According to the National Alliance on Mental Illness (NAMI), dissociative disorders are characterized by an involuntary escape from reality manifested by a disconnection between thoughts, identity, consciousness, and memory. People from all age groups and racial, ethnic, and socioeconomic backgrounds can experience a dissociative disorder. Up to 75% of people experience at least one depersonalization or derealization episode in their lives, with only 2% meeting the full criteria for chronic episodes. Women are more likely than men to be diagnosed with dissociative disorder. The symptoms of a dissociative disorder usually first develop as a response to a traumatic event, such as abuse or military combat, to keep those memories under control. Stressful situations can worsen symptoms and cause problems with functioning in everyday activities. However, the symptoms a person experiences will depend on the type of dissociative disorder that a person has. Treatment for dissociative disorders often involves psychotherapy and medication. Although finding an effective treatment plan can be difficult, many people are able to live healthy and productive lives.
Symptoms and signs of dissociative disorders include:
• Significant memory loss of specific times, people, and events
• Out-of-body experiences, such as feeling as though you are watching a movie of yourself
• Mental health problems such as depression, anxiety, and thoughts of suicide
• A sense of detachment from your emotions, or emotional numbness
• A lack of a sense of self-identity
The symptoms of dissociative disorders depend on the type of disorder that has been diagnosed. There are three types of dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM):
Dissociative Amnesia. The main symptom is difficulty remembering important information about oneself. Dissociative amnesia may surround a particular event, such as combat or abuse, or more rarely, information about the identity and life history. The onset of an amnesic episode is usually sudden, and an episode can last minutes, hours, days, or, rarely, months or years. There is no average for age onset or percentage, and a person may experience multiple episodes throughout her/his life.
Depersonalization disorder. This disorder involves ongoing feelings of detachment from actions, feelings, thoughts, and sensations as if they are watching a movie (depersonalization). Sometimes other people and things may feel like people and things in the world around them are unreal (derealization). A person may experience depersonalization, derealization, or both. Symptoms can last just a matter of moments or return at times over the years. The average onset age is 16, although depersonalization episodes can start anywhere from early to mid-childhood. Less than 20% of people with this disorder start experiencing episodes after the age of 20.
Dissociative identity disorder (DID). Formerly known as multiple personality disorder, this disorder is characterized by alternating between multiple identities. A person may feel like one or more voices are trying to take control of their head. Often these identities may have unique names, characteristics, mannerisms, and voices. People with DID will experience gaps in memory of everyday events, personal information, and trauma. Women are more likely to be diagnosed, as they more frequently present with acute dissociative symptoms. Men are more likely to deny symptoms and trauma histories, and commonly exhibit more violent behavior, rather than amnesia or fugue states. This can lead to elevated false negative diagnoses.
Dissociative Disorders – Causes
Dissociative disorders usually develop as a way of dealing with trauma. Dissociative disorders most often form in children exposed to long-term physical, sexual or emotional abuse. Natural disasters and combat can also cause dissociative disorders.
Dissociative Disorders – Diagnosis
Doctors diagnose dissociative disorders based on a review of symptoms and personal history. A doctor may perform tests to rule out physical conditions that can cause symptoms such as memory loss and a sense of unreality (for example, head injury, brain lesions or tumors, sleep deprivation, or intoxication). If physical causes are ruled out, a mental health specialist is often consulted to make an evaluation.
Many features of dissociative disorders can be influenced by a person’s cultural background. In the case of dissociative identity disorder and dissociative amnesia, patients may present with unexplained, non-epileptic seizures, paralyzes, or sensory loss. In settings where possession is part of cultural beliefs, the fragmented identities of a person who has DID may take the form of spirits, deities, demons, or animals. Intercultural contact may also influence the characteristics of other identities. For example, a person in India exposed to Western culture may present with an “alter” who only speaks English. In cultures with highly restrictive social conditions, amnesia is frequently triggered by severe psychological stress such as conflict caused by oppression. Finally, voluntarily induced states of depersonalization can be a part of meditative practices prevalent in many religions and cultures, and should not be diagnosed as a disorder.
Dissociative Disorders – Treatment
Dissociative disorders are managed through various therapies including:
- Psychotherapies such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)
- Eye movement desensitization and reprocessing (EMDR)
- Medications such as antidepressants can treat symptoms of related conditions
Because dissociative disorders appear on the trauma spectrum, many patients may have conditions associated with trauma, as well as additional trauma-based conditions.
• Posttraumatic stress disorder (PTSD)
• Borderline personality disorder (BPD)
• Substance use disorders / Dual Diagnosis
This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.