Dissociative Identity Disorder: Diagnostic Accuracy and DSM-5 Criteria Change Implications

M Shae Nester; Hugo J Schielke; Bethany L Brand; Richard J Loewenstein

doi:10.1080/15299732.2021.1989123

Dissociative Identity Disorder: Diagnostic Accuracy and DSM-5 Criteria Change Implications

J Trauma Dissociation. 2021 Oct 18:1-13. doi: 10.1080/15299732.2021.1989123. Online ahead of print.

Authors

M Shae Nester¹, Hugo J Schielke², Bethany L Brand¹, Richard J Loewenstein³

Affiliations

¹ Department of Psychology, Towson University, Towson, Maryland, USA.
² Traumatic Stress Injury & Concurrent Program, Homewood Health Centre, Guelph, Ontario, Canada.
³ Department of Psychiatry, University of Maryland School of Medicine, and Private Practice, Baltimore, Marylad, USA.

PMID: 34661505
DOI: 10.1080/15299732.2021.1989123

Abstract

The Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5) revised the diagnostic criteria for dissociative identity disorder (DID) to more accurately reflect the symptom profile of DID patients. No study has examined how this change affects clinical diagnosis of DID. The present study examined clinician reports of patient symptoms in relation to DSM-IV-TR and DSM-5 DID diagnostic criteria. Data were analyzed from 169 clinicians who participated in the Treatment of Patients with Dissociative Disorders Network Study with a patient they assigned a DID diagnosis. Clinicians evaluated their patients with respect to DSM-IV-TR and DSM-5 DID diagnostic criteria. Researchers determined a clinician-assigned DID diagnosis as "accurate" when the patient's reported dissociative symptoms matched DSM-IV-TR and/or DSM-5 criteria for DID. Most of the clinicians (95.27%) accurately diagnosed DID. Of those accurately diagnosed, 83.85% of patients met DSM-IV-TR and DSM-5 DID criteria, 9.94% only met DSM-IV-TR DID criteria, and 6.21% only met DSM-5 DID criteria. Further examination of responses suggested that possible idiomatic responses to the negative wording of the DSM-5 exclusionary criteria might have accounted for the DSM-IV-TR appearing to fit for a greater number of cases in this study. Changes in the DSM criteria for DID did not substantially change the frequency or accuracy of assigned DID diagnoses, but the removal of the requirement in DSM-5 that self-states regularly take control of an individual's behavior slightly increased the number of individuals meeting criteria for DID.

Keywords: Dissociation; accuracy; diagnosis; dissociative disorder; dissociative identity disorder; training.