296 Dissociative Disorders
their dissociative and posttraumatic sympto ms. Long-term supportive treatment may
slowly increase these individuals’ ability to  manage their symptoms  and decrease use of
more restrictive levels of care. 
Differential Diagnosis 
Other specified dissociative disorder. The core of dissociative identity disorder is the
division of identity, with recurrent disruption of conscious functioning and sense of self.
This central feature is sh ared with one form of other specified dissociative disorder, which
may be distinguished from dissociative identity disorder by the presence of chronic or re-
current mixed dissociative symptoms that do not meet Criterion A for dissociative identity
disorder or are not accomp anied by recurrent amnesia.
Major depressive disorder. Individuals with dissociative identity disorder are often de-
pressed, and their symptoms may appear to m eet the criteria for a major depressive episode.
Rigorous assessment indicates that this depression in some cases does not meet full criteria for
major depressive disorder. Othe r specified depressive disorder  in individual s with dissocia-
tive identity disorder often has an importan t feature: the depressed mood and cognitions fluc-
tuate  because they are experienced in some identity states but not others. 
Bipolar disorders. Individuals with dissociative iden tity disorder are often misdiag-
nosed with a bipolar disorder, mo st often bipolar II disorder. The relatively rapid shifts in
mood in individuals with this disorder—typica lly within minutes or hours, in contrast to
the slower mood changes typically seen in individuals with bipolar disorders—are due to
the rapid, subjective shifts in  mood commonly reported acro ss dissociative states, some-
times accompanied by fluctuation in levels of activation. Furtherm ore, in dissociative
identity disorder, elevated or depressed mood  may be displayed in conjunction with overt