#introduction to

[hauntedselves]

Introduction to: Other Specified Dissociative Disorder (OSDD)

Other Specified Dissociative Disorder (OSDD) is a diagnosis in the DSM-5, and covers Partial Dissociative Identity Disorder in the ICD-11. This post details the different subtypes of OSDD according to the DSM-5, and provides the ICD-11 equivalent.

OSDD is a dissociative disorder diagnosed when the patient has significant dissociative symptoms but doesn't fit the criteria for any other dissociative disorder (Dissociative Identity Disorder (DID), Depersonalization/Derealization Disorder (DPDR), and Dissociative Amnesia (DA)). OSDD has four specifiers - type 1, which is equivalent to Partial DID in the ICD-11, type 2, 3 and 4.

OSDD type 1

OSDD 1 is perhaps the most well known of the OSDD types. In the DSM-5, it's called "Chronic and recurrent syndromes of mixed dissociative symptoms", and gives the following description:

"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."

Simply put, it's DID but missing a symptom. The "less than marked discontinuities in sense of self and agency" part refers to someone who experiences DID but their alters aren't fully elaborated or separate, which in DID communities is referred to as "OSDD 1a".

The "alterations of identity or episodes of possession in an in­dividual who reports no dissociative amnesia" part refers to someone who experiences DID without amnesia between alters. In DID communities this is called "OSDD 1b".

(See this tumblr post for more info on the differences between OSDD 1a and b).

In the ICD-11, OSDD 1 is a separate diagnosis called Partial DID. It describes DID where only one alter is active in daily life with occasional switches or passive influence from other alters, usually fragments. This diagnosis covers OSDD 1b, but doesn't account well for people with OSDD 1a. It also doesn't account well for people with OSDD 1b who have well developed alters. See this tumblr post for more information.

OSDD 1 is the only disorder other than DID that involves alters.

OSDD type 2

OSDD 2 is described in the DSM-5 as "identity disturbance due to prolonged and intense coercive persuasion". A person with OSDD 2 has gone through some kind of experience that resulted in questioning their identity and sense of self. This could be torture, brainwashing, thought reform, political imprisonment, indoctrination, or involvement in a cult or terrorist organisation.

For example, an atheist adult who became involved in a religious cult eventually leaves, but is confused and distressed over their new religious beliefs.

OSDD type 3

OSDD 3 is a diagnosis given when a person experiences short term dissociation to a stressful or traumatic event. The dissociation doesn't last longer than a month; if it did, the diagnosis would be changed to a different dissociative disorder (e.g. DPDR).

OSDD type 4

OSDD 4 is a diagnosis given when a person experiences a dissociative trance. The dissociative trance can include involuntary movements or transient paralysis.

In the ICD-11, this is equivalent to Trance Disorder.

FAQ

1. Are alters part of OSDD 2, 3 and 4?

No. DID and OSDD 1 are the only disorders that involve alters.

2. Can I be diagnosed with more than one type of OSDD?

No. Clinicians don't diagnose "OSDD type 2", they only diagnose "OSDD", although they may specify on paperwork, or during a session, that it's type 2. OSDD is a singular, catch-all diagnosis with 4 examples given of different presentations.

3. Can I be diagnosed with OSDD and another dissociative disorder?

OSDD is supposed to be a diagnosis for someone who doesn't meet the criteria for any other dissociative disorder. So if you meet the criteria for DPDR, for example, you probably won't be diagnosed with OSDD.

4. Can I be diagnosed with OSDD and another disorder that isn't dissociative?

Yes! OSDD can be diagnosed alongside any non-dissociative disorder.

5. What is Unspecified Dissociative Disorder?

UDD (or USDD) is a short term diagnosis given when there's not enough time or evidence for a more thorough assessment, or if the diagnosing clinician chooses not to specify what dissociative disorder the person has.

