Table 1

DSM-5 Diagnostic Criteria for Dissociative Disorder

DisorderDiagnostic Criteria
Depersonalization/derealization 1. The presence of persistent or recurrent experiences of depersonalization, derealization, or both; experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions
2. The disturbance is not attributable to the psychological effects of a substance or other mental condition
3. The disturbance is not better explained by another mental disorder
Dissociative amnesia with or without dissociative fugue 1. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, which is inconsistent with ordinary forgetting
2. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
3. The disturbance is not attributable to the physiological effects of a substance
4. The disturbance is not better explained by dissociative identity disorder
Dissociative identity disorder1. Disruption of identity characterized by ≥2 distinct personality states
2. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting
3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
4. The disturbance is not a normal part of a broadly accepted cultural or religious practice (in children, the symptoms are not better explained by imaginary playmates or other fantasy play)
5. The symptoms are not attributable to the physiological effects of a substance
Other specified dissociative disorder (formerly categorized under dissociative disorder not otherwise specified)1. Patient presents with dissociative symptoms but fails to meet the diagnostic criteria of the dissociative syndromes described
2.  Can include chronic and recurrent syndromes of mixed dissociative symptoms
3. Can include identity disturbance resulting from intensive coercive persuasion
4. Acute dissociative reactions to stressful events
5. Dissociative trance
Unspecified dissociative disorder (formerly categorized under dissociative disorder not otherwise specified)1. Patient presents with dissociative symptoms but fails to meet the full diagnostic criteria of the dissociative syndromes described
2. Insufficient information to make a more specific diagnosis

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Washington, DC: APA Press; 2013. 519-33.


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Table 2

Pharmacotherapies Frequently Used in Dissociative Disorders

Drug ClassComments
Antidepressants · Can be used to treat comorbid symptoms of depression or anxiety
· Can be used to stabilize mood
· Can be used to reduce intrusive symptoms and hyperarousal
Benzodiazepines· Can be used to treat anxiety
· Use with caution; they can exacerbate dissociation
Beta blockers, clonidine· Can be used to stabilize mood
· Can be used to reduce intrusive symptoms, hyperarousal, and anxiety
Atypical (second-generation) antipsychotics· Can be used to stabilize mood
· Can be used to reduce overwhelming anxiety and intrusive symptoms
Carbamazepine and other mood stabilizers· Can be used to reduce aggression
· Can be used to reduce intrusive symptoms and hyperarousal
Naltrexone/naloxone· Can be used to reduce self-injurious behavior
Sleep medications· Use with caution, as some (eg, zolpidem) can exacerbate depersonalization and derealization symptoms

Gentile JP, et al. Psychotherapy and pharmacotherapy for patients with dissociative identity disorder. Innov Clin Neurosci. 2013;10(2):22-29.

Abedini MR, Esmaeli A. Zolpidem induces depersonalization and derealization symptoms: a case report. Modern Care J. 2017;14(2);e11424.

Table 3

First-Line Intervention with Dissociative Disorders

· Psychoeducation of individual and family, when relevant
· Assessment of unsafe/risk behaviors and urges
· Development of constructive behavioral repertoires to remain safe
· Identification of alternate identities (in DID) who act unsafely and development of safety plan with them
· Symptom management strategies (eg, grounding techniques, crisis planning, self-hypnosis, and/or medications)
· Management of addiction and/or eating disorders
· Involvement of appropriate agencies if relevant (eg, if the client might be abusive to a child)
· Self-protection in the event of violence against the client
· Hospitalization, when necessary, to prevent harm to self or others

International Society for the Study of Trauma and Dissociation. Guidelines for Treating Dissociative Identity Disorder in Adults, Journal of Trauma & Dissociation Third Revision. 2012;12:115–187.