Diagnoses matter because they determine the path of treatment for what ails you. Ultimately, though, they are only labels … particular labels for particular sets of symptoms. So when we talk about the differences between Dissociative Identity Disorder (DID) and Dissociative Disorder Not Otherwise Specified (DDNOS) we’re talking about symptoms. It gets confusing because:
- These are both complex dissociative disorders. Overlapping symptoms isn’t unusual with a variety of mental illnesses but with these two it’s nothing but overlap. Discerning the differences between DID and a thought disorder like Schizophrenia, for instance, is easier.
- The latter is an NOS disorder. In other words, DDNOS is the diagnosis given when a patient meets some, but not all of the diagnostic criteria for a DID diagnosis.
Sometimes people get so confused by and caught up in the line between these two diagnoses that they throw up their hands and declare that it just doesn’t matter. And depending on your reasons for trying to pin down that line, it might not. Frankly, there are some very good arguments for doing away with both diagnoses and grouping them together under the label Complex Dissociative Disorder, or just calling them both Dissociative Identity Disorder. After all, this is a spectrum we’re talking about here.
Still, as of right now these two diagnoses exist (in the United States) and there are some differences between the two. So let’s talk about them, shall we?
I like to break topics down into bite sized pieces so we’ll start with the obvious: dissociative symptoms. Then we’ll talk about how the symptoms differ, and a couple of the tools clinicians use to determine a dissociative diagnosis. I’ll throw in a DCMS Bookshelf pick that focuses on DID/DDNOS symptoms and tell you about a blogger with a talent for discussing pathology and recovery without harping on diagnoses. Comment today and you’ll get all of that for three installments of just $19.95!
For real though, it’ll be fun. 
um i have no money… but the differences are interesting and can be confusing.
but then i skipped the ddnos dx and went straight to the did dx. its much more entertaining anyway 
hehe. it’ll be interesting to see what you come up with though!
Hi,
Thanks for discussing this topic. It’s interesitng, since in the Netherlands, people will not be diagnosed with DID after the initial evaluation, but will have to be observed by a trained therapist for half a year in treatment before they can get a DID diagnosis. So even if the SCID-D (the tool used for diagnosing dissociative disorders) indicates DID, they will be given a DDNOS diagnosis for a while.
By the way, do you know if the treatmetn for DID and DDNOS differs? I checked the guidelines for treating DID (in the Journal of Trauma and Dissociation last year, but maybe also on the ISST-D website), and it said DDNOS folks benefit from mostly the same treatment as those with DID, but didn’t say where they don’t. On a very criticla Dutch forum, however, I read that DDNOS people should be prevented from exploring their alters since that will make dissociation worse, while exploring alters is essential to DID treatment. As someone who may be rediagnosed with DDNOS (I was diagnosed DID without a proper SCID-D assessment and am in the process of pursuing a re-evaluation), who does have quite severe identity alteration according to both myself and my therapist, I fear being told I’m not dissociative enough to allow me to explore my alters. Since you seem to make a clear distinction between DID and DDNOS and at the same time say diagnoses are there to guide treatment, I was wondeirng if you have any insight on this.
… in the Netherlands, people will not be diagnosed with DID after the initial evaluation, but will have to be observed by a trained therapist for half a year in treatment before they can get a DID diagnosis. So even if the SCID-D (the tool used for diagnosing dissociative disorders) indicates DID, they will be given a DDNOS diagnosis for a while.
I think that’s a smart approach.
By the way, do you know if the treatmetn for DID and DDNOS differs?
So much depends on the treating clinician. Theoretically, the treatment protocol is essentially the same and the places where it differs are simply those places where the DDNOS folks are starting out farther along the integration continuum than the DID folks are. For instance, you mention you don’t have severe dissociative amnesia. Treatment for DID would usually include learning to manage gaps in memory and build greater awareness and communication not just in general but also specifically to help mitigate the problems created by amnesia. So that’s a place where your treatment might vary from others’ with DID.
As for the issue of exploring personality states, I do think that’s a tricky area. It’s also one of the two places where naive clinicians can do the most damage. DDNOS is a serious diagnosis and is applied to individuals with severe dissociation. And severely dissociative people are often suggestible people. So you don’t want to badger your DDNOS client to find names for their self-states, for example, as that could potentially create greater separation.
Bottom line, treatment for both is ultimately about achieving greater awareness and a unified sense of self (put simply) but how clinicians go about that treatment should be informed at least in part by the diagnosis.
I go back and forth on the idea that DDNOS and DID should be combined into one disorder. On one hand, like you said, dissociation is a spectrum, and the delineation between the two disorders further amplifies the fact that DID is more “severe” and “out there” when, really, there is much overlap. Someone diagnosed with DDNOS may be so because their therapist/etc doesn’t support or accept a DID diagnosis. Or perhaps the client doesn’t report/isn’t aware of (as is common with memory loss) all of the disruptions during his/her daily life and therefore only seems to be “DDNOS”. If dissociation were treated more as a spectrum, diagnostically, than as “dp/dr is dissociation ‘lite’, DDNOS is more ‘severe’, and at DID you’re just unbalanced,” then the ideology and anecdotal evidence to support a disorder (DID) that is already accepted into the DSM may become more widely accepted. If a symptom (dissociation) exists on a spectrum, is it truly helpful to break it up into clear-cut separate entities? And on the flip side, if there were to be one, over-arching diagnosis, would we still have to find a way to differentiate between someone who, for instance, has pathological dissociation with dissociated ego states and someone who has pathological dissociation with dissociated identities? Or is it 6 of one, half-dozen of the other?
When looked at from a distance, it’s 6 of one, half-dozen the other. Up close, they are different disorders. Still, I sometimes think we should chuck the DID diagnosis altogether. For what it’s worth though, any clinician with the experience, knowledge, and skills to competently treat complex dissociative disorders already knows dissociation exists on a continuum and treats their clients accordingly.
I think Stephanie raises some very interesting points. It seems like there’s a big difference between DDNOS and DID, when often their symptoms are not far apart at all. Then again, it can make a big difference in treatment.
I was diagnosed with DDNOS 5 or 6 years ago, while working with treaters who weren’t experienced in diagnosing and treating dissociative disorders. I knew I had large chunks of lost time, very little memory of my past, and dissociative episodes in which I shut down and became totally unresponsive to outside stimuli. DDNOS seemed to make sense, and no one did much digging into it.
Six months ago, I was working with a therapist who had extensive experience treating DID, and she brought up the possibility of DID. She told me it would be hard to lose as much time as I had (sometimes months or years) without some part of myself taking on executive functioning, since when I lose time I’m still mostly functional, outwardly. It also explained the very out-of-character things people told me I’d said and done that I had no memory of, as well as the chorus of voices I hear in my head. She had me do a lengthy consult with a psychiatrist who specialized in DID, and he confirmed her diagnosis.
If I hadn’t gotten the DID diagnosis, I’d still be totally unaware of the presence of other parts of myself, and I probably wouldn’t get very far in therapy without knowing what I learned from the DID diagnosis.
Where did the image come from? It’s gorgeous.
It’s a digital collage I made on polyvore.com (check out my other collages here). As for the girl, I don’t know where that picture originated. Glad you like it!
I was diagnosed with ddnos. However with me I do not have seperate people I have created only places that take emotions I dont wish to feel. I am able to pull them up and feel them if I chose or not. However, after a time I forget they are there at all and it eventually will cause me anxiety. My Doctor told me this was a rare form of ddnos.