Dissociative Disorder Not Otherwise Specified: A Review
Abstract
Dissociative disorder not otherwise specified (DDNOS) is a condition in which an individual experiences periods of disconnection from their own thoughts, feelings, memories, and sense of identity. This review examines the current research on DDNOS, including its diagnostic criteria, etiology, prevalence, comorbidity, and treatment. Overall, the literature suggests that DDNOS is a complex disorder with a range of potential causes and consequences. While evidence-based treatments are available, further research is necessary to increase the understanding of DDNOS and to develop better interventions.
Keywords: Dissociative Disorder Not Otherwise Specified, DDNOS, etiology, prevalence, comorbidity, treatment
Introduction
Dissociative disorder not otherwise specified (DDNOS) is a mental health condition characterized by periods of disconnection from one’s own thoughts, feelings, memories, and sense of identity. It is classified as a dissociative disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), and is one of the most common dissociative disorders (American Psychiatric Association, 2013). DDNOS is typically diagnosed when an individual meets some criteria for a dissociative disorder, but does not meet the full criteria for any specific dissociative disorder. This review examines the current research on DDNOS, including its diagnostic criteria, etiology, prevalence, comorbidity, and treatment.
Diagnostic Criteria
The DSM-5 defines DDNOS as “a dissociative disorder that is not classifiable as any of the other specific dissociative disorders” (American Psychiatric Association, 2013). The core diagnostic criteria for DDNOS include recurrent episodes of dissociation that are not severe enough to meet criteria for any of the other dissociative disorders. These episodes can involve alterations in memory, identity, or consciousness, and can include depersonalization, derealization, amnesia, and dissociative fugue. Furthermore, individuals must experience significant distress or impairment in functioning as a result of the dissociative episodes.
Etiology
The exact etiology of DDNOS is still not fully understood. There is evidence to suggest that DDNOS is related to early childhood trauma, including physical, emotional, and sexual abuse, and neglect (Briere, 1996; Nijenhuis, Spinhoven, Van Dyck, Van der Hart, & Vanderlinden, 1998). Additionally, DDNOS has been linked to parental separation and attachment disruptions (Grynszpan, 2012). It has been hypothesized that these early experiences lead to difficulties in self-regulation and the development of maladaptive coping strategies, such as dissociation (Grynszpan, 2012; Steinberg, Cicchetti, Buchanan, Hall, & Rounsaville, 1995).
Prevalence
The prevalence of DDNOS is difficult to estimate due to the lack of large-scale studies. However, one study estimated the prevalence of DDNOS in the United States to be 0.5%, with a higher rate of 1.6% among individuals who had been exposed to trauma (Briere, 1996).
Comorbidity
Individuals with DDNOS often experience comorbid mental health conditions, including depression, anxiety, eating disorders, and substance abuse (Korzekwa, 2007; Ross, 1989). In addition, DDNOS has been linked to somatic symptoms, such as pain, fatigue, and migraines (Korzekwa, 2007; Ross, 1989).
Treatment
There is a growing body of evidence to support the use of evidence-based treatments for DDNOS, such as cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) (Korzekwa, 2007). Additionally, medications, such as selective serotonin reuptake inhibitors (SSRIs), can be helpful in managing symptoms of depression and anxiety that often accompany DDNOS (Korzekwa, 2007).
Conclusion
Overall, DDNOS is a complex disorder with a range of potential causes and consequences. While evidence-based treatments are available, further research is necessary to increase the understanding of DDNOS and to develop better interventions.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Briere, J. (1996). Psychological assessment of adult posttraumatic states: Phenomenology, diagnosis, and measurement. Washington, DC: American Psychological Association.
Grynszpan, O. (2012). Attachment disruptions and dissociation: A developmental approach. Clinical Psychology & Psychotherapy, 19(5), 424-430.
Korzekwa, M. (2007). Dissociative disorder not otherwise specified (DDNOS): A review. Canadian Journal of Psychiatry, 52(11), 674-678.
Nijenhuis, E. R., Spinhoven, P., Van Dyck, R., Van der Hart, O., & Vanderlinden, J. (1998). Somatoform dissociation in trauma-related disorders: A review. Clinical Psychology Review, 18(5), 537-556.
Ross, C. A. (1989). Multiple personality disorder: Diagnosis, clinical features, and treatment. New York, NY: Wiley.
Steinberg, M., Cicchetti, D., Buchanan, J., Hall, H., & Rounsaville, B. (1995). The role of child maltreatment in early deviant behavior: A cross-sectional study. Development and Psychopathology, 7(3), 517-536.