Some of the least understood and most stigmatized disorders in the DSM-5 are those that fall under the categories of depersonalization, dissociative, and psychotic disorders. To better understand what these disorders entail, we'll go over some definitions:
Psychosis - a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality. This can include the following:
Hallucinations - sensations that appear to be real but are created within the mind.
Delusions - beliefs that conflict with reality.
Depersonalization - a state in which one's thoughts and feelings seem unreal or not to belong to oneself, or in which one loses all sense of identity.
Dissociation - a mental process of disconnecting from one's thoughts, feelings, memories or sense of identity.
Derealization - an alteration in the perception or experience of the external world so that it seems unreal.
Delusional Disorder F22
Onset – common in elderly
Duration – 1month or more
Symptoms:
Criteria for Schizophrenia are not met.
If Hallucinations are present, they are related to the delusion.
Functioning is not markedly impaired.
Any mood episodes are brief in comparison to delusional symptoms.
Types:
Erotomanic
Grandiose
Jealous
Persecutory
Somatic
Mixed
Unspecified
Differential:
Schizophrenia/Schizophreniform Disorder – (absence of other characteristic symptoms)
Depressive/Bipolar/Schizoaffective Disorders – (mood disturbance related to delusions)
Delirium – (neurological in nature)
Obsessive-Compulsive and Related Disorders – (delusion caused by obsession/compulsion)
Major Neurocognitive Disorder – (neurological in nature)
Treatment:
Cognitive therapy
Psychoeducation
Brief Psychotic Disorder F23
Onset – average mid-30s
Duration – at least 1 day <1 month
Differential:
Other Psychotic Disorders – (not brief, meets other criteria)
Depressive and Bipolar Disorders – (caused by mood episode)
Malingering – (gains something by faking psychosis)
Factitious Disorder – (gains nothing by faking psychosis)
Personality Disorders – (not brief, virtually life-long)
Treatment:
Psychoeducational approach
Cognitive-behavioral therapy
Schizophreniform Disorder F20.81
Duration: 1-6 months
Symptoms:
Same as Schizophrenia but with different duration. May not include impaired social functioning.
Differential:
Delirium or Major Neurocognitive Disorder – (not delirious/neurologically caused)
Depressive or Bipolar Disorder with Psychotic Features (coincides with mood disorder symptoms)
Schizotypal, Schizoid, or Paranoid Personality Disorders – (duration is >6 months)
Autism Spectrum Disorder – (repetitive/ritualistic/social issues)
Attention-Deficit/Hyperactivity Disorder – (attention/hyperactivity)
Obsessive-Compulsive Disorder – (caused by compulsion/obsession)
Post-Tramatic Stress Disorder – (caused by trauma)
Traumatic Brain Injury – (caused by brain injury)
Schizophrenia F20.9
Duration: 6 months
Onset: 90% are 15-45yo
Symptoms - 2 or more symptoms such as:
delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms (i.e. abolition, monosyllabic speech, lack of motivation, flat affect)
Etiology:
Genetics
Complications in Pregnancy
Viral factors
Stress
Dysfunctional Family
Brain structure
Differential:
Delusional Disorder – (more symptoms than just delusions)
Schizoaffective Disorder (major mood episode involved)
Brief Psychotic Disorder – (<1 month vs >6 months)
Schizophreniform Disorder (<6months vs >6 months)
Schizotypal Personality Disorder (lifelong)
Autism Spectrum Disorder or Communication Disorders (ritualistic/social issues without psychosis)
Major Depressive Disorder with Psychotic Features or with Catatonia (psychosis that happens mainly during mood episode is NOT schizophrenia)
Bipolar Disorder with Psychotic Features or with Catatonia (psychosis that happens mainly during mood episode is NOT schizophrenia)
Post-Tramatic Stress Disorder – (trauma is cause)
Schizoaffective Disorder
Duration: The presence of both of the following during the course of the illness:
2 weeks of psychotic symptoms without the presence of a major mood episode
A major mood episode concurrent with active phase symptoms of Schizophrenia
Symptoms:
Major depressive episode or manic episode present for the majority of active and residual Criterion A of Schizophrenia. Schizophrenic symptoms for at least 2 weeks absent a mood episode. Symptoms not better attributed to a substance or medication or another physical/mental illness.
Diagnostic Coding:
Bipolar Type F25.0
Depressive Type F25.1
Differential:
Schizophrenia – (symptoms of major mood episode are present for the majority of total duration of active/residual portions of the illness)
Bipolar I/MDD with Psychotic Features – (delusions or hallucinations for 2+ weeks in absence of major mood episode)
Dissociative Identity Disorder F44.81
Symptoms:
Presence of 2 or more distinct identities/personality states who recurrently take control of the person's behavior. Person has an inability to recall important personal information.
Differential:
Major Depressive Disorder – (can coincide, dissociation)
PTSD – (trauma caused/criteria)
Psychotic Disorders – (other types of psychosis)
Factitious Disorder and Malingering (Faking for gain or not)
Bipolar Disorders – (manic episodes/depressive episodes)
Personality Disorders – (ongoing traits/characteristics)
Conversion Disorder – (absence of identity disruption)
Seizure Disorders – (actual seizures/physical symptoms)
Dissociative Amnesia F44.0
Duration – minutes to decades
Symptoms:
Inability to recall important personal information, usually of traumatic or stressful nature
Types:
With dissociative fugue F44.1
Differential:
Dissociative Identity Disorder – (Identity disruption)
Post-Tramatic Stress Disorder – (trauma caused)
Factitious Disorder or Malingering –(faking for gain or not)
Neurocognitive Disorders (neurologically caused)
Seizure Disorders – (physical seizures)
Depersonalization/Derealization Disorder F48.1
Onset – adolescence or early adulthood
Duration – varies (brief – years)
Symptoms:
Persistent or recurrent experiences of feeling detached from, and as if one is an observer of one's mental processes or body (like in a dream).
Reality testing is intact.
Differential:
Illness Anxiety Disorder – (presence of depersonalization/derealization absence of IAD criteria)
Obsessive-Compulsive Disorder – (criteria not met-may have obsession/repetition)
Psychotic Disorders – (other psychosis)
Major Depressive Disorder – (not full depersonalization/derealization)
Anxiety Disorders – (symptoms of panic attack – must be ongoing not brief)
Unspecified Dissociative Disorder F44.9
Other Specified Dissociative Disorder F44.89
Comments