DSM-5-TR / text explaining DID Criteria A

DID_CriterionA.md

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Criterion A symptoms are related to discontinuities of experience that  
  
can affect any aspect of an individual’s functioning. Individuals with  
  
dissociative identity disorder may report the feeling that they have  
  
suddenly become depersonalized observers of their own speech and  
  
actions, which they may feel powerless to stop (i.e., impaired sense of  
  
self and impaired sense of agency). These individuals may also report  
  
perceptions of voices (e.g., a child’s voice, voices commenting on the  
  
individual’s thoughts or behavior, persecutory voices and command  
  
hallucinations). In some cases, hearing voices is specifically denied,  
  
but the individual reports multiple, perplexing, independent thought  
  
streams over which the individual experiences no control. Individuals  
  
with dissociative identity disorder may report hallucinations in all  
  
sensory modalities: auditory, visual, tactile, olfactory, and  
  
gustatory. Strong emotions, impulses, thoughts, and even speech or  
  
other actions may suddenly materialize, without a sense of personal  
  
ownership or control (i.e., lack of sense of agency). Conversely,  
  
thoughts and emotions may unexpectedly vanish, and speech and actions  
  
are abruptly inhibited. These experiences are frequently reported as  
  
ego-dystonic and puzzling. Attitudes, outlooks, and personal  
  
preferences (e.g., about food, activities, gender identity) may  
  
suddenly shift. Individuals may report that their bodies feel different  
  
(e.g., like a small child, the opposite gender, different ages  
  
simultaneously). Alterations in sense of self and agency may be  
  
accompanied by a feeling that attitudes, emotions, and behaviors—even  
  
the individual’s own body—are “not mine” or are “not under my control.”  
  
Although most Criterion A symptoms are subjective, these sudden  
  
discontinuities in speech, affect, and behavior may be witnessed by  
  
family, friends, or the clinician. In most individuals with  
  
dissociative identity disorder, switching/shifting of states is subtle  
  
and may occur with only subtle changes in overt presentation. State  
  
switching may be more overt in the possession form of dissociative  
  
identity disorder. In general, the individual with dissociative  
  
identity disorder experiences himself or herself as multiple,  
  
simultaneously overlapping and interfering states.  
  
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