Skip to main content
SpringerLink
Log in

Dissociative Disorders

  • Chapter
  • First Online:
Diagnostic Interviewing

Abstract

Dissociative disorders (DDs) involve a disconnection from the present moment including one’s emotions, body, or surroundings, frequently in an effort to regulate internal states (e.g., emotions, overwhelming levels of physical arousal) during times of heightened stress. The development of a DD has most consistently been associated with antecedent trauma, particularly when exposure happens repeatedly in childhood (Dalenberg et al., 2012, 2014). To further understand DDs, we begin by presenting common symptoms, followed by a discussion of the current diagnostic criteria, prevalence, and difficulties with accurate diagnosis. Further, we discuss strategies for gathering information, including interviews, psychological measures (e.g., self-report and performance-based), and behavioral observations. We conclude with factors to consider when ruling out other diagnoses with similar presentations, such as schizophrenia or borderline personality disorder.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    The case examples included in this chapter have been de-identified and altered to protect the clients’ confidentiality.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders DSM-5 (5th ed.). Washington, DC: American Psychiatric Press.

    Book  Google Scholar 

  • Armstrong, J. G. (1992). Keeping one’s balance in a moving system: The effects of the multiple personality disordered patient on the cognitive development of the therapist. In J. D. Sinnott & J. Cavanaugh (Eds.), Bridging paradigms: Positive development in adulthood and cognitive aging. New York, NY: Praeger.

    Google Scholar 

  • Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–735.

    Article  Google Scholar 

  • Brand, B. L. (2016). The necessity of clinical training in trauma and dissociation. Journal of Anxiety and Depression, 5(4), 251. https://doi.org/10.4172/2167-1044.1000251

    Article  Google Scholar 

  • Brand, B. L., Armstrong, J. G., & Loewenstein, R. J. (2006). Psychological assessment of patients with dissociative identity disorder. The Psychiatric Clinics of North America, 29(1), 145–168.

    Article  Google Scholar 

  • Brand, B. L., Armstrong, J. G., Loewenstein, R. J., & McNary, S. W. (2009). Personality differences on the Rorschach of dissociative identity disorder, borderline personality disorder, and psychotic inpatients. Psychological Trauma: Theory, Research, Practice, and Policy, 1(3), 188–205.

    Article  Google Scholar 

  • Brand, B. L., & Chasson, G. S. (2015). Distinguishing simulated from genuine dissociative identity disorder on the MMPI-2. Psychological Trauma: Theory, Research, Practice, and Policy, 7(1), 93–101. https://doi.org/10.1037/a0035181

    Article  Google Scholar 

  • Brand, B. L., Chasson, G. S., Palermo, C. A., Donato, F. M., Rhodes, K. P., & Voorhees, E. F. (2016). MMPI-2 item endorsements in dissociative identity disorder vs. simulators. The Journal of the American Academy of Psychiatry and the Law, 44(1), 63–72.

    Google Scholar 

  • Brand, B. L., & Loewenstein, R. J. (2010). Dissociative disorders: An overview of assessment, phenomenology and treatment. Psychiatric Times, 27(10), 62–69.

    Google Scholar 

  • Brand, B. L., & Loewenstein, R. J. (2014). Does phasic trauma treatment make patients with dissociative identity disorder treatment more dissociative? Journal of Trauma & Dissociation, 15(1), 52–65.

    Article  Google Scholar 

  • Brand, B. L., Tursich, M., Tzall, D., & Loewenstein, R. J. (2014). Utility of the SIRS-2 in distinguishing genuine from simulated dissociative identity disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 6(4), 308–317.

    Article  Google Scholar 

  • Brand, B. L., Webermann, A. R., Snyder, B. L., & Kaliush, P. R. (2018). Detecting genuine and simulated dissociative identity disorder with the test of memory malingering. Psychological Trauma: Theory, Research, and Practice. https://doi.org/10.1037/tra0000405

  • Briere, J. (2001). Detailed assessment of posttraumatic stress. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Briere, J. (2002). The multiscale dissociation inventory (MDI) professional manual. Lutz, FL: Psychological Assessment Resources.

