What is DDNOS/OSDD? Understanding Other Specified Dissociative Disorder

Understanding DDNOS and OSDD

DDNOS (Dissociative Disorder Not Otherwise Specified) and OSDD (Other Specified Dissociative Disorder) are diagnostic categories for people who experience significant dissociative symptoms that don’t quite fit the criteria for other specific dissociative disorders like Dissociative Identity Disorder (DID) or Dissociative Amnesia (Brand et al., 2016).

In 2013, the diagnostic manual (DSM-5) changed the name from DDNOS to OSDD, but many people still use both terms interchangeably. This condition represents the most common dissociative disorder diagnosis, affecting more people than DID, yet it remains largely misunderstood and under-recognized (Dorahy et al., 2014).

OSDD/DDNOS is often described as being “almost DID” or “DID-like,” but this framing can be problematic because it suggests it’s somehow less significant or valid than other dissociative disorders. In reality, OSDD/DDNOS can be just as impactful and distressing as other dissociative conditions and deserves recognition and appropriate treatment in its own right (Dell, 2009).

The condition typically develops as a result of repeated childhood trauma, particularly when it occurs within attachment relationships. Like other dissociative disorders, it represents an adaptive response to overwhelming experiences during critical developmental periods.

Types of OSDD/DDNOS

OSDD-1 (Most Common Type)

OSDD-1 is the most frequently diagnosed subtype and shares many similarities with DID but lacks one or more key features:

OSDD-1a (Identity Disturbance without Distinct Parts):

• Experiences identity confusion and fragmentation
• May feel like different versions of themselves at different times
• Lacks clearly distinct, separate personality states
• May have “modes” or different aspects of self that feel quite different
• Often experiences emotional parts or ego states rather than full identities

OSDD-1b (Distinct Parts without Amnesia):

• Has clearly distinct personality states or “parts”
• Parts may have different names, ages, preferences, and characteristics
• Lacks significant amnesia between different parts
• May have some memory barriers but generally maintains co-consciousness
• Parts are aware of each other and share memories

Other OSDD Types

OSDD-2 (Identity Disturbance in Adults): Involves identity disturbance due to prolonged intense coercive persuasion. May occur in situations like cults, captivity, or extreme abuse.

OSDD-3 (Acute Dissociative Reactions): Short-term dissociative reactions to acute stress. Symptoms last less than one month and often resolve with stress reduction and support.

OSDD-4 (Dissociative Trance): Involves trance states that cause distress or impairment, different from culturally accepted trance states.

Note: The most commonly discussed and researched type is OSDD-1, which is the primary focus of this article.

How OSDD-1 Differs from DID

Key Similarities

Both conditions involve:

• Identity fragmentation and confusion
• Trauma-related origins, usually in childhood
• Significant impairment in daily functioning
• May have internal “parts” or different aspects of self
• Often accompanied by other trauma symptoms

Critical Differences

OSDD-1a vs. DID:

• Identity States: OSDD-1a has less distinct, more fluid identity states
• Separation: Parts feel more like different moods or modes than separate people
• Amnesia: Usually has amnesia for traumatic events but not between parts
• Co-consciousness: Often maintains awareness across different states

OSDD-1b vs. DID:

• Identity States: Has distinct parts similar to DID
• Amnesia: Lacks significant amnesia barriers between parts
• Memory Sharing: Parts typically share memories and awareness
• Communication: Often has better internal communication than in DID

The Spectrum Perspective

Rather than viewing these as completely separate conditions, many experts see them as existing on a spectrum of dissociative identity disturbance:

Mild Identity Issues → OSDD-1a → OSDD-1b → DID

This spectrum acknowledges that dissociative experiences exist in varying degrees and that the boundaries between diagnoses aren’t always clear-cut.

Symptoms and Experiences

Identity and Self-Concept Issues

People with OSDD-1 often experience significant confusion about their identity:

Fragmented Sense of Self:

• Feeling like different people at different times
• Inconsistent preferences, values, or beliefs
• Confusion about “who I really am”
• Feeling like you have multiple aspects or sides

Mood and Personality Shifts:

• Dramatic changes in mood, behaviour, or personality
• Others may comment on these shifts
• May feel like switching between different “modes”
• Changes may be triggered by stress or specific situations

Internal Conflict:

• Feeling like you’re arguing with yourself
• Having conflicting thoughts, feelings, or desires
• Internal voices or commentary (not hallucinations)
• Different parts wanting different things

Memory and Amnesia Issues

While OSDD-1 typically involves less amnesia than DID, memory issues are still common:

Selective Memory Problems:

