions, benefitting
both clinical practice and research use.
Evolving the Diagnosis of Personality Disorders
The Personality Disorders Work Group began its efforts on DSM-5 by reviewing recent research on
these disorders and considering general feedback from the field about the categorical approach.
The Work Group's first revision represented a significantly different approach to diagnosis. It attempted
to break down the concise models of personality disorders, which sometimes are too rigid to fit patients'
symptoms, and replaced them with a trait-specific method. Using this model, clinicians would
have determined if their patients had a personality disorder by looking at the traits suggested by their
symptoms and ranking each trait by severity.
As evidenced by the field's reaction, this new model was too complex for clinical practice. After considering
that response and additional research, the Work Group evolved the diagnostic criteria for personality
disorders to marry the most useful aspects of DSM-IV criteria with features from the first revision's
trait-based approach.
The result was reflected in a second proposal, a hybrid model that included evaluation of impairments
in personality functioning (how an individual typically experiences himself or herself as well as others)
plus five broad areas of pathological personality traits.
Although this hybrid proposal was not accepted for DSM-5's main manual, it is included in Section III
for further study. Using this alternate methodology, clinicians would assess personality and diagnose
a personality disorder based on an individual's particular difficulties in personality functioning and on
specific patterns of those pathological traits.
The hybrid methodology retains six personality disorder types:
• Borderline Personality Disorder
• Obsessive-Compulsive Personality Disorder
• Avoidant Personality Disorder
• Schizotypal Personality Disorder
• Antisocial Personality Disorder
• Narcissistic Personality Disorder
Each type is defined by a specific pattern of impairments and traits. This approach also includes a diagnosis
of Personality Disorder—Trait Specified (PD-TS) that could be made when a Personality Disorder is
considered present, but the criteria for a specific personality disorder are not fully met. For this diagnosis,
the clinician would note the severity of impairment in personality functioning and the problematic
personality trait(s).
This hybrid dimensional-categorical model and its components seek to address existing issues with the
categorical approach to personality disorders. APA hopes that inclusion of the new methodology in
Section III of DSM-5 will encourage research that might support this model in the diagnosis and care
of patients, as well as contribute to greater understanding of the causes and treatments of personality
disorders.
Posttraumatic Stress Disorder (PTSD) will be included in a new chapter in DSM-5 on Trauma- and Stressor-Related
Disorders. This move from DSM-IV, which addressed PTSD as an anxiety disorder, is among
several changes approved for this condition that is increasingly at the center of public as well as professional
discussion.
The diagnostic criteria for the manual's next edition identify the trigger to PTSD as exposure to actual or
threatened death, serious injury or sexual violation. The exposure must result from one or more of the
following scenarios, in which the individual:
• directly experiences the traumatic event;
• witnesses the traumatic event in person;
• learns that the traumatic event occurred to a close family member or close friend (with the actual
or threatened death being either violent or accidental); or
• experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not
through media, pictures, television or movies unless work-related).
The disturbance, regardless of its trigger, causes clinically significant distress or impairment in the individual's
social interactions, capacity to work or other important areas of functioning. It is not the physiological
result of another medical condition, medication, drugs or alcohol.
Changes in PTSD Criteria
Compared to DSM-IV, the diagnostic criteria for DSM-5 draw a clearer line when detailing what constitutes
a traumatic event. Sexual assault is specifically included, for example, as is a recurring exposure
that could apply to police officers or first responders. Language stipulating an individual's response to
the event—intense fear, helplessness or horror, according to DSM-IV—has been deleted because that
criterion proved to have no utility in predicting the onset of PTSD.
DSM-5 pays more attention to the behavioral symptoms that accompany PTSD and proposes four
distinct diagnostic clusters instead of three. They are described as re-experiencing, avoidance, negative