    Google Scholar 

  • Briere, J. (2011). Trauma symptom inventory-2 (TSI-2): Professional manual. Lutz, FL: Psychological Assessment Resources.

    Google Scholar 

  • Briere, J., Dietrich, A., & Semple, R. J. (2016). Dissociative complexity: Antecedents and clinical correlates of a new construct. Psycholical Trauma: Theory, Research, Practice, and Policy, 8(5), 577–584. https://doi.org/10.1037/tra0000126

    Article  Google Scholar 

  • Brown, L. S. (2008). Cultural competence in trauma therapy: Beyond the flashback. Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • Butcher, J. N., Graham, J. R., Ben-Porath, Y. S., Tellegen, A., & Dahlstrom, W. G. (2001). Manual for the administration and scoring of the MMPI–2. Minneapolis, MN: Minnesota University Press.

    Google Scholar 

  • Coons, P. M., & Milstein, V. (1990). Self-mutilation associated with dissociative disorders. Dissocation, 3(2), 81–87.

    Google Scholar 

  • Cronin, E., Brand, B. L., & Mattanah, J. F. (2014). The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders. European Journal of Psychotraumatology, 5. https://doi.org/10.3402/ejpt.v5.22676

  • Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardena, E., … Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological Bulletin, 138(3), 550–588. https://doi.org/10.1037/a0027447

    Article  Google Scholar 

  • Dalenberg, C. J., Brand, B. L., Loewenstein, R. J., Gleaves, D. H., Dorahy, M. J., Cardeña, E., … Spiegel, D. (2014). Reality versus fantasy: Reply to Lynn et al. (2014). Psychological Bulletin, 140(3), 911–920.

    Article  Google Scholar 

  • Dell, P. F. (2002). Dissociative phenomenology of dissociative identity disorder. The Journal of Nervous and Mental Disease, 190(1), 10–15.

    Article  Google Scholar 

  • Dell, P. F. (2006a). A mew model of dissociative identity disorder. Psychiatric Clinics of North America, 29(1), 1–26.

    Article  Google Scholar 

  • Dell, P. F. (2006b). The multidimensional inventory of dissociation (MID): A comprehensive measure of pathological dissociation. Journal of Trauma & Dissociation, 7(2), 77–106.

    Article  Google Scholar 

  • Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., … Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian and New Zealand Journal of Psychiatry, 48(5), 402–417.

    Article  Google Scholar 

  • Dorahy, M. J., Lewis, C. A., & Mulholland, C. (2005). The detection of dissociative identity disorder by northern Irish clinical psychologists and psychiatrists: A clinical vignettes study. Journal of Trauma & Dissociation, 6(4), 39–50. https://doi.org/10.1300/J229v06n04_03

    Article  Google Scholar 

  • Dorahy, M. J., Shannon, C., Seagar, L., Corr, M., Stewart, K., Hanna, D., … Middleton, W. (2009). Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history: Similarities and differences. Journal of Nervous and Mental Disease, 197(12), 892–898. https://doi.org/10.1097/NMD.0b013e3181c299ea

    Article  Google Scholar 

  • Exner, J. E., & Erdberg, P. (2005). The Rorschach: A comprehensive system (3rd ed.). Hoboken, NJ: Wiley.

    Google Scholar 

  • Foote, B., Smolin, Y., Neft, D. I., & Lipschitz, D. (2008). Dissociative disorders and suicidality in psychiatric outpatients. Journal of Nervous and Mental Disease, 196(1), 29–36.

    Article  Google Scholar 

  • Frewen, P. A., & Lanius, R. (2015). Healing the traumatized self: Consciousness, neuroscience, treatment. New York, NY: W. W. Norton & Company.

    Google Scholar 

  • Hays, P. A. (2016). Addressing cultural complexities in practice: Assessment, diagnosis, and therapy (3rd ed.). Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • Herman, J. L. (1997). Trauma and recovery: The aftermath of violence--from domestic abuse to political terror. New York, NY: Basic Books.

