Misdiagnosis and Differential DiagnosisPosttraumatic Stress DisorderMany differential (alternative) diagnoses exist, including Adjustment Disorders, and Acute Stress Disorder, which has a shorter duration (under a month), Anxiety disorders and Obsessive-compulsive disorder (OCD), Major depressive disorder, Dissociative Disorders and Personality Disorders. Interpersonal difficulties which begin or were greatly increased, after a traumatic event may indicate PTSD since a personality disorder would have these difficulties independently of whether any trauma occurred. Flashbacks in PTSD need to be distinguished from the illusions and hallucinations present in schizophrenia and other psychotic disorder. [2] Show
Acute Stress DisorderAdjustment Disorders, Panic Disorder, Dissociative Disorders, Posttraumatic Stress Disorder, Obsessive-compulsive disorder (OCD), Psychotic Disorders and Traumatic Brain Injury are other diagnoses which could be considered. Adjustment DisordersMajor Depressive Disorder (depression), Acute Stress Disorder or PTSD and Personality Disorders can be considered as alternative diagnoses, as well as normal stress reactions. [2] Dissociative Identity DisorderThe
most common misdiagnoses are Bipolar Disorder (formerly known as manic depression), Schizophrenia, and Borderline Personality Disorder (BPD).[5] All these disorders can co-exist with Dissociative Identity Disorder, since it is a Dissociative Disorder and so not in the same category of disorders as the others.
Complex PTSD (C-PTSD) is commonly comorbid with Dissociative Identity Disorder. [5]:135 Complex PTSD is a well-recognized condition which involves additional symptoms beyond those needed for a PTSD diagnosis. Differences between Complex PTSD and Dissociative Identity Disorder are the described in the PTSD section above. Complex PTSD is not a DSM diagnosis (only PTSD and its dissociative subtype are) but many of Complex PTSD's symptoms and wider effects are listed in both the DSM-5's Additional Features Supporting Diagnosis and the Risk and Prognostic Factors sections for DID, and in the DID/DDNOS or Complex PTSD treatment guidelines. Dissociative Identity Disorder and Complex PTSD have many similarities, and certain symptoms or factors are common in both:
Dissociative DisordersDissociative Disorders are frequent misdiagnosed. Dissociative Disorders are a differential diagnosis for Conversion Disorder, PTSD, and
ADHD; childhood trauma and/or abuse is listed as a risk factor for all of these conditions. ADHD which should not be diagnosed if symptoms are better explained by a dissociative disorder, according to its DSM-5 diagnostic criteria. [3]:60, [3]:279, [3]:321 Sleep-related Dissociative Disorders (a less common form of Other Specified Dissociative Disorder) are a differential diagnosis for two Sleep-Wake
Disorders; Nightmare Disorder and Rapid Eye Movement Sleep Behavior Disorder. [3]:407, 410 Dissociative Disorders may also be misdiagnosed, with other Dissociative Disorders given instead. Dissociative Amnesia (with or with Fugue) has Dissociative Identity Disorder as differential diagnosis, and Depersonalization/Derealization lists other Dissociative Disorders as
a differential diagnosis. [3]:300, [3]:305 Borderline Personality Disorder
Borderline Personality Disorder (BPD) is a common misdiagnosis for Post-traumatic Stress Disorder and Dissociative Identity Disorder (DID).[2] While many people with BPD also have PTSD,[4]
BPD may be diagnosed instead of, rather than in addition, to PTSD. Recent research has been shown clear differences between both PTSD and Complex PTSD and BPD. [3], [4] A key difference from Dissociative Identity Disorder is the presence of recurrent episodes of amnesia.[1], [2] Comorbid DiagnosesThe majority of people with a Trauma or Dissociative Disorder also have other diagnoses at the same time, known as comorbid diagnosis.