6. What are the other dissociative disorders included in the ICD-11?

The ICD-11 includes DID, Partial DID, DA, Trance Disorder, Possession Trance Disorder, DPDR, OSDD, and Dissociative Neurological Symptom Disorder.

7. What is DDNOS?

Dissociative Disorder Not Otherwise Specified was the name for the DSM-IV's version of OSDD. When the new DSM came out in 2013, DDNOS was changed to OSDD. You might still see people who were diagnosed under the old DSM use DDNOS, since that's what they were diagnosed with at the time.

Glossary

Dissociation: Dissociation is essentially a feeling of disconnection. There are five types of dissociation: depersonalization, derealization, dissociative amnesia, identity confusion, and identity alteration. Identity confusion is feeling unsure about who you are, which goes beyond normal, healthy questioning of identity. Identity alteration is only experienced in DID and OSDD 1 and is caused by alters switching.

DID: Dissociative Identity Disorder is a disorder caused by childhood trauma. A person with DID experiences amnesia in daily life, caused by (separate & elaborated) alters fronting.

DPDR: Depersonalization/Derealization Disorder is characterised by chronic dissociation. Depersonalization is feeling a disconnection between you and your body, memories, emotions, and/or sensations. Derealization is a disconnect between you and your environment or reality.

DA: Dissociative Amnesia is amnesia, not caused by another condition, that goes beyond ordinary forgetting. Usually the amnesia is for traumatic events.

Alter(s): Also called parts, alternate personalities or personality states, self states, identities or identity states, and ego states, as well as many other names. These are parts of the self that have become separated due to childhood trauma. They can range from fragments, which are alters that don't have a strong sense of separation or differentiation, to fully formed alters, which often do feel strongly separated and differentiated. When one alter stops being in control of the body and another alter steps in, this is called switching.

Resources

DID/OSDD Self Help Masterlist

DID Archive

This is not Dissociative * not all content available

Positive Outcomes for Dissociative Survivors (PODS)

The Dissociative Initiative

International Society for the Study of Trauma & Dissociation

Sidran Institute

Multiplicity And Me

The CTAD Clinic

Trauma & Dissociation

The DSM-5-TR, ICD-11 & PDM-2

Lots of downloadable pdfs of therapy worksheets

Help! I'm dissociating!

Dissociating and need some grounding tools?

Self Help Masterlist for DID/OSDD (see the trauma, self care and dissociation sections)

Self Help for PTSD

Grounding Techniques

Grounding Kits

Managing Triggers

Using Anchors to Manage Triggers

How to manage triggers in DID/OSDD

3 Types of Triggers and 3 Techniques for Taming Them

More grounding techniques

A loved one is dissociating and you don't know what to do?

Dissociative Crisis

Understanding Emotional Flooding

How to help someone who is experiencing dissociation

Ideas for dealing with dissociative symptoms

How to help someone who is having a flashback or panic attack

I would love to hear from you if you have any resources or experience (lived or otherwise) with OSDD 2, 3 and 4, as information about these subtypes is hard to come by!

[hauntedselves]

Clinical lycanthropy

Clinical lycanthropy (CL) falls under the umbrella of Delusional Misidentification Syndrome (DMS). DMS is a collection of delusions involving misidentification of others, the self, objects, or places. In the case of clinical lycanthropy, it is a delusional misidentification of the self. People with CL believe that they are an animal, or are transforming into one.

The animal doesn't have to be a wolf or werewolf, though canines are the most common - there have been case reports of CL involving snakes, cats, cows and even bees. (Technically, CL has many different names depending on what animals are involved - e.g., CL involving dogs is called kynanthropy, cows is boanthropy, cats is ailuranthropy, and multiple animals (or general/unspecified animal transformation) is zoanthropy). CL occurs all over the world, and the animals involved are often significant in the culture(s) of the person with CL - for example, CL involving rabbits in the US, where rabbits are popular pets, foxes in Japan and hyenas in Africa. Guessoum et al. theorise that CL is a culture-bound syndrome (reflective of culture).

