Dissociative Disorders

What are dissociative disorders?

Dissociative disorders are mental health conditions that involve feelings of being detached from reality, being outside of your own body or experiencing memory loss (amnesia).

The word “dissociation” means to be disconnected from others, from the world around you or from yourself.

Dissociative disorders typically develop after short-term or long-term trauma.

Types of dissociative disorders

The three types of dissociative disorders include:

• Dissociative identity disorder (DID): People with DID have two or more separate identities. These identities (called “alters”) control their behavior at various times. Each alter has its own personal history, traits, likes and dislikes.
• Dissociative amnesia: This condition happens when you can’t remember essential information about your life. The forgetting may be limited to specific aspects of your life or may include much of your life history and/or identity.
• Depersonalization/derealization disorder: This is a condition in which you feel detached from your thoughts, feelings and body (depersonalization), and/or disconnected from your environment (derealization).

There’s also a symptom called dissociative fugue. It’s a temporary mental state in which a person has memory loss and ends up in an unexpected place.

Because dissociative disorders appear on the trauma spectrum, many people with a dissociative disorder may have co-occurring trauma-related mental health conditions, such as:

• Post-traumatic stress disorder (PTSD).
• Borderline personality disorder (BPD).
• Substance use disorders.
• Depression.
• Anxiety disorders.

Who do dissociative disorders affect?

People of all ages and racial, ethnic and socioeconomic backgrounds can develop a dissociative disorder. Women and people assigned female at birth are more likely to have a diagnosis.

People who experienced physical and/or sexual abuse in childhood have the greatest risk of developing dissociative identity disorder (DID). About 90% of people who have DID in the United States, Canada and Europe experienced childhood abuse and neglect.

How common are dissociative disorders?

Dissociative disorders are rare. About 2% of people in the United States have them.

What are the symptoms of dissociative disorders?

The symptoms of dissociative disorders depend on the type. Symptoms usually first develop after a traumatic event.

Stressful situations can worsen symptoms and cause issues with daily functioning.

Symptoms of dissociative identity disorder (DID)

A person with DID has two or more distinct identities. The “core” identity is the person’s usual personality. “Alters” are the person’s alternate personalities. The core is the identity you had before developing DID and alters.

Each alter has a particular set of behaviors, attitudes, preferences, memories and ways of thinking. Other people may be able to tell the difference between the alters, as well as the person with DID. Shifting from one alter to another is involuntary and sudden.

Another symptom of DID is ongoing gaps in memory about everyday events, personal information and/or past traumatic events.

These symptoms can range widely in severity. For some people, the condition minimally interferes with their life. For others, it causes significant issues.

Symptoms of dissociative amnesia

In dissociative amnesia, the main symptom is an episode of amnesia (memory loss) that comes on suddenly. It can last months or years.

There are three types of amnesia:

• Localized: You can’t remember an event or period of time (the most common form of amnesia).
• Selective: You can’t remember certain details of events within a given period of time.
• Generalized: You can’t remember anything about your identity and life history (the rarest form).

You may not be aware of your memory loss or have only a little awareness. But loved ones usually recognize the memory loss.

Symptoms of depersonalization/derealization disorder

The symptoms of depersonalization/derealization disorder include experiencing one or both of the following episodes in a recurring pattern over a lengthy period of time:

• Depersonalization: This involves feelings of unreality or of being detached from your mind, body or self. It feels as if you’re observing your life and the events from afar rather than being an active participant.
• Derealization: This involves feelings of unreality or of being detached from your surroundings. People and things may not seem real.

During these episodes, you’re aware of your surroundings and know that what you’re experiencing isn’t normal.

These symptoms may start as early as childhood. The average age of the first episode is 16. Fewer than 20% of people with this condition will have their first episode after age 20.

What causes dissociative disorders?

Dissociative disorders often develop as a way to deal with a catastrophic event or with long-term stress, abuse or trauma.

This is particularly true if such events take place early in childhood. At this time of life, there are limitations to your ability to fully understand what’s happening. In addition, your coping mechanisms aren’t fully developed and getting support and resources depends on the presence of caring and knowledgeable adults.

Mentally removing yourself from a traumatic situation can be a coping mechanism that helps you escape pain in the short term. This coping mechanism can become an issue if it continues to separate you from reality and removes memories of entire periods of time.

Traumatic situations may include:

• Repeated physical, mental or sexual abuse.
• An accident.
• A natural disaster.
• Military combat.
• Being a victim of a crime.

Scientists have recently been studying specific brain structures and functions that are related to dissociation. So far, they’ve found that during dissociation, structures in the memory regions deep in your brain show rhythmic activity but seem disconnected from other regions responsible for thought and planning.

How are dissociative disorders diagnosed?

Healthcare providers diagnose dissociative disorders by assessing your symptoms and personal history.

Your provider may order tests to rule out possible medical conditions that can cause similar symptoms (such as memory loss), including:

• Head injury.
• Brain tumors.
• Sleep deprivation.
• Substance and/or alcohol use.

Once they rule out possible causes, they’ll likely refer you to a mental health specialist, such as a psychologist, to make a diagnosis through clinical interview and observations.

Mental health professionals use criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders to diagnose specific dissociative disorders.

How are dissociative disorders treated?

Treatment of dissociative disorders usually consists of psychotherapy (talk therapy) to help you gain control over the dissociative process and symptoms.

Psychotherapy takes place with a trained, licensed mental health professional, such as a psychologist or psychiatrist. It can provide support, education and guidance to you and/or your family to help you function better and increase your well-being.

Specific types of psychotherapy commonly used for dissociative disorders include:

• Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of psychotherapy. Your therapist or psychologist helps you take a close look at your thoughts and emotions. Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.
• Dialectical behavior therapy (DBT): DBT is specially adapted for people who experience emotions very intensely. The main goal is to strike a balance between validation (acceptance) of who you are and your challenges and the benefits of change. Your therapist will help you learn new skills to improve emotion regulation.

Therapy can be difficult, as it involves remembering and learning to deal with past trauma. But it can significantly help your symptoms in the long term.

Other therapies that can help include:

• Hypnosis: Hypnosis (hypnotherapy) is a state of deep relaxation and focused concentration. When you’re under hypnosis, this intense level of concentration and focus allows you to ignore ordinary distractions and be more open to guided suggestions to make changes to improve your health.
• EMDR therapy: Eye movement desensitization and reprocessing (EMDR) therapy involves moving your eyes a specific way while you process traumatic memories. EMDR’s goal is to help you heal from trauma or other distressing life experiences. Compared to other therapy methods, EMDR is relatively new.

No specific medications treat dissociative disorders. But your provider may recommend certain medications, such as antidepressants, to treat co-occurring mental health conditions.

What is the prognosis for dissociative disorders?

The prognosis (outlook) for dissociative disorders varies.

With professional treatment (usually psychotherapy), many people with a dissociative disorder can address the major symptoms of the condition and improve their daily functioning.

For some people, the dissociative disorder, especially dissociative identity disorder (DID), severely impacts their life.

Suicide attempts and self-harm are common in people with DID. More than 70% of people with DID attempt suicide.

If you or a loved one are thinking about suicide, dial 988 on your phone to reach the Suicide and Crisis Lifeline. Someone will be available to help you 24/7.

When should I see my healthcare provider?

If you’re experiencing symptoms of a dissociative disorder, talk to a healthcare provider or mental health professional.

A note from Cleveland Clinic

As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to your life. Talk to a healthcare provider if you’re experiencing symptoms of dissociation. Mental health professionals can offer treatment plans that can help you manage your condition.