Dissociative Identity Disorder - Diagnosis

Diagnosis

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses DID according to the diagnostic criteria found in in section 300.14 (dissociative disorders). The criteria require that an adult be recurrently controlled by two or more discrete identities or personality states, accompanied by memory lapses for important information that is not caused by alcohol, drugs or medications and other medical conditions such as complex partial seizures. While otherwise similar, the diagnostic criteria for children also specifies symptoms must not be confused with imaginative play. Diagnosis is normally performed by a clinically trained mental health professional such as a psychiatrist or psychologist through clinical evaluation, interviews with family and friends, and consideration of other ancillary material. Specially designed interviews (such as the SCID-D) and personality assessment tools may be used in the evaluation as well. Since most of the symptoms depend on self report and are not concrete and observable, there is a degree of subjectivity in making the diagnosis. People are often disinclined to seek treatment, especially since their symptoms may not be taken seriously; thus dissociative disorders have been referred to as "diseases of hiddenness".

The diagnosis has been criticized as proponents of the iatrogenic or sociocognitive hypothesis believe it as a culture-bound and often iatrogenic condition. Other researchers disagree and argue that the existence of the condition and its inclusion in the DSM is supported by multiple lines of reliable evidence, with diagnostic criteria allowing it to be clearly discriminated from conditions it is often mistaken for (schizophrenia, borderline personality disorder, and seizure disorder). That a large proportion of cases are diagnosed by specific clinicians, and that symptoms be created in nonclinical research subjects given appropriate cueing has been suggested as evidence that a small number of clinicians who specialize in DID are responsible for the iatrogenic creation of alters.