CL is a somatic delusion, meaning it involves the body. Hallucinations can be part of CL, for example: feeling or seeing hair growing on the body, or teeth sharpening into fangs. Some people with CL see themselves transforming when they look in the mirror. Some people don't hallucinate their transformations, but they have "body schema illusions" (i.e., feel like their body has changed).

There is often overlap with other DMS delusions, particularly other delusional misidentifications of the self. Some people, with or without CL, believe that others have transformed into animals. There have been more than a few cases of people with CL and Cotard's, where they believe they or their organs are dead or dying. Often, a person will cycle through different DMs, sometimes reoccuringly.

Sometimes, the act of transformation in CL, or the strength of the delusion, is dependent on the phases of the moon. There has historically been an association with psychosis and the moon, especially when it's full - this is where we get the word "lunatic" from.

Clinical lycanthropy is associated strongly with mood disorders, psychotic disorders, and sleep disorders (particularly obstructive sleep apnea). It may be associated with stress and trauma, and can manifest symbolically. For example, a person who goes through abuse and feels dirty and worthless might develop clinical kynanthropy (dog) as a psychotic reaction to trauma. Or a person who goes through abuse might develop clinical kynanthropy as a reaction to their need for love and attention.

Sources:

Guessoum et al., Clinical Lycanthropy, Neurobiology, Culture: A Systematic Review, Frontiers in Psychiatry, 2021.

Blom, When Doctors Cry Wolf: A Systematic Review of the Literature on Clinical Lycanthropy, History of Psychiatry, 2014.

Garlipp et al., Lycanthropy - Psychopathological and Psychodynamical Aspects, Acta Psychiatrica Scandinavia, 2004.

[hauntedselves]

DSM 5 Alternate Model for Personality Disorders

Part 1: Intro | Part 2: Specific PDs (ASPD, AVPD, BPD, NPD, OCPD, STPD, PD-TS)

The current model for diagnosing personality disorders has issues that the DSM itself acknowledges (especially the fact that there’s a huge amount of overlap and most people would better fit the ‘other specified PD’ definition due to that overlap), so in Section III of the DSM 5 they include an alternate model.

“In the following alternative DSM-5 model, personality disorders are characterized by impairments in personality functioning and pathological personality traits. The specific personality disorder diagnoses that may be derived from this model include antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal personality disorders. This approach also includes a diagnosis of personality disorder—trait specified (PD-TS) that can be made when a personality disorder is considered present but the criteria for a specific disorder are not met.” The alternate model doesn’t include dependent, histrionic, paranoid or schizoid personality disorders.

The alternate model uses impairments in self (identity and self-direction) and interpersonal (empathy and intimacy) functioning to define a personality disorder. Within those, there are different trait domains: Negative Affectivity (vs. Emotional Stability), Detachment (vs. Extraversion), Antagonism (vs. Agreeableness), Disinhibition (vs. Conscientiousness), and Psychoticism (vs. Lucidity) . This results in 25 trait facets, of different combinations, which each result in different personality disorders.

The general criteria of a personality disorder is the same for all specific personality disorders. In this model, criteria A and B change depending on the specific PD, while criteria C to G stay the same for all PDs.

General criteria for Personality Disorder

A. Moderate or greater impairment in personality (self/interpersonal) functioning.

B. One or more pathological personality traits.

C. The impairments in personality functioning and the individual’s personality trait expression are relatively inflexible and pervasive across a broad range of personal and social situations.

D. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time, with onsets that can be traced back to at least adolescence or early adulthood.

E. The impairments in personality functioning and the individual’s personality trait expression are not better explained by another mental disorder.

F. The impairments in personality functioning and the individual’s personality trait expression are not solely attributable to the physiological effects of a substance or another medical condition (e.g., severe head trauma).

G. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normal for an individual’s developmental stage or sociocultural environment.

