Dissociative Disorders
What are Dissociative Disorders?
Dissociation is defined as a disconnection from others, the world around you, and yourself. Dissociative disorders create altered perceptions and distortions of reality, often with a lack of continuity between thoughts, feelings, behaviors, memories, and identity. Often people with dissociative disorders experience lost time or amnesia. Dissociative disorders are often related to experienced trauma. Symptoms and severity of symptoms depend on the type of dissociative disorder, the experienced trauma, and emotional regulation. Times of stress can also increase symptoms. There are three main types of dissociative disorders. The three types include:
- Dissociative amnesia. The main symptom of dissociative amnesia is severe memory loss that cannot be otherwise explained by a medical condition. The memory loss is significant and goes well beyond normal forgetfulness. People who experience dissociative amnesia have an inability to recall autobiographical information, usually of a traumatic or stressful nature. Additionally, people with dissociative amnesia may wander away from their life and forget who they are or where they have been (dissociative fugue). Dissociative amnesia causes clinically significant distress and impairment in social, occupational, academic, or other important areas of functioning.
- Dissociative identity disorder (DID). DID, formerly known as multiple personality disorder, is characterized by consistent changing or “switching” between ego states, or alternate states of consciousness, that is outside of the person’s control. With DID, the boundaries between the ego states are more rigid or even impermeable. Because of this, the individual ego states sometimes have no awareness of the other ego states and typically cannot communicate or work together as a whole system. The main criteria of DID is having the presence of two or more identities, and having persistent gaps in memory, personal information, and daily activities. People with a DID diagnosis usually have a significant trauma history.
- Depersonalization-derealization disorder. Both dissociative disorders exhibit a sense of detachment from the self. Depersonalization involves feeling detached from your body, or being on the outside looking in. A person may feel detached or disconnected from their physical bodies as well as from their sense of self, and will experience their thoughts, feelings, and actions as if they were observing it from a distance. Derealization involves a sense of the world around you as being or feeling unreal. It is often characterized by a sensation of detachment and that the world and people around you feel foggy and dreamlike. The symptoms can appear episodically, lasting a few moments, or may come and go over several years. These symptoms may cause significant distress.
People with dissociative disorders often experience a significant amount of stress. If symptoms include suicidal thinking and there is concern that you may harm yourself or others, please call 911 or 988 for the Suicide and Crisis Lifeline. It is imperative to be proactive about your mental health, so if you are experiencing symptoms of dissociation and significant distress, please contact your mental health provider immediately.
Symptoms
Dissociative disorders have a broad range of symptoms and are dependent on the specific disorder. In general, symptoms include:- Amnesia (memory loss) or an experience of lost time; inability to recall personal information, events, or people
- Sensation of feeling detached or disconnected from your body or sense of Self (thoughts, feelings, perceptions); distorted sense of time, emotional and physical numbing
- Sensation that the world and people around you are not real; things may appear foggy or dreamlike
- A blurred or altered sense of identity
- Symptoms of dissociative disorders can cause significant distress, which may result in severe anxiety, depression, self-harm, or suicidal thinking
- Symptoms cause clinically significant distress or impairment in social, occupational, academic, or other important areas of functioning
- The symptoms are not attributable to another medical condition or substance use
Causes
Dissociative disorders typically develop because of trauma, usually complex or developmental trauma (ongoing trauma over a sustained period during the developmental years). However, it is important to note that dissociation is something all humans experience, to a certain degree. Dissociation is experienced on a spectrum and dissociative disorders are much farther up the spectrum.
Dissociation is a normal protective response that the body can have, especially when under intense or chronic traumatic stress. In addition to complex or developmental trauma being a catalyst for dissociative disorders to develop, people in combat, first-responders, or survivors of natural disaster may also develop dissociative disorders to help cope with the trauma. Children who experience sexual, physical, or emotional abuse, or neglect are at greater risk for developing a dissociative disorder.
Complications
There are several complications for people with dissociative disorders. Complications include:- Higher prevalence of self-harm
- Higher incidence of suicidal thinking or behaviors
- Increased risk for substance abuse and addictions
- Depression
- Anxiety
- Post-traumatic stress disorder
- Personality disorders
- Eating disorders
- Sleep disturbance
- Dizziness, light-headedness, non-epileptic seizures
- Significant stress or impairment in social, occupational, or academic functioning
Diagnosis
Dissociative disorders are typically diagnosed by a mental healthcare professional once any medical conditions or substance use are ruled out. Sometimes people will visit their healthcare provider first due to physical complaints that present with certain dissociative disorders. If your healthcare provider rules out anything medical, they will most likely refer you to a mental health professional. Your mental health provider will take a thorough history at your first session and will continue to gather and assess information over the next few sessions, using their clinical judgment to make an appropriate diagnosis.
Treatment
Treatment for dissociative disorders typically includes a combination of psychotherapy and medication. There is no current medication that specifically treats dissociative disorders; however, medication is usually prescribed to help reduce severe anxiety, depression, PTSD related symptoms, and help with any sleep disturbance that is common with dissociative disorders. An evidenced-based therapy for trauma that has proven effective with dissociative disorders is EMDR (eye movement desensitization and reprocessing).
Treatment and recovery from a dissociative disorder may be a long and challenging journey, as it includes facing, integrating, and resolving past traumas. Consult with your healthcare and mental health provider if you have symptoms of a dissociative order, especially if you have a known trauma history.