cognitions and mood, and arousal.
Re-experiencing covers spontaneous memories of the traumatic event, recurrent dreams related to it,
flashbacks or other intense or prolonged psychological distress. Avoidance refers to distressing memories,
thoughts, feelings or external reminders of the event.
Negative cognitions and mood represents myriad feelings, from a persistent and distorted sense of
blame of self or others, to estrangement from others or markedly diminished interest in activities, to an
inability to remember key aspects of the event.
Finally, arousal is marked by aggressive, reckless or self-destructive behavior, sleep disturbances, hypervigilance
or related problems. The current manual emphasizes the "flight" aspect associated with PTSD;
the criteria of DSM-5 also account for the "fight" reaction often seen.
2 • Posttraumatic Stress Disorder
The number of symptoms that must be identified depends on the cluster. DSM-5 would only require
that a disturbance continue for more than a month and would eliminate the distinction between acute
and chronic phases of PTSD.
PTSD Preschool Subtype and PTSD Dissociative Subtype
DSM-5 will include the addition of two subtypes: PTSD in children younger than 6 years and PTSD with
prominent dissociative symptoms (either experiences of feeling detached from one's own mind or
body, or experiences in which the world seems unreal, dreamlike or distorted).
PTSD Debate within the Military
Certain military leaders, both active and retired, believe the word "disorder" makes many soldiers who
are experiencing PTSD symptoms reluctant to ask for help. They have urged a change to rename the
disorder posttraumatic stress injury, a description that they say is more in line with the language of
troops and would reduce stigma.
But others believe it is the military environment that needs to change, not the name of the disorder, so
that mental health care is more accessible and soldiers are encouraged to seek it in a timely fashion.
Some attendees at the 2012 APA Annual Meeting, where this was discussed in a session, also questioned
whether injury is too imprecise a word for a medical diagnosis.
In DSM-5, PTSD will continue to be identified as a disorder.
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), sleep-wake
disorders encompass 10 conditions manifested by disturbed sleep and causing distress as well as impairment
in daytime functioning. These conditions, which include both individual disorders and several
disorder groups, are approached categorically and dimensionally.
Consequences of Disturbed Sleep
Disturbed sleep, whether because of quality, timing or duration, can have many adverse health consequences.
The most obvious concerns are fatigue and cognitive focus, but mood can be greatly affected,
too.
A sleep disorder not only is a risk factor for subsequent development of certain mental conditions but a
potential warning sign for serious mental or medical issues. For example, sleep disturbances can signal
the presence of medical and neurological problems such as congestive heart failure, osteoarthritis, and
Parkinson's disease.
Sleep disorders range from insomnia disorder to narcolepsy and breathing-related disorders to restless
legs syndrome. They are diagnosed through comprehensive assessment, which may entail a detailed
patient history, physical exam, questionnaires and sleep diaries, and clinical testing. They often are addressed
in similarly comprehensive ways involving behavioral, pharmacologic and other treatments in
combination with medical care.
Changes to Sleep-Wake Disorders
A prime goal of DSM-5 changes to sleep-wake disorders is to increase the clinical utility of definitions
and diagnostic criteria, especially for general medical or mental health clinicians, and to clarify when
referral is appropriate to a sleep specialist.
To that end, some conditions that were separate in DSM-IV now are grouped together to help facilitate
diagnosis. Others have been divided based on greater understanding of the pathology triggering certain
disorders or their underlying neurobiological and genetic factors.
To help capture the dynamic relationship between sleep-wake disorders and certain mental or medical
conditions, a greater emphasis is placed on how they can interact and impact each other. These disorders
have been shown to be mutually exacerbating.
DSM-5 underscores the need for independent clinical attention of a sleep disorder regardless of mental
or other medical problems that may be present. Two previous diagnoses—sleep disorder related to
another mental disorder and sleep disorder related to another medical condition—have been eliminated
and greater specificity of co-existing conditions provided for each of the 10 sleep-wake disorders