Source: dsm-psychiatry-online.org (institutional access needed)

[hauntedselves]

trauma and psychosis

the DSM-5 and ICD-11 sections for PTSD and CPTSD don’t mention psychosis, aside from “auditory pseudo-hallucinations” (attributed to dissociation, not psychosis) and differentiating flashbacks from hallucinations and hypervigilance from paranoia.

but there is a link between the two, and researchers have even proposed a subtype of PTSD, psychotic PTSD (or PTSD-SP).

not only is there psychosis caused by trauma, but there’s also trauma caused by psychosis (PTSD-PP). a person can have both trauma caused by psychosis and psychosis caused by trauma.

the difference lies in the reasons why they are experiencing the symptoms: in PTSD-PP, a person has trauma revolving around their psychotic symptoms (e.g., a person who had a psychotic episode involving the FBI spying on them through their TV is now triggered by their TV, even though they’re no longer psychotic), where in PTSD-SP, the psychosis is caused by their trauma (e.g., a person who was religiously abused now has a delusion that they’re a demon).

as someone who has both psychosis-caused trauma and trauma-caused psychosis, i’m interested to see where this research goes!

[hauntedselves]

ICD-11 model for personality disorders

In the new edition of the ICD, personality disorders have been collapsed into one singular disorder, specified further by trait domains. A person would be diagnosed only with ‘Dissociality in personality disorder or personality difficulty’ instead of ‘Dissocial Personality Disorder’. (Personality difficulty is a sub-threshold level of personality disorder traits).

The five traits are:

Negative Affectivity

Detachment (vaguely equivalent to DSM 5′s Schizoid PD)

Dissociality (equivalent to Antisocial PD)

Disinhibition

Anankastia (equivalent to Obsessive-Compulsive PD)

‘Borderline pattern’ is an optional specifier and ideally should be used in conjunction with other traits. (Equivalent to and essentially the same criteria as Borderline PD).

Negative affectivity

The core feature of the Negative Affectivity trait domain is the tendency to experience a broad range of negative emotions. Common manifestations of Negative Affectivity, not all of which may be present in a given individual at a given time, include: experiencing a broad range of negative emotions with a frequency and intensity out of proportion to the situation; emotional lability and poor emotion regulation; negativistic attitudes; low self-esteem and self-confidence; and mistrustfulness.

Detachment

The core feature of the Detachment trait domain is the tendency to maintain interpersonal distance (social detachment) and emotional distance (emotional detachment). Common manifestations of Detachment, not all of which may be present in a given individual at a given time, include: social detachment (avoidance of social interactions, lack of friendships, and avoidance of intimacy); and emotional detachment (reserve, aloofness, and limited emotional expression and experience).

Dissociality

The core feature of the Dissociality trait domain is disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality, not all of which may be present in a given individual at a given time, include: self-centeredness (e.g., sense of entitlement, expectation of others’ admiration, positive or negative attention-seeking behaviours, concern with one's own needs, desires and comfort and not those of others); and lack of empathy (i.e., indifference to whether one’s actions inconvenience or hurt others, which may include being deceptive, manipulative, and exploitative of others, being mean and physically aggressive, callousness in response to others' suffering, and ruthlessness in obtaining one’s goals).

Disinhibition

The core feature of the Disinhibition trait domain is the tendency to act rashly based on immediate external or internal stimuli (i.e., sensations, emotions, thoughts), without consideration of potential negative consequences. Common manifestations of Disinhibition, not all of which may be present in a given individual at a given time, include: impulsivity; distractibility; irresponsibility; recklessness; and lack of planning.

Anankastia

The core feature of the Anankastia trait domain is a narrow focus on one’s rigid standard of perfection and of right and wrong, and on controlling one’s own and others’ behaviour and controlling situations to ensure conformity to these standards. Common manifestations of Anankastia, not all of which may be present in a given individual at a given time, include: perfectionism (e.g., concern with social rules, obligations, and norms of right and wrong, scrupulous attention to detail, rigid, systematic, day-to-day routines, hyper-scheduling and planfulness, emphasis on organisation, orderliness, and neatness); and emotional and behavioural constraint (e.g., rigid control over emotional expression, stubbornness and inflexibility, risk-avoidance, perseveration, and deliberativeness).

