Which diagnosis best fits duration, episodicity, and exclusions?
A
Dissociative identity disorder
Disruption of identity characterised by ≥2 distinct personality states/possession experiences with marked discontinuity in sense of self and agency, accompanied by alterations in affect, behaviour, consciousness, memory, perception, cognition, and/or sensory-motor functioning
AA. Disruption of identity characterised by ≥2 distinct personality states/possession experiences with marked discontinuity in sense of self and agency, accompanied by alterations in affect, behaviour, consciousness, memory, perception, cognition, and/or sensory-motor functioning B. Recurrent gaps in recall of everyday events, personal information, and/or traumatic events inconsistent with ordinary forgetting C. Clinically significant distress or impairment
BA. Pervasive pattern of instability of interpersonal relationships, self-image, and affect, with marked impulsivity beginning by early adulthood; ≥5 of 9: frantic efforts to avoid abandonment; unstable intense relationships; identity disturbance; impulsivity in ≥2 damaging areas; suicidal/self-mutilating behaviour; affective instability; chronic emptiness; inappropriate intense anger; transient stress-related paranoia/dissociation
Common specifiers
ANo formal DSM-5-TR specifiers for DID
BMild / Moderate / Severe; With prominent dissociative features; With predominant impulsive behaviour; With predominant affective instability
Differential flags
APTSD with dissociative subtype (flashbacks and amnesia without identity fragmentation); Borderline personality disorder (identity disturbance vs identity fragmentation); Psychotic disorder (identity fragmentation vs voices/passivity experiences - critical distinction)
BBipolar II disorder (episodic mood elevation; not reactive mood instability); MDD (full depressive episodes; without chronic identity/relational disturbance); PTSD (highly comorbid with BPD)