defined.
DSM-5 also replaces primary insomnia with the diagnosis of insomnia disorder, a switch to avoid the
2 • Sleep-Wake Disorders
primary/secondary designation when this disorder co-occurs with other conditions and to reflect
changes throughout the classification.
The new chapter features dimensional assessments alongside categorical assessments for important
reasons. Doing so helps clinicians to capture the severity of symptoms and facilitate measurementbased
clinical care. Examining these disorders through a dimensional lens also will help to identify
behaviors contributing to the genesis or persistence of a condition.
Finally, where supported by science and considerations of clinical utility, DSM-5 integrates pediatric and
developmental criteria and text for numerous sleep-wake disorders.
The upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) replaces
somatoform disorders with somatic symptom and related disorders and makes significant changes
to the criteria to eliminate overlap across the somatoform disorders and clarify their boundaries. The
changes better reflect the complex interface between mental and physical health.
Characteristics of Somatic Symptom Disorder
Somatic symptom disorder (SSD) is characterized by somatic symptoms that are either very distressing
or result in significant disruption of functioning, as well as excessive and disproportionate thoughts,
feelings and behaviors regarding those symptoms. To be diagnosed with SSD, the individual must be
persistently symptomatic (typically at least for 6 months).
Several important changes have been made from previous editions of DSM. The DSM-IV disorders of
somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder have
been removed, and many, but not all, of the individuals diagnosed with one of these disorders could
now be diagnosed with SSD. The DSM-IV diagnosis of somatization disorder required a specific number
of complaints from among four symptom groups. The SSD criteria no longer have such a requirement;
however, somatic symptoms must be significantly distressing or disruptive to daily life and must be accompanied
by excessive thoughts, feelings, or behaviors.
Another key change in the DSM-5 criteria is that while medically unexplained symptoms were a key
feature for many of the disorders in DSM-IV, an SSD diagnosis does not require that the somatic symptoms
are medically unexplained. In other words, symptoms may or may not be associated with another
medical condition. DSM-5 narrative text description that accompanies the criteria for SSD cautions that
it is not appropriate to diagnose individuals with a mental disorder solely because a medical cause cannot
be demonstrated. Furthermore, whether or not the somatic symptoms are medically explained, the
individual would still have to meet the rest of the criteria in order to receive a diagnosis of SSD.
Promoting Holistic Care
The well-tested DSM-5 criteria for SSD remove overlap and confusion from previous editions and encourage
comprehensive assessment of patients for accurate diagnoses and holistic care.
The DSM-IV criteria included a large number of disorders that overlapped and made it difficult for primary
care providers to effectively isolate the problem plaguing their patients. Because those suffering
from SSD are primarily seen in general medical settings as opposed to psychiatric settings, the criteria
in DSM-5 clarify confusing terms and reduce the number of disorders and sub-categories to make the
criteria more useful to non-psychiatric care providers.
To ensure that the new criteria would indeed help clinicians better identify individuals who need care;
scientists tested the SSD criteria in actual clinical practices during the DSM-5 field trials. SSD's diagnostic
reliability performed very well in these field tests.
2 • Somatic Symptom Disorder
Comprehensive assessment of patients requires the recognition that psychiatric problems often cooccur
in patients with medical problems. While DSM-IV was organized centrally around the concept of
medically unexplained symptoms, DSM-5 criteria instead emphasize the degree to which a patient's
thoughts, feelings and behaviors about their somatic symptoms are disproportionate or excessive. The
new narrative text for SSD notes that some patients with physical conditions such as heart disease or
cancer will indeed experience disproportionate and excessive thoughts, feelings, and behaviors related
to their illness, and that these individuals may qualify for a diagnosis of SSD. This in turn may enable
them to access treatment for these symptoms. In this sense, SSD is like depression; it can occur in the
context of a serious medical illness. It requires clinical training, experience and judgment based on
