Other Specified Dissociative Disorder

The process of determining which disease or condition explains a person's symptoms and signs often involves assessing the symptoms and then determining whether the symptoms identified meet the criteria for one of the three central dissociative disorders, or if they would be classified as an otherwise specified dissociative disorder (OSDD) or dissociative disorder not otherwise specified. Other specified dissociative disorder is referred to as “specified” as opposed to unspecified because when diagnosed, one of four subtypes must be selected, each with distinct symptoms. 

Chronic and recurrent syndromes of mixed dissociative symptoms

The chronic and recurrent syndrome of mixed dissociative symptoms subtype is most typically used to describe situations in which a person is experiencing some symptoms of dissociative identity disorder, but not enough to receive a formal DID diagnosis. The symptoms often present in one of two ways:

• A person experiences identity disturbances that can influence their thoughts and decisions. However, the alternative personality does not achieve executive functioning, meaning the person still maintains their core sense of self.
• A person alternates between expressing different identities but doesn’t demonstrate dissociative amnesia, meaning they are fully aware that they are changing identities.

Identity disturbance

In this subtype, an identity disturbance is defined as long-term changes in a person’s personality or conscious questioning of aspects of one’s sense of self. To receive a diagnosis of this OSDD subtype, a person must have experienced one or more of the following:

• Brainwashing
• Thought reform
• Indoctrination while being held captive
• Torture
• Political imprisonment
• Recruitment by a terrorist organization, a cult, or a religious sect

Acute dissociative reactions to stressful events

To be diagnosed with this subtype, a person’s dissociative symptoms must last for less than a month and be caused by some form of stress. Below are some of the most common symptoms: 

• Reduced levels of consciousness
• Derealization, or believing you are no longer present in the same world as everyone around you, i.e., having the sense that you are viewing your surroundings through warped glass
• Depersonalization, or the perception that you are no longer in your body and are watching events happen to you
• Short periods of amnesia or stupor
• Disturbances in perception, such as viewing objects as larger or smaller than they are or sensing that time is slowing down
• Changes in sensory and motor functioning, such as experiencing paralysis or becoming numb

Dissociative trance

Trance states can be an integral part of some religious or cultural practices. Dissociative trance is different. It is an involuntary experience that typically results in distress, as well as the following symptoms:

• Reduced awareness of one’s surroundings or total loss of awareness
• Unresponsiveness
• Lack of reaction to changes in one’s environment

Some people in dissociative trances involuntarily move their fingers or lose consciousness entirely. 

Experiences of severe trauma² most frequently cause other specified dissociative disorders. Often, this trauma occurs in early childhood, although dissociative symptoms can sometimes take years or decades to emerge.

The disorder, which is characterized by a loss of awareness or orientation to their surroundings and/or identity, is thought to stem more from childhood experiences possibly because children are still forming their identities, so they may more easily be able to dissociate and “step outside of themselves” in times of intense distress. This ability may develop into a coping mechanism that continues into adulthood.

The second subtype of OSDD, identity disturbance due to prolonged and intensive coercive persuasion, is the exception to the childhood trauma rule, as those experiences usually take place during adulthood.

Examples of traumatic experiences in childhood (or adulthood) that can lead to OSDD include:

• Long-term physical, emotional, and sexual abuse, particularly from a child’s caregiver
• A chaotic, scary, or unpredictable childhood home environment
• Living through war, natural disasters, kidnapping, or torture
• Experiencing a significant number of intense medical procedures early in one’s life

Stressful situations, even if they are unrelated to past traumatic experiences, can cause dissociative symptoms in people with OSDD. In some instances, dissociation can be combined with a flashback in which the person believes they are reliving the past trauma. These flashbacks can result in unsafe behavior, such as trying to “escape” or engaging in self-harm, at which point it is typically most effective to involve a medical professional. 

The goal of treatment for other specified dissociative disorder is to reduce or eliminate dissociative symptoms, as well as address the significant mental distress these symptoms can cause.

Medication

The US Food and Drug Administration (FDA) does not list any medications as approved treatments for other specified dissociative disorders. However, naltrexone has shown some promise in reducing dissociative symptoms. 

