Dissociative disorder not otherwise specified

Dissociative Disorder Not Otherwise Specified (DDNOS) is a category used in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for dissociative disorders that do not neatly fit into the other specific classifications of dissociative disorders. The DSM has undergone several revisions, and the terminology and criteria for DDNOS have evolved. In the most recent edition, DSM-5, DDNOS is largely subsumed under the category of Other Specified Dissociative Disorder (OSDD).

Definition

Dissociative disorders involve a disconnection and lack of continuity between thoughts, memories, surroundings, actions, and identity. People with dissociative disorders escape reality in ways that are involuntary and unhealthy and cause problems with functioning in everyday life. DDNOS encompasses a range of symptoms that do not fully meet the criteria for other specific dissociative disorders like Dissociative Identity Disorder (DID), Dissociative Amnesia, or Depersonalization/Derealization Disorder.

Symptoms

Symptoms of DDNOS can vary widely but may include:

• Frequent episodes of feeling detached from one’s self (depersonalization)
• Experiencing the world as unreal or dreamlike (derealization)
• Memory gaps regarding daily events, personal information, and/or traumatic events
• A sense of observing oneself from outside (out-of-body experience)
• Difficulty integrating past memories, identity, and immediate sensations

Diagnosis

Diagnosis of DDNOS requires a comprehensive evaluation, including a detailed psychiatric history and, often, psychological testing. The DSM criteria for DDNOS/OSDD are used as a guideline for diagnosis. It is important for the diagnosing clinician to differentiate DDNOS from other psychiatric conditions, including other dissociative disorders, Post-Traumatic Stress Disorder (PTSD), and psychosis.

Treatment

Treatment for DDNOS typically involves psychotherapy, with the goal of integrating the dissociated aspects of the patient's identity or experiences. Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Eye Movement Desensitization and Reprocessing (EMDR) are among the therapeutic approaches that may be used. In some cases, medication may be prescribed to address co-occurring conditions such as depression or anxiety.

Epidemiology

The prevalence of DDNOS is difficult to determine due to its broad and varied symptomatology and the challenges in diagnosis. However, it is considered to be more common than the better-known Dissociative Identity Disorder.

History

The concept of DDNOS has evolved over time with successive editions of the DSM. In DSM-IV, DDNOS was a catch-all category for dissociative disorders that did not meet the full criteria for any other specific dissociative disorders. With the publication of DSM-5, the category was refined and renamed Other Specified Dissociative Disorder (OSDD), aiming to provide a more accurate description of the conditions it encompasses.

See Also

• Dissociative Identity Disorder (DID)
• Dissociative Amnesia
• Depersonalization/Derealization Disorder
• Post-Traumatic Stress Disorder (PTSD)
• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavior Therapy (DBT)
• Eye Movement Desensitization and Reprocessing (EMDR)