guidance such as that contained in the DSM-5 text to recognize when a patient's thoughts feelings and
behaviors are indicative of a mental disorder that can benefit from focused treatment.
This change in emphasis removes the mind-body separation implied in DSM-IV and encourages clinicians
to make a comprehensive assessment and use clinical judgment rather than a check list that may
arbitrarily disqualify many people who are suffering with both SSD and another medical diagnosis from
getting the help they need.
DSM is the manual used by clinicians and researchers
The chapter on Feeding and Eating Disorders in the fifth edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM-5) includes several changes to better represent the symptoms and behaviors
of patients dealing with these conditions across the lifespan. Among the most substantial changes
are recognition of binge eating disorder, revisions to the diagnostic criteria for anorexia nervosa and
bulimia nervosa, and inclusion of pica, rumination and avoidant/restrictive food intake disorder. DSM-IV
listed the latter three among Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence, a
chapter that will not exist in DSM-5.
In recent years, clinicians and researchers have realized that a significant number of individuals with
eating disorders did not fit into the DSM-IV categories of anorexia nervosa and bulimia nervosa. By
default, many received a diagnosis of "eating disorder not otherwise specified." Studies have suggested
that a significant portion of individuals in that "not otherwise specified" category may actually have
binge eating disorder.
Binge Eating Disorder
Binge eating disorder was approved for inclusion in DSM-5 as its own category of eating disorder. In
DSM-IV, binge-eating disorder was not recognized as a disorder but rather described in Appendix B:
Criteria Sets and Axes Provided for Further Study and was diagnosable using only the catch-all category
of "eating disorder not otherwise specified."
Binge eating disorder is defined as recurring episodes of eating significantly more food in a short period
of time than most people would eat under similar circumstances, with episodes marked by feelings of
lack of control. Someone with binge eating disorder may eat too quickly, even when he or she is not
hungry. The person may have feelings of guilt, embarrassment, or disgust and may binge eat alone
to hide the behavior. This disorder is associated with marked distress and occurs, on average, at least
once a week over three months.
This change is intended to increase awareness of the substantial differences between binge eating
disorder and the common phenomenon of overeating. While overeating is a challenge for many Americans,
recurrent binge eating is much less common, far more severe, and is associated with significant
physical and psychological problems.
Anorexia Nervosa
Anorexia nervosa, which primarily affects adolescent girls and young women, is characterized by distorted
body image and excessive dieting that leads to severe weight loss with a pathological fear of
becoming fat. The criteria have several minor but important changes:
• Criterion A focuses on behaviors, like restricting calorie intake, and no longer includes the word
"refusal" in terms of weight maintenance since that implies intention on the part of the patient and
can be difficult to assess. The DSM-IV Criterion D requiring amenorrhea, or the absence of at least
three menstrual cycles, will be deleted. This criterion cannot be applied to males, pre-menarchal
females, females taking oral contraceptives and post-menopausal females. In some cases, individuals
exhibit all other symptoms and signs of anorexia nervosa but still report some menstrual activity.
2 • Feeding and Eating Disorders
Bulimia Nervosa
Bulimia nervosa is characterized by frequent episodes of binge eating followed by inappropriate behaviors
such as self-induced vomiting to avoid weight gain. DSM-5 criteria reduce the frequency of binge
eating and compensatory behaviors that people with bulimia nervosa must exhibit, to once a week
from twice weekly as specified in DSM-IV.
Overall Changes
The Eating Disorders Work Group intended for DSM-5 changes to minimize use of the catch-all diagnoses
of Other Specified Feeding and Eating Disorder and Unspecified Feeding and Eating Disorder.
A primary goal is for more people experiencing eating disorders to have a diagnosis that accurately
describes their symptoms and behaviors. Determining an accurate diagnosis is a first step for clinicians
and patients in defining a treatment plan.
Dissociative disorders involve problems with memory, identity, emotion, perception, behavior and sense of self. Dissociative symptoms can potentially disrupt every area of mental functioning.

