All about Other Specified Dissociative Disorder (OSDD) – an explanation about OSDD-1A & OSDD-1B

Team

Author: Stronghold et al.

Editor: Laura Puddefoot (The Elephant Journals System), ISSTD member. Nathan.

Community Reviewers: Luna System, Alexandrite System, Radio Collective, The Crisses.

Clinical reviewers: Jamie Brazell, M.Ed., LMFT, CST.
Heather Scarboro Med, LCMHC, LCAS, NCC, ISSTD member.

Letter

Dear Community,

I want to express my concerns about misinformation that has been spread in our community. Since I have partaken in spreading this misinformation – I have decided to write to you today. Not to challenge your identity but to correct the misinformation that has spread in regards to OSDD.

Research of a not yet peer reviewed meta-analysis of 98 studies (most of which are peer reviewed themselves) revealed (N=31,000) 31,000 college students showed DID had a prevalence of 3.7%, while OSDD showed a prevalence of 4.5% (Kate et al., 2019). 

Where the terminology OSDD-1A and OSDD-1B came from

Prior to today, within the (online) DID/OSDD community, OSDD-1A was described as having amnesia but no parts while OSDD-1B is described as having parts but without amnesia.

I want to start this letter by explaining I am not pointing this out because you are in any way wrong or not experiencing what you are experiencing. Your Plural experience is valid no matter the label you use. I am not writing this because you cannot or should not identify with the labels you identify with – it is your choice. As you likely know, we are strong proponents for labeling your experiences in Plurality in whatever way you feel best suits your system. Very often, the clinical terminology does not suit our experiences well enough – even if we also identify with those labels. 

However, we have spoken up when people have said in the past that they were diagnosed with structural dissociation. This is not possible as it is not a disorder on its own – it’s a theory. So, I am writing this to you to explain that you can identify with OSDD-1A and OSDD-1B but can only be diagnosed with OSDD, not OSDD 1A or 1B. These were concepts made up by a (non-clinical) website called did-research.org. Over a month ago, The Plural Association reached out to this website and asked for a response to our letter, unfortunately, so far they have chosen to not respond.

These labels are not in the DSM or published by any other reputable sources. There are no scholarly articles on Google Scholar. Many of the other databases that show reputable published work provide absolutely zero results for the search terms “OSDD1A” and “OSDD1B”. The website did-research.org presents this information as if it is factual. It is not. This letter and article will explain why it is not. 

If you still want to identify with OSDD-1A or OSDD-1B that is completely accepted and within your rights. These labels might not be clinical terminology, under the Plural umbrella everymany can use the label(s) they identify with. We know and recognize that whole communities have been built around these concepts. However, we feel you have the right to know the truth behind these labels and their origins.

Article

The only source for OSDD-1A and OSDD-1B comes from a website called did-research.org. If you look in the footnote it shows that the information comes from 2 sources: 

The first being about Multiple Personality Disorder: Dell, P. F., & O’Neil, J. A. (2009). The long struggle to diagnose multiple personality disorder (MPD): Partial MPD. In Dissociation and the dissociative disorders: DSM-V and beyond. New York: Routledge. 

The second one being the theory of Structural Dissociation: Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. New York: W.W. Norton. 

The Theory of Structural Dissociation on OSDD DDNOS

As you might know, the writer of the theory of structural dissociation lost his license after abusing a patient with this theory for 21 years. (Stronghold, 2020) (Click hyperlink for video regarding this topic.) 

Within the 2nd book, we would like to draw you attention to the authors stating that DDNOS is a lesser form of DID:

Figure 1: Theory of Structural Dissociation

When reading The Haunted Self (2012), we can see that OSDD is not mentioned.

Figure 2: The Haunted Self

Figure 3: The Haunted Self

However, we can see that DDNOS is mentioned 38 times even though it was already known that a year later, the DSM-V removed DDNOS and replaced it with OSDD.

Figure 4: The Haunted Self

It seems the website did-research.org changed DDNOS examples 1A and 1B to OSDD 1A and 1B. Since then people have taken the OSDD descriptions from within the DSM and split it in half. This is not what is written in the DSM.

The DSM speaks of OSDD examples

The DSM-V says, “chronic and recurrent syndrome of mixed dissociative symptoms” (American Psychiatric Association, 2013), does not show signs of amnesia can still present with identity disturbance associated with less-than-marked discontinuities in sense of self and agency, or alterations of identity or episodes of possession, not one or the other.