    Google Scholar 

  • International Society for the Study of Dissociation, Chu, J. A., Dell, P. F., Somer, E., Van der Hart, O., Cardeña, E., … Twombly, J. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma and Dissociation, 12(2), 115–187. https://doi.org/10.1080/15299732.2011.537247

    Article  Google Scholar 

  • Kluft, R. P. (1987a). First-rank symptoms as a diagnostic clue to multiple personality disorder. The American Journal of Psychiatry, 144(3), 293–298.

    Article  Google Scholar 

  • Kluft, R. P. (1987b). The simulation and dissimulation of multiple personality disorder. American Journal of Clinical Hypnosis, 30, 104–118.

    Article  Google Scholar 

  • Lanius, R. A., Brand, B. L., Vermetten, E., Frewen, P. A., & Spiegel, D. (2012). The dissociative subtype of posttraumatic stress disorder: Rationale, clinical and neurobiological evidence, and implications. Depression and Anxiety, 29(8), 701–708. https://doi.org/10.1002/da.21889

    Article  Google Scholar 

  • Leonard, D., Brann, S., & Tiller, J. (2005). Dissociative disorders: Pathways to diagnosis, clinician attitudes and their impact. The Australian and New Zealand Journal of Psychiatry, 39(10), 940–946.

    Article  Google Scholar 

  • Loewenstein, R. J. (1991). An office mental status examination for complex chronic dissociative symptoms and multiple personality disorder. Psychiatric Clinics of North America, 14(3), 567–604.

    Article  Google Scholar 

  • Longden, E., Madill, A., & Waterman, M. G. (2012). Dissociation, trauma, and the role of lived experience: Toward a new conceptualization of voice hearing. Psychological Bulletin, 138(1), 28–76. https://doi.org/10.1037/a0025995

    Article  Google Scholar 

  • Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018). Dissociation in psychiatric disorders: A meta-analysis of studies using the dissociative experiences scale. American Journal of Psychiatry, 175(1), 37–46.

    Article  Google Scholar 

  • Mendez, N., Martinez-Taboas, A., & Pedrosa, O. (2000). Experiences, beliefs and attitudes of Puerto Rican psychologists toward dissociative identity disorder. Ciencias de la Conducta, 15, 69–84.

    Google Scholar 

  • Murray, H. A. (1943). Thematic apperception test. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Nijenhuis, E. R. S., Spinhoven, P., Van Dyck, R., Van Der Hart, O., & Vanderlinden, J. (1996). The development and psychometric characteristics of the somatoform dissociation questionnaire (SDQ-20). Journal of Nervous and Mental Disease, 184(11), 688–694. https://doi.org/10.1097/00005053-199611000-00006

    Article  Google Scholar 

  • Palermo, C. A., & Brand, B. L. (2018). Can the trauma symptom Inventory-2 distinguish coached simulators from dissociative disorder patients? Psychological Trauma: Theory, Research, Practice, & Policy. https://doi.org/10.1037/tra0000382

  • Perniciaro, L. A. (2015). The influence of skepticism and clinical experience on the detection of dissociative identity disorder by mental health clinicians. (75), ProQuest Information & Learning, US. Retrieved from http://proxy-tu.researchport.umd.edu/login?ins=tu&url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2015-99080-169&site=ehost-live. Available from EBSCOhost psyh database.

  • Pica, M., Beere, D., Lovinger, S., & Dush, D. (2001). The responses of dissociative patients on the thematic apperception test. Journal of Clinical Psychology, 57(7), 847–864.

    Article  Google Scholar 

  • Platt, M. G., Luoma, J. B., & Freyd, J. J. (2016). Shame and dissociation in survivors of high and low betrayal trauma. Journal of Aggression, Maltreatment & Trauma, 26(1), 34–49. https://doi.org/10.1080/10926771.2016.1228020

    Article  Google Scholar 

  • Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. New York, NY: Guilford Press.

    Google Scholar 

  • Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. New York, NY: Guilford Press.

    Google Scholar 

  • Rogers, R., Sewell, K. W., & Gillard, N. D. (2010). Structured innterview of reported symptoms-2 (SIRS-2) and professional manual. Lutz, FL: Psychological Assessment Resources.