[2], [7]:606 Dual diagnosis is a term commonly used when a substance abuse disorder also exists, for example alcoholism. Conversion Disorder is common in people with Dissociative Disorders. Posttraumatic Stress DisorderAround 80% of people with PTSD have another psychiatric disorder at the same time. Depression, bipolar, anxiety or substance use disorders are common. [2]:280 Both substance use and conduct disorders are more common in males than females. U.S. military and combat veterans have high rates of Traumatic Brain Injury (TBI, caused by a physical head injury) occurring along with PTSD. [7]:606 In children, Oppositional Defiant Disorder and Separation Anxiety Disorder are the most common comorbid diagnoses. Acute Stress DisorderExtremely negative thoughts relating to the trauma are common, including excessive guilt for not preventing the trauma or not adapting successfully after trauma. Catastrophic thinking may occur, for example viewing flashbacks as a sign of reduced mental ability. Panic attacks, chaotic or impulsive behavior are common, for example reckless driving or making irrational decisions. Children may show separation anxiety. People who also have a mild Traumatic Brain Injury (mTBI) commonly experience post-concussive symptoms, such as headaches, dizziness, sensitivity to light/sound, concentration problems and irritability, all of which are also common in Acute Stress Disorder. [2] Adjustment DisordersThese can occur along with almost any other mental disorder, provided the other disorder(s) do not fully explain the person's symptoms. Adjustment Disorders are commonly found in people with accompanying physical illness(es). [2] Dissociative Identity DisorderMost people with DID develop PTSD at some point, Complex PTSD symptoms are also very common.(despite not being classed as a separate disorder in the DSM). [2] , [5]:135 Depression, anxiety, and substance use disorders are commonly diagnosed in people with DID. Self-injury, non-epileptic seizures, conversion disorders and suicidal behavior are also common. [2]:7 294 Dissociative AmnesiaMany people with dissociative amnesia have PTSD at some point in their life, especially when the traumatic events prior to the amnesia are recalled. Somatic symptom disorders and conversion disorder are also common. Many people with this disorder have a personality disorder, with the most common being dependent personality disorder, avoidant personality disorder and borderline personality disorder.[2] When amnesia reduces more symptoms often become apparent, which may lead to other diagnoses such as persistent depression (dysthymia) or another depressive disorder, or Adjustment Disorder. Common symptoms include dysphoria, grief, rage, shame, guilt, psychological conflict/turmoil, suicidal or homicidal ideas and impulses. [2] Depersonalization/Derealization DisorderDepression and anxiety disorders are common. Rates of PTSD are low. The most common co-occurring personality disorders are avoidant, borderline, and obsessive-compulsive personality disorder. [2] Somatic Symptom and related DisordersSomatic Symptom and related Disorders, previously known as somatoform disorders, include prominent somatic (bodily) symptoms which cause significant distress or impaired functioning. These are physical symptoms and commonly treated with physical,
rather than psychiatric, care. Many symptoms are medically unexplained, meaning they do not have a known medical cause at this point, however the physical symptoms are real and there are high rates of co-occurring physical health conditions in people with Somatic symptom disorder in particular. [2] Early traumas,
including abuse, and genetics/biological vulnerability are known to contribute to these illnesses. This group of disorders are varied, and include Illness Anxiety Disorder (health anxiety which is severe enough to cause physical symptoms) and controversially also includes Factitious Disorder. Conversion DisorderThis is also known as Functional Neurological Symptom Disorder, and involves "altered voluntary motor or sensory function" without a recognized neurological or medical cause but significant enough to cause impaired functioning or significant distress.. For example, loss of use of a limb. The ICD-10 psychiatric manual recognizes these as Dissociative [Conversion] Disorders, including weakness or paralysis, abnormal movement, speech or swallowing symptoms, sensory loss (including inability to feel pain). A psychological stressor may or may not be a known cause. Conversion Disorder includes psychogenic or non-epileptic seizures. Depersonalization, derealization, and dissociative amnesia are common. [2] Cite this pageOther Disorders. Traumadissociation.com. Retrieved from . This information can be copied or modified for any purpose, including commercially, provided a link back is included. License: CC BY-SA 4.0 |