Other Specified Dissociative Disorder and DDNOS

    Other Specified Dissociative Disorder
    Dissociative Disorder Not Otherwise Specified - caused by trauma

    Other Specified Dissociative Disorder is a diagnosis which was introduced in the DSM-5 psychiatric manual, released in 2013.[1] Along with Unspecified Dissociative Disorder it replaces the diagnosis of Dissociative Disorder Not Otherwise Specified (DDNOS). Other Specified Dissociative Disorder is known to be caused by psychological trauma[1]:608-609.

    The equivalent diagnosis in the International Classification of Diseases is Other dissociative [conversion] disorders which also includes several different possible presentations. In common with all Dissociative Disorders, symptoms usually appear after trauma and include embarrassment or confusion about symptoms, and the desire to hide them.[1]:578

    DSM-5 Diagnostic Criteria
    Code 300.15

    "This category applies to presentations in which symptoms characteristic of a dissociative disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the dissociative disorders diagnostic class. The other specified dissociative disorder category is used in situations in which the clinician chooses to specify reason that the presentation does not meet the criteria for any specific dissociative disorder. This is done by recording "other specified dissociative disorder" followed by the specific reason (e.g., "dissociative trance").
    Example presentations that can be specified using the "other specified" designation include the following:

    1. "1. Chronic and recurrent syndromes of mixed dissociative symptoms. This category includes identity disturbance associated with less than marked discontinuities in sense of self and agency, or alterations of identity or episodes of possession in an individual who reports no dissociative amnesia.
    2. 2. Identity disturbance due to prolonged and intense coercive persuasion: Individuals who have been subjected to intense coercive persuasion (e.g., brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, recruitment by sects/cults or by terror organizations) may present with prolonged changes in, or conscious questions of, their identity.
    3. 3. Acute dissociative reactions to stressful events: This category is for acute, transient conditions that typically last less than 1 month, and sometimes only a few hours or days. These conditions are characterized by constriction of consciousness; depersonalization; derealization; perceptual disturbances (e.g., time slowing, macropsia); micro-amnesias; transient stupor; and/or alterations in sensory-motor functioning (e.g., analgesia, paralysis).
    4. 4. Dissociative trance: This condition is characterized by an acute narrowing or complete loss of awareness of immediate surroundings that manifest as profound unresponsiveness or insensitivity to environmental stimuli. May be accompanied by minor stereotyped behaviors of which the individual is unaware and/or that he or she cannot control, as well as transient paralysis or loss of consciousness. The dissociative trance is not a normal part of a broadly accepted collective cultural or religious practice. " [1]:306-307

    Ganser's syndrome (the giving and receiving of approximate answers) is described as fitting within this category, despite not appearing as an example presentation. [1]:292,306-207

    Dissociative Disorder Not Otherwise Specified and DSM-5
    Dissociative Disorder Not Otherwise Specified, OSDD and DSM-5 DDNOS, OSDD and DSM-5 small screen version
    The DSM-5 diagnostic manual no longer uses the term Not Otherwise Specified Disorder in diagnoses, including DDNOS, instead it introduced the Otherwise Specified Disorder and Unspecified Disorder diagnoses. This means that most people with Dissociative Disorder Not Otherwise Specified in the DSM-IV manual will be diagnosed with Other Specified Dissociative Disorder in the newer DSM-5. [1,4,6]

    Others people may be classed as Depersonalization/Derealization Disorder or Unspecified Dissociative Disorder, or even Dissociative Identity Disorder if they meet the slightly broadened DSM 5 criteria for DID.[1]

    OSDD, Dissociative Identity Disorder and DDNOS1

    The first example presentation of Other Specified Dissociative Disorder is very similar to the DSM-IV's first example of Dissociative Disorder Not Otherwise Specified (DDNOS).[1][6] Both these describe a form of complex dissociative disorder which is very similar to Dissociative Identity Disorder, but falls just short of meeting the criteria. OSDD example 1 is either identity disturbance with less distinct parts than in Dissociative Identity Disorder (they cannot physically take executive control over the person's body, but strongly influence the person's thoughts and actions and amnesia is present), known as DDNOS-1a [7]:409, or distinct dissociative parts (alters or alternate identities) exist and can take executive control, but without amnesia, [5][6] known as DDNOS-1b.[7]:409 However, the slightly changed wording for Dissociative Identity Disorder means that some people who previously were diagnosed as DDNOS-1 will now be diagnosed with Dissociative Identity Disorder. The two relevant changes involve the fact that identity alteration (changing identities between different personality states/alters/alter identities) can be self-reported or reported by a family member of friend rather than just clinical staff, and secondly a slight broadening of the amnesia criterion. [1]