    Google Scholar 

  • Ross, C. A. (n.d.). The dissociative disorders interview schedule – DSM-5 version. Retrieved from http://www.rossinst.com/downloads/DDIS-DSM-5.pdf

  • Ross, C. A., Miller, S. D., Reagor, P., Bjornson, L., Fraser, G. A., & Anderson, G. (1990). Schneiderian symptoms in multiple personality disorder and schizophrenia. Comprehensive Psychiatry, 31, 111–118.

    Article  Google Scholar 

  • Sar, V. (2011). Epidemiology of dissociative disorders: An overview. Epidemiology Research International. https://doi.org/10.1155/2011/404538

  • Schore, A. (2009). Attachment trauma and the developing right brain: Origins of pathological dissociation. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 107–141). New York, NY: Routledge/Taylor & Francis Group.

    Google Scholar 

  • Sierra, M., & Berrios, G. E. (2000). The Cambridge depersonalisation scale: A new instrument for the measurement of depersonalisation. Psychiatry Research, 93(2), 153–164.

    Article  Google Scholar 

  • Stadnik, R. D., Brand, B. L., & Savoca, A. (2013). Personality assessment inventory profile and predictors of elevations among dissociative disorder patients. Journal of Trauma & Dissociation, 14(5), 546–561. https://doi.org/10.1080/15299732.2013.792310

    Article  Google Scholar 

  • Steele, K., Boon, S., & van der Hart, O. (2017). Treating trauma-rleated dissociation: A practical, integrated approach. New York, NY: W. W. Norton & Company.

    Google Scholar 

  • Steinberg, M., Rounsaville, B., & Cicchetti, D. (1990). The structured clinical interview for DSM-III-R dissociative disorders: A preliminary report. American Journal of Psychiatry, 147, 76–82.

    Google Scholar 

  • Steinberg, M. (1993). The structured clinical interview for DSM-III-R dissociative disorders (SCID-D). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Steinberg, M. (1994). The structured clinical interview for DSM-IV dissociative disorders-revised (SCID-D-R). Washington, D.C.: American Psychiatric Press.

    Google Scholar 

  • Steinberg, M. (2001). Updating diagnostic criteria for dissociative disorders: Learning from scientific advances. Journal of Trauma and Dissociation, 2, 59–63.

    Article  Google Scholar 

  • Stoltenborgh, M., Bakermans-Kranenburg, M. J., Alink, L. R. A., & van Ijzendoorn, M. H. (2015). The prevalence of child maltreatment across the globe: Review of a series of meta-analyses. Child Abuse Review, 24(1), 37–50. https://doi.org/10.1002/car.2353

    Article  Google Scholar 

  • Tombaugh, T. N. (2002). The Test of Memory Malingering (TOMM) in forensic psychology. Journal of Forensic Neuropsychology, 2(3–4), 69–96. https://doi.org/10.1300/J151v02n03_04

    Article  Google Scholar 

  • Waller, N., Putnam, F. W., & Carlson, E. B. (1996). Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychological Methods, 1(3), 300–321. https://doi.org/10.1037/1082-989X.1.3.300

    Article  Google Scholar 

  • Wolf, G. K., Reinhard, M., Cozolino, L. J., Caldwell, A., & Asamen, J. K. (2009). Neuropsychiatric symptoms of complex posttraumatic stress disorder: A preliminary Minnesota multiphasic personality inventory scale to identify adult survivors of childhood abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 1(1), 49–64.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Private Practice, Lynnwood, WA, USA

    Tyson D. Bailey

  2. Christiana Care Health System, Newark, DE, USA

    Stacey M. Boyer

  3. Towson University, Towson, MD, USA

    Bethany L. Brand

Authors
  1. Tyson D. Bailey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stacey M. Boyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bethany L. Brand
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Psychology, University of Colorado, Colorado Springs, CO, USA

    Daniel L. Segal

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bailey, T.D., Boyer, S.M., Brand, B.L. (2019). Dissociative Disorders. In: Segal, D.L. (eds) Diagnostic Interviewing. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-9127-3_16

Download citation

Publish with us

Policies and ethics

Search

Navigation