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. Prominent hallucinations or delusions B. Evidence that disturbance is direct pathophysiological consequence of another medical condition C. Not better explained by another mental disorder
Common specifiers
ANo formal DSM-5-TR specifiers for DID
BWith delusions; With hallucinations; Severity (Mild / Moderate / Severe)
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)
BPrimary schizophrenia spectrum (no GMC; prior episodes); Substance/medication-induced psychosis; Delirium with psychotic features (not coded separately)