    Link with DDNOS2

    The DSM-IV's second example presentation of Dissociative Disorder Otherwise Specified (DDNOS-2) was described as "derealization" without depersonalization.[6] This is now included in the expanded Depersonalization/Derealization Disorder diagnosis,[1]:302 which will reduce the number of people with an "other specified" dissociative disorder. [1]:302,[5]

    Link with Unspecified Dissociative Disorder

    Both Other Specified Dissociative Disorder and Unspecified Dissociative Disorder have been assigned diagnostic code 300.15. [1]:306-307 Together they act as a "residual category for dissociative symptoms which do not fit within a more specific category". Unspecified Dissociative Disorder is used when either the clinician decides not to specify the reason that the other criteria aren't met, or not information information exists to make a more specific diagnosis. [4]:198

    ICD Diagnostic Criteria

    The most recent approved version of the International Classification of Diseases, the diagnostic guide published by the World Health Organization, is the ICD-10 which was published in 1992.[2] The ICD-11 is currently being discussed and a draft version now exists.

    ICD 11 draft - Other specified dissociative disorders, Other mixed specified dissociative disorders

    Codes 7B3Y and 7B32.Y
    No criteria or description exists yet for Other specified mixed dissociative disorders, code 7B32.Y, or Other specified dissociative disorders, code 7B3Y. [3] Last updated December 2014.

    ICD 10 - Other dissociative [conversion] disorders

    This is not a single disorder but a group of specified disorders, including: Multiple personality disorder (now known as Dissociative Identity Disorder), Transient dissociative [conversion] disorders occurring in childhood and adolescence, and Other specified dissociative [conversion] disorders.

    • Code F44.80 Ganser's syndrome: characterized by "approximate answers", usually occurring along with other dissociative symptoms, often in circumstances that suggest a psychogenic (psychological) cause
    • Code F44.81 Multiple personality disorder (dissociative identity disorder)
    • Code F44.82 Transient dissociative [conversion] disorders occurring in childhood and adolescence
    • Code F44.88 Other specified dissociative [conversion] disorders including Psychogenic confusion and Twilight state (not described)

    In common with other specified disorders, example presentations are given instead of explicit criteria. The general dissociative disorder criteria must also be met::
    "G1. No evidence of a physical disorder that can explain the symptoms that characterize the disorder (but physical disorders may be present that give rise to other symptoms).
     G2. Convincing associations in time between the symptoms of the disorder and stressful events, problems or needs." [2]:122-123

    It cannot be diagnosed when a more specific diagnosis is appropriate. [2]:122-123


    1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association. ISBN 0890425558 (pp.302-302). ISBN 0890425574 (pp.608-609).
    2. World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines. Retrieved December 8, 2014, from http://www.who.int/classifications/icd/en/bluebook.pdf
    3. World Health Organization. (December 8, 2014). ICD-11 Beta Draft (Joint Linearization for Mortality and Morbidity Statistics).
    4. Black, Donald W. (2014) (coauthors: Grant, Jon E.). DSM-5 Guidebook: The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Pub. ISBN 9781585624652.
    5. Spiegel, David; Loewenstein, Richard J. Lewis-Fernández, Roberto, Sar, Vedat, Simeon, Daphne, Vermetten, Eric, Cardeña, Etzel, Dell, Paul F. (2011). Dissociative disorders in DSM-5. Depression and anxiety, volume 28, issue 9, page 824-852 also cited as Depression and Anxiety 28(12) E17-E45. (doi:10.1002/da.20874)
    6. American Psychiatric Association, (1994). Diagnostic and statistical manual of mental disorders:DSM-IV. American Psychiatric Association. ISBN 0890420629.
    7. Dell, P. F. (2010). Ch 24 The Long Struggle to Diagnose Multiple Personality Disorder (MPD). Dissociation and the Dissociative Disorders: DSM-V and Beyond, 383.

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