How overt or covert the personality states are depends on psychological motivation, stress level, cultural context, emotional resilience, and internal conflicts and dynamics (APA, 2022), and severe or prolonged stress may result in sustained periods of identify confusion/alteration. The key diagnostic criteria for dissociative identity disorder is the presence of two or more distinct personality states or an experience of possession (Criteria A). There are three main types of dissociative disorders: dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder. However, because of the identifiable stressor (and lack of additional symptoms listed below), they meet diagnostic criteria for a stress disorder as opposed to a dissociative disorder. Furthermore, individuals who suffer from acute stress disorder and PTSD often experience dissociative symptoms, such as amnesia, numbing, flashbacks, and depersonalization/derealization. Occasionally, one may experience temporary dissociative symptoms due to lack of sleep or ingestion of a substance however, these would not qualify as a dissociative disorder due to the lack of impairment in functioning. These symptoms are likely to appear following a significant stressor or years of ongoing stress (i.e., abuse Maldonadao & Spiegel, 2014).
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