Tests and diagnosis

By Mayo Clinic Staff

Doctors diagnose dissociative disorders based on a review of symptoms and your personal history. Your doctor may perform tests to rule out physical conditions — for example, head injury, certain brain diseases, sleep deprivation or intoxication — that can cause symptoms such as memory loss and a sense of unreality. If your doctor rules out physical causes, he or she will likely refer you to a mental health specialist to determine your diagnosis.

To be diagnosed with a dissociative identity disorder, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Dissociative amnesia

For a diagnosis of dissociative amnesia, the DSM includes these criteria:

  • You've had one or more episodes — usually something traumatic or stressful — in which you couldn't remember important personal information, or you can't remember your identity or life history. This memory loss is too extensive to be explained by ordinary forgetfulness.
  • Your episodes of memory loss don't occur only during the course of another mental health disorder, such as post-traumatic stress disorder. Also your symptoms are not due to alcohol or other drugs, and they're not caused by a neurological or other medical condition, such as amnesia related to head trauma.
  • You also may experience dissociative fugue, where you purposefully travel or experience confused wandering that involves amnesia — inability to remember your identity or other important personal information.
  • Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life.

Dissociative identity disorder

For a diagnosis of dissociative identity disorder, the DSM includes these criteria:

  • You display, or others observe, two or more distinct identities or personalities, which may be described in some cultures as possession that is unwanted and involuntary. Each identity has its own pattern of perceiving, relating to and thinking about yourself and the world.
  • You have recurrent gaps in memory for everyday events, skills, important personal information and traumatic events that are too extensive to be explained by ordinary forgetfulness.
  • Your symptoms are not a part of broadly accepted cultural or religious practice.
  • Your symptoms are not due to alcohol or other drugs, or a medical condition. In children, symptoms are not due to imaginary playmates or other fantasy play.
  • Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life.

Depersonalization-derealization disorder

For a diagnosis of depersonalization-derealization disorder, the DSM includes these criteria:

  • You have persistent or recurrent experiences of feeling detached from yourself, as if you're an outside observer of your thoughts, sensations, actions or your body (depersonalization). Or you feel detached or experience a lack of reality for your surroundings as if you're in a dream or the world is distorted (derealization).
  • While you're experiencing an episode of depersonalization or derealization, you're aware the experience is not reality.
  • Your symptoms do not occur only during the course of another mental disorder, such as schizophrenia or panic disorder, or during another dissociative disorder. Your symptoms are also not explained by the direct effects of alcohol or other drugs, or a medical condition, such as temporal lobe epilepsy.
  • Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life.
Mar. 26, 2014

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