Naltrexone is a medication that blocks the sense of euphoria associated with the use of some substances, such as alcohol and opioids and is commonly prescribed to treat substance use disorders. It has been indicated to potentially alleviate the sense of disconnection and numbness while dissociating, but not symptoms associated with identity disturbance or change.

Other medications prescribed for people with dissociative symptoms are often intended to treat mental health conditions resulting from dissociative experiences, not the dissociative symptoms themselves.

Self-care

Characterized by constriction of consciousness, depersonalization, derealization, and other disruptions, dissociative disorders can be stigmatized in the media, with portrayals of patients who are described as having “split” or “multiple” personalities, often with violent tendencies. This depiction is inaccurate. People who experience dissociative symptoms are far more likely to harm themselves than harm others.

However, the portrayal of dissociation as “craziness” can lead to intense feelings of shame and embarrassment in people who have dissociative experiences, which may mean that self-care is more difficult for these individuals. Some people may attempt to hide their condition from others or deny that dissociation is happening. 

One way for patients with OSDD to combat this stigma and prioritize their emotional well-being is to connect with other people living with a dissociative disorder through support groups or online forums. If there are no support groups for dissociative disorders in a person’s area, a beneficial alternative may be support groups for survivors of trauma or people living with PTSD.  

For people with alternate identities or who experience prolonged dissociative states, basic care, such as making sure one has access to food, water, and shelter, can become complicated. In these situations, taking care of yourself may involve reaching out to a supportive, trusted loved one or medical professional to ensure you remain safe and healthy during dissociative events.

Because of the stigma surrounding dissociation, people with OSDD may be hesitant to seek professional help or acknowledge to themselves that they would benefit from assistance. Online therapy through a platform like BetterHelp may be a more convenient method of connecting to support. With a legitimate online therapy platform, clients can be matched with a therapist whom to connect from the comfort of their homes. 

Organizations focused on assisting people who have experienced dissociation and trauma can also be beneficial. The Traumatic Stress Institute focuses on reducing the prevalence of traumatic experiences in society and helping people who have already experienced trauma with informative articles and a list of hotlines for people seeking further assistance. The International Society for the Study of Trauma and Dissociation provides an FAQ page specifically on the topic of dissociation, as well as a search tool for therapists and treatment facilities specializing in addressing dissociative disorders.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Dissociative responses are often prompted by reminders of past trauma, which can elicit strong negative emotions from which the individual dissociates to escape. Researchers recommend the use of grounding exercises, in which an individual focuses on aspects of their immediate environment and the present moment, as a form of treatment for dissociative disorders. Grounding exercises may help people shift attention away from their emotions and onto the external world, which might prevent dissociation.

Grounding techniques can involve cognitive aspects, like answering questions such as, “What is the date?”, “How old am I?”, or “What season are we in?” They may also focus on a person’s sensory experience, with tasks like counting all of the green items in the room, describing the texture of one’s chair, or identifying five sounds in the immediate environment. 

Self-mirroring therapy may offer another form of treatment for dissociative disorders. With this form of therapy, a client is recorded on video during a counseling session in which they are asked to recall an emotionally significant event. The individual then watches the video of themselves at a later point. Researchers found that this technique reduced dissociative symptoms.

It is possible that, in observing their emotional reaction from a distance, individuals can differentiate themselves from their emotional responses. They may recognize that while emotions can be overwhelming, they eventually pass, which could reduce the tendency to use dissociation as an escape mechanism.

Below are several statistics on dissociative disorders and other specified dissociative disorder: 

• Together, the four subtypes of other specified dissociative disorder make up around 40% of all dissociative disorder diagnoses.
• Internationally, dissociative disorders are thought to be present in 1% to 5% of the global population. Prevalence can be challenging to assess, however, given how many people with dissociative disorders may hide their condition or not be aware of their symptoms. It can also be common for dissociative disorders to be misdiagnosed as another mental health condition, particularly PTSD. 
• Evidence suggests that dissociative symptoms may be more common in women.
• A research study found that roughly 73% of adolescent patients who received treatment for dissociative disorders did not continue to demonstrate dissociative symptoms.

What Is Dissociation? Definition, Causes, And Treatment

What Are The Symptoms Of Dissociative Amnesia? 

Is Childhood Trauma Holding You Back? 

Exploring How EMDR Therapy Heals Trauma

How Does Childhood Trauma Affect Adulthood?