Examples of dissociative symptoms include the experience of detachment or feeling as if one is outside one's body, and loss of memory or amnesia. Dissociative disorders are frequently associated with previous experience of trauma.

There are three types of dissociative disorders:

Dissociative identity disorder
Dissociative amnesia
Depersonalization/derealization disorder
The Sidran Institute, which works to help people understand and cope with traumatic stress and dissociative disorders, describes the phenomenon of dissociation and the purpose it may serve as follows:

Dissociation is a disconnection between a person's thoughts, memories, feelings, actions or sense of who he or she is. This is a normal process that everyone has experienced. Examples of mild, common dissociation include daydreaming, highway hypnosis or "getting lost" in a book or movie, all of which involve "losing touch" with awareness of one's immediate surroundings.

During a traumatic experience such as an accident, disaster or crime victimization, dissociation can help a person tolerate what might otherwise be too difficult to bear. In situations like these, a person may dissociate the memory of the place, circumstances or feelings about of the overwhelming event, mentally escaping from the fear, pain and horror. This may make it difficult to later remember the details of the experience, as reported by many disaster and accident survivors.
Dissociative Identity Disorder
Dissociative Identity Disorder

Dissociative identity disorder is associated with overwhelming experiences, traumatic events and/or abuse that occurred in childhood. Dissociative identity disorder was previously referred to as multiple personality disorder.

Symptoms of dissociative identity disorder (criteria for diagnosis) include:

The existence of two or more distinct identities (or "personality states"). The distinct identities are accompanied by changes in behavior, memory and thinking. The signs and symptoms may be observed by others or reported by the individual.
Ongoing gaps in memory about everyday events, personal information and/or past traumatic events.
The symptoms cause significant distress or problems in social, occupational or other areas of functioning.
In addition, the disturbance must not be a normal part of a broadly accepted cultural or religious practice. As noted in the DSM-51, in many cultures around the world, experiences of being possessed are a normal part of spiritual practice and are not dissociative disorders.

The attitude and personal preferences (for example, about food, activities, clothes) of a person with dissociative identity disorder may suddenly shift and then shift back. The identities happen involuntarily and are unwanted and cause distress. People with dissociative identity disorder may feel that they have suddenly become observers of their own speech and actions, or their bodies may feel different (e.g., like a small child, like the opposite gender, huge and muscular).

The Sidran Institute notes that a person with dissociative identity disorder "feels as if she has within her two or more entities, each with its own way of thinking and remembering about herself and her life. It is important to keep in mind that although these alternate states may feel or appear to be very different, they are all manifestations of a single, whole person." Other names used to describe these alternate states including "alternate personalities," "alters," "states of consciousness" and "identities."

For people with dissociative identity disorder, the extent of problems functioning can vary widely, from minimal to significant problems. People often try to minimize the impact of their symptoms.

Risk Factors and Suicide Risk

People who have experienced physical and sexual abuse in childhood are at increased risk of dissociative identity disorder. The vast majority of people who develop dissociative disorders have experienced repetitive, overwhelming trauma in childhood. Among people with dissociative identity disorder in the United States, Canada and Europe, about 90 percent had been the victims of childhood abuse and neglect.

Suicide attempts and other self-injurious behavior are common among people with dissociative identity disorder. More than 70 percent of outpatients with dissociative identity disorder have attempted suicide.1

Treatment

With appropriate treatment, many people are successful in addressing the major symptoms of dissociative identity disorder and improving their ability to function and live a productive, fulfilling life.

Treatment typically involves psychotherapy. Therapy can help people gain control over the dissociative process and symptoms. The goal of therapy is to help integrate the different elements of identity. Therapy may be intense and difficult as it involves remembering and coping with past traumatic experiences. Cognitive behavioral therapy and dialectical behavioral therapy are two commonly used types of therapy. Hypnosis has also been found to be helpful in treatment of dissociative identity disorder.

There are no medications to directly treat the symptoms of dissociative identity disorder. However, medication may be helpful in treating related conditions or symptoms, such as the use of antidepressants to treat symptoms of depression.
Depersonalization Disorder Dissociative Amnesia
Related conditions

Both acute stress disorder and posttraumatic stress disorder (PTSD)may involve dissociative symptoms, such as amnesia and depersonalization or derealization.