• Gaps in childhood memories, especially traumatic events
• Difficulty remembering specific periods or experiences
• Memories that feel like they happened to someone else
• Emotional amnesia (remembering events but not feelings)

Time Loss and Confusion:

• Missing time periods (though usually shorter than in DID)
• Confusion about what happened recently
• Finding evidence of activities you don’t remember
• Others telling you about things you did but don’t recall

Emotional and Relational Challenges

OSDD-1 significantly affects emotional regulation and relationships:

Emotional Dysregulation:

• Intense, sudden mood changes
• Difficulty managing emotions consistently
• Feeling overwhelmed by emotions
• Emotional numbness alternating with intense feelings

Relationship Difficulties:

• Others may feel confused by personality changes
• Difficulty maintaining consistent relationships
• May feel close to someone one day and distant the next
• Partners or friends may feel like they’re relating to different people

Causes and Development

Childhood Trauma and Attachment

Like other dissociative disorders, OSDD-1 typically develops from repeated childhood trauma:

Types of Trauma Associated with OSDD-1:

• Emotional, physical, or sexual abuse
• Severe neglect or abandonment
• Witnessing domestic violence
• Medical trauma or invasive procedures
• Inconsistent or frightening caregiving

Attachment Disruption:

• Occurs when primary caregivers are sources of both comfort and fear
• Creates impossible situation for child’s developing brain
• Leads to fragmented internal working models of relationships
• Results in identity fragmentation as adaptation

Developmental Factors

Several factors influence whether a child develops OSDD-1:

Age of Trauma: Trauma occurring before age 6-9 is most likely to result in dissociative disorders. Earlier trauma often leads to more severe dissociation.

Severity and Chronicity: Repeated, ongoing trauma more likely to cause OSDD-1 than single incidents. Severity of trauma influences degree of dissociation.

Lack of Integration: Normal child development involves integrating different aspects of self. Trauma disrupts this integration process, resulting in separate aspects of self that don’t merge normally.

Living with OSDD-1

Daily Life Challenges

OSDD-1 can significantly impact various aspects of daily functioning:

Work and School:

• Inconsistent performance due to switching between parts
• Difficulty with tasks that require sustained identity consistency
• May excel in some areas while struggling in others
• Coworkers or classmates may be confused by personality changes

Decision Making:

• Different parts may want different things
• Difficulty making consistent choices
• May make decisions and later regret them
• Internal conflict about major life choices

Self-Care:

• Different parts may have different self-care needs
• May neglect basic needs during difficult periods
• Inconsistent health behaviours
• Difficulty maintaining routines

Relationships and Social Functioning

OSDD-1 creates unique challenges in relationships:

Family Relationships: Family members may be confused by personality changes and may need education about the condition.

Romantic Relationships: Partners may feel like they’re dating multiple people and need understanding about the nature of the condition.

Friendships: Friends may be confused by inconsistent behaviour, and different parts may have different preferences for social connections.

Diagnosis and Assessment

Diagnostic Criteria for OSDD-1

The official criteria include:

Identity Disturbance: Disruption of identity characterised by markedly discontinuous sense of self. Alterations in sense of self, agency, affect, behaviour, consciousness, memory, perception, cognition, or sensory-motor functioning.

Amnesia: Recurrent gaps in recall of everyday events, personal information, or traumatic events. (Note: OSDD-1b may have minimal amnesia)

Distress or Impairment: Symptoms cause significant distress or impairment in functioning. Not better explained by substance use or medical condition.

Assessment Process

Getting an accurate diagnosis typically involves:

• Clinical Interviews: Detailed history of symptoms and development, assessment of trauma history
• Specialised Questionnaires: Dissociative Experiences Scale (DES), structured clinical interviews
• Observation and Monitoring: Therapist observation of switching or part presentation over time

Challenges in Diagnosis

Several factors can complicate diagnosis:

• Misdiagnosis: Often misdiagnosed as bipolar disorder, borderline personality disorder, or other conditions
• Shame and Hiding: Many people hide symptoms due to shame or fear of being seen as “crazy”
• Covert Nature: OSDD-1 symptoms may be less obvious than DID, with subtle internal switching

Treatment and Management

Therapeutic Approaches

Treatment for OSDD-1 typically involves specialised therapy approaches:

Phase-Oriented Treatment:

• Phase 1: Safety, stabilisation, and symptom reduction
• Phase 2: Processing and integration of traumatic memories
• Phase 3: Integration and reconnection with life

Therapy Modalities:

• Internal Family Systems (IFS) therapy
• Dialectical Behaviour Therapy (DBT) for emotional regulation
• Trauma-focused therapies (EMDR, somatic approaches)
• Cognitive Behavioural Therapy (CBT) for symptom management
• Expressive therapies (art, music, movement)

