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Review of DSM5 Mental Disorders for NCMHCE Study
1. Dissociative identity disorder2. Depersonalization/derealization disorder3. Dissociative amnesia4. Other specified/unspecified dissociative disorder
AssessmentsMental Status ExamCambridge Depersonalization Scale CDS
Treatments 1. MedicationAntidepressants AnticonvulsantsAtypical anti-psychotics
2. Therapies Safety or Crisis Plan Psychodynamic Psychotherapy,
insight oriented Cognitive Behavioral Therapy, for
coping Hypnotherapy Relaxation Training REBT, disputing irrational beliefs
Diagnosis 1. Disruption of identity characterized by two or more distinct personality states Observed by others or reported by the individual2. Recurrent memory gaps of everyday events, personal information and/or traumatic events Not ordinary forgetting
ComorbidPTSDBorderline Personality DisorderAvoidant Personality DisorderSomatic Symptom DisorderEating disordersSubstance related disordersOCDSleep disorders
Rule OutPTSDSchizophreniaBipolar DisorderBorderline Personality Disorder
S1. Find OutDetailed historyMedical historyAffective functioningSuicide historyAnxiety Cognitive functioningTrauma and loss historyCurrent family and social environment (safety)Substance abuse history
S2. Refer & AssessPsychiatric evaluationBegin outpatient therapy and identify possible dissociated aspects
Verify alternate personalities
S4. Treatments 1. MedicationAntidepressants AnticonvulsantsAtypical anti-psychotics
2. Therapies Safety or Crisis Plan Psychodynamic Psychotherapy,
insight oriented Cognitive Behavioral Therapy, for
coping Hypnotherapy
S5. Monitoring 1. Follow through on referrals2. Medication compliance3. Journaling dissociative episodes and memory lapses 4. Self destructive behavior
S6. TerminationMedication monitoring for compliance, to reduce high rate of relapseReturn to therapy if relapseSupport group
Diagnosis IInability to recall important autobiographical informationusually of a traumatic or stressful nature outside of ordinary forgettingNot attributed to use of substances, medical or neurological condition
SpecifyWith/without dissociative fugue:Purposeful travel or bewildered wandering
Rule OutDissociative Identity DisorderPTSDAcute Stress Disorder Somatic Symptom Disorder
S1. Find OutDetailed historyMedical historyAffective functioningSuicide historyAnxiety Cognitive functioningTrauma and loss historyCurrent family and social environment (safety)Substance abuse history
S2. Refer & AssessPsychiatric evaluation
S4. Treatments 1. MedicationAntidepressants AnticonvulsantsAtypical anti-psychotics
2. Therapies Psychodynamic Psychotherapy,
insight oriented Cognitive Behavioral Therapy, for
coping Hypnotherapy
Diagnosis1. Persistent or recurrent experiences of depersonalization, derealization or bothDepersonalization:
Experience of unreality, detachment, or being an outside observer
In regards to one’s thoughts, feelings, sensations, body actions
Derealization: Experiences unreality or detachment
in regards to surroundings Objects or people are thought to be
unreal, dreamlike, foggy, lifeless or distorted
2. During these experiences reality testing remains intactOften associated with early trauma
Rule OutSchizophrenia
S1. Find OutCognitive functioningMental health historyWork functioningSubstance abuse historyAnxiety historyTrauma historySocial history
S2. Assess or ReferMental Status ExamCambridge Depersonalization Scale CDS
S4. Treatments 1. MedicationAntidepressants Anti anxiety
2. Therapies Psychoeducation Identifying stressors Relaxation Training REBT, disputing irrational beliefs
S5. MonitoringFrequency and intensity of depersonalization episodesAffective functioning
S6. TerminationContinue relaxation methodsKeep a journal to record potential stressors that trigger the symptomsJoin a meditation or relaxation group
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