What are dissociative disorders?
The word “dissociation” means to be disconnected from others, from the world around you, or from yourself.
The term “dissociative disorders” describes a persistent mental state that is marked by feelings of being detached from reality, being outside of one’s own body, or experiencing memory loss (amnesia).
About 2% of the U.S. population experiences true dissociative disorders (not just momentary feelings of dissociation). All age groups, racial, ethnic, and socioeconomic backgrounds are affected. Women are more likely than men to be diagnosed.
Types of dissociative disorders
There are three primary types of dissociative disorders:
- Dissociative identity disorder
- Depersonalization/derealization disorder
- Dissociative amnesia
Acute stress disorder and post-traumatic stress disorder (PTSD) are closely related to dissociative disorders, sharing such symptoms as memory loss, depersonalization, or derealization.
Symptoms and Causes
What causes dissociative disorders?
Dissociative disorders often first 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 on one’s ability to fully understand what is happening, coping mechanisms are not fully developed, and getting support and resources depends on the presence of caring and knowledgeable adults.
Mentally removing oneself from a traumatic situation — such as an accident, natural disaster, military combat, being a crime victim, or repeated physical, mental or sexual abuse — can be a coping mechanism that helps one escape pain in the short term. It becomes a problem if over the long term it continues to separate the person from reality, and blanks out memories of entire periods of time.
What are the symptoms of dissociative disorders?
Once known as multiple personality disorder, dissociative identity disorder usually stems from catastrophic experiences, abuse or trauma that occurred when the person was a child. Among people with this disorder, about 90% have been the victim of childhood abuse (physical or sexual) or neglect.
Symptoms of dissociative identity disorder include:
The existence of two or more distinct identities or “personality states.” Each identity has a particular set of behaviors, attitudes, preferences, memories, and ways of thinking that are observable by others and may even be reported by the affected person. Shifting from one identity to another is involuntary, sudden, and can reverse at a moment’s notice.
- Long-term gaps in memory concerning everyday events, personal information, or traumatic events of the past.
- Problems in social settings, the workplace, or other areas of functioning in daily life. The seriousness of such problems can range from minimal to significant.
Suicide attempts, self-mutilation, and other self-injuring behaviors are common among those with dissociative identity disorder. More than 70% of outpatients with this condition have attempted suicide.
Symptoms of depersonalization/derealization disorder
One or both of the following conditions exist in the same person in a recurring pattern over a long period of time:
- Depersonalization – Feelings of unreality or of being detached from one’s own mind, body or self. It is as if one is an observer of rather than a participant in their own life events.
- Derealization – Feelings of unreality or of being detached from one’s surroundings. People and things may not seem real.
During these episodes the person is aware of their surroundings, and knows that what they are experiencing is not normal. Even if the person shows little emotion during these episodes, they are usually interpreted as being quite upsetting.
Symptoms may start as early as childhood, with 16 years old being the average age of first experience. Fewer than 20% will have their first experience of the disorder after age 20.
Symptoms of dissociative amnesia
Dissociative amnesia means not being able to recall information about one’s past. This is not the same as simply being forgetful, as it is usually related to a traumatic or particularly stressful event or period of time. An episode of amnesia comes on suddenly and can last as little as minutes, or as long as months or years. There is no particular age of onset, and episodes can occur periodically throughout life.
There are three types of amnesia:
- Localized – Cannot remember an event or period of time (most common form of amnesia)
- Selective – Cannot remember certain details of events about a given period of time.
- Generalized – Complete loss of identity of life history (rarest form).
The person may not be aware of their memory loss or have only little awareness. Even when they do realize a loss of memory, the person often downplays the importance of not recalling a particular event or period of time.
Diagnosis and Tests
How are dissoviative disorders diagnosed?
Diagnosis of dissociative disorders involves a review of symptoms and the person’s life history. Physical tests may be performed to rule out physical or medical conditions that could cause symptoms such as memory loss or feelings of unreality. Such conditions might include head injury, brain tumor, sleep problems, or drug or alcohol use. Once physical causes are ruled out, a mental health specialist will step in to analyze the details of the individual’s case.
Management and Treatment
How are dissociative disorders treated?
Treatment of dissociative disorders usually consists of psychotherapy, with the goal of helping the person integrate different identities, and to gain control over the dissociative process and symptoms. Therapy can be long and difficult, as it involves remembering and learning to deal with past trauma.
Cognitive (that is, dealing with a patient’s conscious intellectual activity) behavioral therapy has been found to be effective. Hypnosis may be another helpful treatment. A newer therapy called Eye Movement Desensitization and Reprocessing (EMDR) focuses specifically on the role that disturbing memories play in the development of mental disorders.
No particular medications treat dissociative disorders, although antidepressants may be needed to treat symptoms of depression.