292 Dissociative Disorders
fragmentation of identity may vary with culture (e.g., possession-form presentations) and cir-
cumstance. Thus, individuals ma y experience discontinuities in identity and memory that
may not be immediately evident to others or are obscured by attempts to hide dysfunction. In-
dividuals with dissociative identity disorder experience a) recurrent, inexplicable intrusions
into their conscious functioning and sense of se lf (e.g., voices; dissociated actions and speech;
intrusive thoughts, emotions, and im pulses), b) alterations of sense of  self (e.g., attitudes, pref-
erences, and feeling like one’s body or actions are not one’s own), c) odd changes of perception
(e.g., depersonalization or derealization, such as feeling deta ched from one’s body while cut-
ting), and d) intermittent functional neurolog ical symptoms. Stress often produces transient
exacerbation of dissociative symptoms that makes them more evident.
The residual category of other specified disso ciative disorder has seven examples: chronic
or recurrent mixed dissociative symptoms that approach, but fall  short of, the diagnostic cri-
teria for dissociative identity disorder; dissociative states secondary to brainwashing or
thought reform; two acute presentations, of less than 1 month’s duration, of mixed dissociative
symptoms, one of which is also marked by the presence of psychotic symptoms; and three sin-
gle-symptom dissociative presentations—dissociat ive trance, dissociative stupor or coma, and
Ganser’s syndrome (the giving of  approximate and vague answers). 
Dissociative Identity Disorder
Diagnostic Criteria 300.14 (F44.81)
A. Disruption of identity characterized by two or more distinct personality states, which