Typical features

• Variable dissociative symptoms: memory gaps, episodes of depersonalisation or derealisation, transient identity confusion, dissociative trance or fugue‑like behaviours that are clinically significant.
• Symptoms cause distress or impairment in social, occupational or other important areas of functioning.
• May be subthreshold for dissociative identity disorder or present atypically (e.g., brief recurrent derealisation episodes without full depersonalisation/derealisation disorder criteria).

Assessment priorities

1. Detailed symptom chronology: onset, duration, triggers, episode characteristics, and any memory gaps or functional consequences.
2. Collateral information when available and appropriate—carefully obtain consent for third‑party history where safety or memory gaps suggest need.
3. Screen for trauma history, PTSD, self‑harm, suicidality, substance use and comorbid psychiatric disorders (mood, psychotic, personality disorders).
4. Exclude medical/neurological causes: consider EEG for episodic loss of awareness, MRI for focal neurological signs, metabolic screening and review of medications/substances.

Formulation & diagnosis

• Use a trauma‑informed biopsychosocial formulation: predisposing vulnerabilities (developmental adversity), precipitating events (trauma, severe stress) and maintaining factors (avoidance, secondary gains, substance use).
• Document reasons for using “other specified” (e.g., insufficient information, atypical presentation) and plan for follow‑up assessment or specialist referral.

Management principles

1. Prioritise safety: assess for suicidality, risk during dissociative episodes (wandering, driving), and safeguarding concerns where relevant.
2. Stabilisation: grounding and orientation techniques, sleep and substance management, crisis planning and reduction of immediate stressors.
3. Stepped care: brief stabilisation and skills in primary care, refer to specialist trauma/dissociation services for complex or persistent cases for phase‑based therapy and longer‑term work.

Psychological treatments

• Phase‑oriented trauma therapies (stabilisation → trauma processing → integration) for survivors of complex trauma.
• EMDR or trauma‑focused CBT when appropriate and when safety and stability achieved; pacing is essential to avoid retraumatisation.
• Skills training (DBT elements), grounding, reality‑orientation exercises and coping plans to reduce episode frequency and functional impact.

Pharmacology & adjuncts

• No medications specifically treat dissociation—use psychotropic medication to manage comorbid anxiety, depression or PTSD as indicated (SSRIs, SNRIs, prazosin for nightmares) and avoid substances that may worsen dissociation.
• Consider adjunctive occupational therapy, social support services and peer‑support groups for community reintegration and skills practice.

When to refer & red flags

• Urgent psychiatric referral for active suicidality, high‑risk dissociative behaviour (wandering, self‑harm during episodes), severe functional decline or complex trauma requiring specialist treatment.
• Neurology referral if episodes suggest seizures, new focal deficits, or atypical features on history/exam.

Key takeaways

• Other Specified Dissociative Disorder allows clinicians to begin treatment when dissociative symptoms cause impairment but do not meet specific diagnostic criteria — document rationale and plan for follow‑up.
• Prioritise safety, stabilisation and teaching of grounding/orientation skills, and arrange trauma‑informed psychotherapy for persistent or complex presentations.
• Coordinate multidisciplinary care (psychiatry, neurology, OT, social work) and escalate for red flags promptly.