Dissociative disorders are very serious mental illnesses most often triggered by traumatic experiences and characterized by detachment from oneself or from others, the existence of multiple personalities, and memory loss. Types of dissociative disorders include dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder. These conditions are thought to be the mind’s way of coping with trauma, but dissociation is not healthy and causes significant distress and impairment. Dissociative disorders can be treated with long-term therapy, medications, and residential care.
What Are Dissociative Disorders?
Dissociative disorders are a group of mental health conditions characterized by a loss of touch with reality that causes a person to experience a disconnection in some way. This may affect memories, a person’s sense of identity and self, emotions, consciousness, and perceptions. They cause a person to feel disconnected, and examples of this include having an out-of-body sensation or losing one’s personal memories and experiencing amnesia.
The dissociation from reality these disorders cause is not voluntary and can cause serious distress and impairment. Dissociating in this way is often a response to a traumatic experience, but it is unhealthy and does not allow an individual to process the trauma in a productive manner. Treatment for dissociative disorders involves therapy and sometimes medication. Treatment may take a long time and can be difficult, which means that residential options are often best. With time and good treatment, individuals can recover, learn better ways of coping with trauma, and live more normal lives.
Types of Dissociative Disorders
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the manual that mental health professionals use to diagnose conditions, lists three main types of dissociative disorders:
- Dissociative Identity Disorder (DID). This type of dissociative condition was once known as multiple personality disorder. It occurs when someone has more than one personal identity and alternates between them. Each identity represents a unique individual with a specific name, tone of voice, personality traits, and physical mannerisms, and these identities can cause a person to feel as if there are conflicting voices in their head. A person with DID may have memory gaps and have often experienced trauma. It is more commonly diagnosed in women.
- Dissociative Amnesia. Dissociative amnesia is serious memory loss, when a person cannot remember personal details and information. The loss of memory may be just one period of time, a specific event during one period of time, or a complete loss of one’s life history. The latter is extremely rare. The memory loss often relates to a traumatic experience.
- Depersonalization/Derealization Disorder. This disorder causes either episodes of depersonalization or derealization, or both. Depersonalization is the experience of being detached or separated from one’s own mind or body. It may feel like being outside of one’s body, watching it. Derealization occurs when a person feels detached from his or her surroundings, as if the things around them are not real or don’t exist, even though they do.
Facts and Statistics
Dissociative disorders are not uncommon. Approximately two percent of U.S. adults have ever been diagnosed with one of these conditions, and women are more commonly diagnosed than men.
- According to the National Alliance on Mental Illness, nearly half of adults will experience at least one episode of depersonalization or derealization, although most never meet the criteria for a diagnosis.
- Dissociative identity disorder was once considered rare, but research has shown that prevalence rates are over one percent.
- Studies have found that as many as 18 percent of women may be diagnosed with a dissociative disorder.
- Strong predictors for dissociative disorders are childhood sexual abuse, emotional abuse, and neglect.
- In most cases, the first signs of a dissociative disorder occur after a traumatic experience.
- A dissociative experience is typically a way of coping with trauma or bad memories, although it occurs involuntarily.
- There is a dissociative subtype of post-traumatic stress disorder, in which a person experiences depersonalization or derealization.
- Symptoms of DID often overlap with those of borderline personality disorder, making diagnosis difficult. These two conditions commonly co-occur.
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Symptoms and Diagnosis of Dissociative Disorders
Dissociative disorders are diagnosed according to the criteria set in the DSM-5. It outlines the three main types of dissociative disorders and their characteristic symptoms, as well as other specified or unspecified dissociative disorders. These latter two are diagnoses that are made when a patient has slightly different symptoms or has some but not all symptoms needed to make a diagnosis of one of the three conditions. General symptoms that someone with any type of dissociative disorder may experience include:
- Loss of memory of specific events, people, time periods, or personal information
- Feeling as if things, objects, or other people are not real or are distorted
- Feeling detached from oneself, from the mind, the body, personal emotions, or self-identity.
- Out-of-body experiences
- Difficulty with developing self-identity or feeling as if one’s identity is unclear or blurry
- Emotional numbness
- Other mental health symptoms, such as depression or anxiety
- Suicidal thoughts
- Difficulty coping with everyday situations, and a significant amount of resulting stress
Depending on the specific type of dissociative disorder, a person will experience other symptoms, such as hearing conflicting voices in one’s head, feeling possessed by other personalities, sudden unexpected memory loss, or feeling like time is speeding up or slowing down. Someone with dissociative amnesia may also experience what is called dissociative fugue. This causes a person to lose personal memories and to wander away from their lives as a result. It may be brief, such as coming home late from work, or longer and involving extensive travel.
Causes and Risk Factors
Unlike most mental illnesses there is usually a known cause for dissociative disorders in the form of a traumatic experience. In most cases in which one of these conditions is diagnosed, the patient has experienced something traumatic and the dissociation arose as a way for the brain to try to cope with it. It is important to remember that this is not a conscious or intentional coping mechanism. It happens without the person meaning to lose touch with reality, and it is not a healthy way to cope with tragedy.
Dissociation may act as a defense mechanism in the brain in order to forget negative memories, as with dissociative amnesia. Or, it can occur as a way to observe the trauma or the memory of trauma from outside the mind or body, as if it is happening or happened to someone else. Children are more able to dissociate and are more vulnerable to falling victim to this coping mechanism. Children who develop dissociation when young are more likely to experience it as adults as well and to be diagnosed with a specific dissociative condition. Not all people who experience trauma will dissociate, so there may be a genetic component as well.
Studies have found that certain mental illnesses are more common in people diagnosed with dissociative disorders than those who have not been diagnosed. These include major depression, borderline personality disorder, and post-traumatic stress disorder. Someone with a dissociative disorder is also more likely to have suicidal thoughts or attempt suicide, cause self-harm, misuse alcohol or drugs, have anxiety, have sleeping disorders, or have eating disorders.
Treatment and Prognosis of Dissociative Disorders
Treatment is essential for dissociative disorders, which are unlikely to resolve without professional help. In addition to the disorder itself, one of these conditions causes serious complications, such as an inability to work, damaged relationships, addiction, suicide, poverty, homelessness, and incarceration. Serious, dedicated, and residential long-term treatment is important for individuals to overcome dissociative disorders and to learn to cope with past trauma.
The main component of treatment for dissociative disorders is psychotherapy. This helps the patient learn to recognize and identify trauma and develop healthier ways of coping with it. The process may be slow to protect the patient, but with time individuals can learn to address trauma and talk about it. A specific type of therapy that may be used for these conditions is called eye movement desensitization and reprocessing. It involves focusing on traumatic memories while moving the eyes, which has been shown to help trauma survivors recover over several weeks of treatment.
In addition to these kinds of therapy, a patient may benefit from using certain medications, like antidepressants, anti-anxiety medications, and antipsychotic drugs. Alternative therapies, lifestyle changes, healthy coping mechanisms, stress management strategies, and creative therapies can supplement treatment and are often available in residential treatment for dissociative disorders.
The prognosis for dissociative disorders depends on the individual, the severity of symptoms, how long a person has been repressing traumatic experiences, and other factors. In general, patients who can commit time and energy to long-term care can expect to be able to manage and minimize symptoms and to be able to return to normal life after residential treatment.