Figure 5: DSM-V American Psychiatric Association (2013) 

How DDNOS-1A and DDNOS-1B were described in the DSM-IV

This is not remotely the same as what DDNOS-1A and DDNOS-1B were said to be described as. Following further research we found out that DDNOS 1A and 1B were also only examples – not a diagnosis: 

Figure 6: DSM-IV American Psychiatric Association (2000)

If you want to reclaim the no-longer existing DDNOS and/or if you were diagnosed before 1994, that’s within your rights to choose and identify and of course it is part of Plural umbrella. However, if you were not made aware of this information we wanted to update you on this.

We as The Plural Association would also like to make a statement that we will no longer use the OSDD 1A and 1B terminology, We believe it can be damaging in the mislabeling and management for the community at large. The information provided was incomplete as it was only to be used for example purposes – not a diagnosable disorder.

The Plural Association always use the labels and language the System we talk with is most comfortable with and of course we will also do this in regards to OSDD1A and OSDD1B. However in our articles and other writings, we instead will (like the DSM-5 states), use the word and label OSDD, without further specifying any examples or numbers. We will discuss the importance of why these are examples – not criteria for being diagnosed. That does not mean you have to do the same but we no longer want to take part in spreading this misinformation.

What the DSM-V actually explains about OSDD

As you can see the DSM-IV clearly states 1, 2, 3, and 4 are examples of presentations of OSDD. It is not exclusive to these four examples. These are not criteria for OSDD. There is only one DSM-V code to diagnose OSDD and that is code 300.15. There is no possibility to add one of the examples (1, 2, 3, or 4) as a diagnosis. The only diagnosis is OSDD in the DSM-V. There is no way to further specify examples or subtypes like 1, 2, 3, 4, 1A, or 1B.  

Together with both Plural peer support workers and licensed therapists we have tried to uncover the truth for you to ensure you have access to correct information.

To further add to this evidence base, the DSM-V provides seven examples, not just the same four as the previous edition. 

Figure 7: DSM-V American Psychiatric Association (2013)

Figure 8: DSM-V American Psychiatric Association (2013)

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). https://doi.org/10.1176/appi.books.9780890420249 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Did-research. (2020) Other Specified Dissociative Disorders. did-research. https://did-research.org/comorbid/dd/osdd_udd/

Dell, P., and O’Neil, J. (2009). The long struggle to diagnose multiple personality disorder (MPD): Partial MPD. In Dissociation and the dissociative disorders: DSM-V and beyond, 383

Kate, M., Hopwood, T., and Jamieson, G. (2019) The Prevalence of Dissociative Disorders and dissociative experiences in college populations: a meta-analysis of 98 studies. Journal of Trauma and Dissociation. 4(29)  

Stronghold et al,. (2020) Why the theory of structural dissociation is ableist. The Plural Association. https://powertotheplurals.com/why-the-theory-of-structural-dissociation-is-ableist/

Van der Hart, O., Nijenhuis, E., and Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. WW Norton & Company.

Appendix A. Letter of Support

September 27, 2020

To whom it may concern, 

I am a licensed therapist and member of the ISST-D.  My specialty areas are dissociative disorders, trauma disorders, and anxiety disorders. I am writing to you today to encourage support for consideration and revision of the non-clinical diagnoses, OSDD-1A, and OSDD-1B. 

As a clinician, a diagnosis of OSDD-1A, 1B would be unethical due to improper diagnosing, as stated in the code of ethics: 

“The American Counseling Association (ACA) Code of Ethics, Section E, requires counselors to take special care in providing the proper diagnosis of mental disorders in the proper manner.”

It is absolutely acceptable for individuals and systems to identify with OSDD1A,1B, however due to these terms being created from non-clinical, blending of criterion from DSM-IV, they are not relevant clinically currently in the DSM-V.  

I am also writing in support of the work The Plural Association is providing on behalf of all who experience dissociative disorders. This non-profit has created a multitude of psychoeducation and support to assist those in need. I often refer clients and colleagues to their resources. 

Thank you for reading.  Please don’t hesitate to request more information if needed. 

Sincerely, 

Heather Scarboro M.Ed., LCMHC, LCAS, NCC 

Owner/Psychotherapist Healing Selves Therapeutics, PLLC