Borderline pattern

The Borderline pattern specifier may be applied to individuals whose pattern of personality disturbance is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by many of the following: Frantic efforts to avoid real or imagined abandonment; A pattern of unstable and intense interpersonal relationships; Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self; A tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviours; Recurrent episodes of self-harm; Emotional instability due to marked reactivity of mood; Chronic feelings of emptiness; Inappropriate intense anger or difficulty controlling anger; Transient dissociative symptoms or psychotic-like features in situations of high affective arousal.

[hauntedselves]

delusional misidentification syndrome

delusional misidentification syndrome (DMS) is a term for a collection of delusions, revolving around misidentifying people, places, objects, or yourself.

examples of DMS delusions include:

Cotard’s delusion: the belief that you (or an organ) are dead or dying

Capgras delusion: that someone you know (usually a partner or someone close to you) has been replaced by a doppelgänger

Frégoli delusion: that different people are actually one singular person in disguise

delusional companion syndrome: that objects are sentient

clinical lycanthropy: that you have transformed, or are transforming, into an animal

DMS often has the following features:

misidentification occurs with things or beings significant to the person (e.g. their siblings)

the misidentification is consistent (e.g., the misidentification is of a particular person, not of any random person)

there is a lack of awareness

there is denial of any problems associated with the DMS

many people with DMS have right frontal hemisphere dysfunction in their brain

since DMS involves psychosis, it can be part of psychotic disorders, but DMS is most often associated with neurological disorders, developmental disorders, and traumatic brain injuries.

DMS is associated with dissociation, paranoia, and depression, particularly in Cotard's.

Sources: Feinburg & Roane, Delusional Misidentification, Psychiatric Clinics of North America, 2005; Wikipedia

[hauntedselves]

Millon's proposed personality disorders

Millon theorises 5 personality disorders alongside the existing 10: turbulent, sadistic, melancholic/depressive, masochistic, and negativistic/passive-agressive.

The turbulent personality pattern is characterised by impetuous emotional expression, high-spirited self-image, unsteady intrapsychic architecture, mercurial mood/temperament, scattered cognitive style, exalted self-image, piecemeal intrapsychic content, and overemphasising. TL;DR: high energy, but borderline-like in mood.

The sadistic personality pattern is characterised by precipitating expressive behaviour, combative self-image, eruptive intrapsychic architecture, abrasive interpersonal conduct, hostile mood/temperament, isolation, dogmatic cognitive style, and pernicious intrapsychic content. TL;DR: combative and relieves pain for themselves by inflicting it on others.

The melancholic/depressive personality pattern is characterised by disconsolate emotional expression, depleted intrapsychic architecture, fatalistic cognitive style, woeful mood/temperament, self-punishment, worthless self-image, defenseless interpersonal conduct, and forsaken intrapsychic content. TL;DR: depressed, pessimistic, and views themselves as helpless.

The masochistic personality pattern is characterised by abstinent emotional expression, acquiescent interpersonal conduct, dysphoric mood/temperament, undeserving self-image, inverted intrapsychic architecture, diffident cognitive style, discredited intrapsychic content, and undermining themselves. TL;DR: they avoid pain by turning it into something they desire, often making suffering out to be something noble.

The negativistic/passive-agressive personality pattern is characterised by an embittered emotional expression, contrary interpersonal conduct, displacing emotions to relieve them, irritable mood/temperament, discontent self-image, fluctuating intrapsychic content, cynical cognitive style, and divergent intrapsychic architecture. TL;DR: irritable, resentful and cynical, they want to be respected but see themselves as selfish, and their inner conflict is taken out indirectly on others.