Integration vs. Functional Multiplicity

Treatment goals can vary:

• Some people work toward full integration of parts
• Others aim for cooperative functioning between parts
• Treatment goals depend on individual needs and preferences
• Both approaches can be successful

Self-Help and Coping Strategies

Many people with OSDD-1 benefit from self-help approaches:

Internal Communication:

• Journaling to communicate between parts
• Internal dialogue and negotiation
• Mindfulness to increase awareness of switches
• Mapping internal system and parts

Grounding and Stability:

• Grounding techniques for dissociative episodes
• Routine and structure to promote stability
• Safety planning for difficult times
• Stress management and self-care

Simplified Version for Difficult Moments: OSDD/DDNOS is when you have significant dissociative symptoms but don’t quite meet all the criteria for other dissociative disorders. You might feel like different people at different times, or have distinct parts but share memories between them. This is a real condition that developed to protect you from overwhelming experiences, and with proper support and treatment, life can improve significantly.

Myths and Misconceptions

Common Misunderstandings

“It’s just a personality quirk”: OSDD-1 involves significant distress and impairment that goes far beyond normal personality variations and requires professional recognition and treatment.

“It’s not as serious as DID”: OSDD-1 can be just as debilitating as DID and deserves recognition and treatment in its own right. Severity depends on individual circumstances, not diagnosis.

“People with OSDD-1 are dangerous”: There is no evidence that people with dissociative disorders are more violent. They are more likely to harm themselves than others and are often very empathetic and caring individuals.

“It’s caused by watching too many films about DID”: OSDD-1 is a trauma-based condition, not suggestion. Symptoms typically predate awareness of dissociative disorders, and real neurobiological differences are found in brain imaging.

Media Representation

Popular media often misrepresents dissociative disorders with focus on dramatic switching rather than daily struggles, emphasis on violence or danger, and lack of accurate portrayal of treatment and recovery.

Hope and Recovery

Positive Outcomes

Many people with OSDD-1 experience significant improvement:

Symptom Reduction:

• Decreased dissociative episodes over time
• Better emotional regulation and stability
• Improved memory and reduced amnesia
• Enhanced daily functioning

Improved Relationships:

• Better communication with family and friends
• More stable and consistent relationships
• Increased capacity for intimacy and trust
• Ability to maintain long-term connections

Personal Growth:

• Increased self-awareness and understanding
• Development of healthy coping strategies
• Greater life satisfaction and meaning
• Ability to help others with similar experiences

Factors That Promote Recovery

Professional Support: Working with trauma-informed therapists, consistent therapeutic relationships, and appropriate medication management when needed.

Personal Factors: Commitment to healing and growth, development of self-compassion, building healthy coping strategies, and creating safety and stability in life.

Social Support: Understanding family and friends, connection with others who have similar experiences, professional and peer support networks, and reduction of shame and stigma.

Grounding Practice: Take a moment to check in with yourself and any parts or aspects of yourself that might be present. Place your hand on your heart and acknowledge all parts of yourself with kindness. You are worthy of understanding, support, and healing, exactly as you are. Remember that having OSDD-1 is not your fault, and recovery is possible.

Crisis Resources

UK Crisis Support:

• Samaritans: 116 123 (free, 24/7)
• Text SHOUT to 85258 for crisis text support
• Mind: 0300 123 3393 (Mon-Fri 9am-6pm)
• NHS 111: For urgent mental health support

International:

• US: 988 Suicide & Crisis Lifeline
• Canada: 1-833-456-4566
• Australia: 13 11 14 (Lifeline)

Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified mental health professionals regarding any mental health concerns. If you are experiencing a mental health emergency, please contact emergency services or crisis helplines immediately.

Recommended Reading

For Understanding OSDD/DDNOS:

• “Dissociation and the Dissociative Disorders” edited by Paul Dell and John O’Neil – Comprehensive clinical perspectives
• “The Stranger in the Mirror” by Marlene Steinberg – Understanding various dissociative experiences
• “Coping with Trauma-Related Dissociation” by Suzette Boon, Kathy Steele, and Onno van der Hart – Practical guide including OSDD

For Healing and Parts Work:

• “No Bad Parts” by Richard Schwartz – Introduction to Internal Family Systems approach
• “Complex PTSD: From Surviving to Thriving” by Pete Walker – Healing from complex trauma
• “The Body Keeps the Score” by Bessel van der Kolk – Understanding trauma’s impact on identity and sense of self

Frequently Asked Questions