Dissociative disorders are characterized by an involuntary escape from reality characterized 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/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 a 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. Though finding an effective treatment plan can be difficult, many people are able to live healthy and productive lives.
Symptoms
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 one’s self. Dissociative amnesia may surround a particular event, such as combat or abuse, or more rarely, information about identity and life history. The onset for 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 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. 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 in their head. Often these identities may have unique names, characteristics, mannerisms and voices. People with DID will experience gaps in memory of every day 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 diagnosis.
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.
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, paralyses 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.
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
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.
The goals of treatment for dissociative disorders are to help the patient safely recall and process painful memories, develop coping skills, and, in the case of dissociative identity disorder, to integrate the different identities into one functional person. It is important to note that there is no drug that deals directly with treating dissociation itself. Rather, medications are used to combat additional symptoms that commonly occur with dissociative disorders.
Psychotherapy
Different psychotherapies are used to treat dissociative episodes to decrease symptom frequency and improve coping strategies for the experience of dissociation. Some of the more common therapies include:
- Cognitive behavioral therapy (CBT) helps change the negative thinking and behavior associated with depression. The goal of this therapy is to recognize negative thoughts and to teach coping strategies.
- Dialectical behavioral therapy (DBT) focuses on teaching coping skills to combat destructive urges, regulate emotions and improve relationships while adding validation. Involving individual and group work, DBT encourages practicing mindfulness techniques such as meditation, regulated breathing and self-soothing.
- Eye movement desensitization and reprocessing (EMDR) is designed to alleviate the distress associated with traumatic memories. It combines the CBT techniques of re-learning thought patterns with visual stimulation exercises to access traumatic memories and replace the associated negative beliefs with positive ones.
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If you or a family member or friend is struggling, there is help. NAMI is there to provide you with support for you and your family and information about community resources.
Find out if there is a NAMI program or support group near you. Contact the NAMI HelpLine at 1-800-950-NAMI (6264) or [email protected] if you have any questions about dissociative disorders or finding support and resources.
Helping Yourself
Self-care is a must. It provides a sense of grounding. Here are some tips:
- Keep a journal. Journaling is one way to help improve awareness. It can include writing or artwork from any part of the dissociated self.
- Mindfulness. Techniques that use the senses to guide yourself back to the present are useful you are in the throes of a flashback, feeling “out-of-body”, or recalling memories that are too painful to cope with. These can include things like touching a piece of fabric, sniffing something with a strong scent, or focusing on breathing slowly and deeply.
- Letting alters emerge. In DID, planning for separate identities to come out in a safe place and time allows them to have experiences you may have been denied in an abusive childhood.
If you live with a mental health condition, learn more about managing your mental health and finding the support you need.
Helping A Family Member Or Friend
As with any mental illness, the caring support of loved ones cannot be underestimated. Specifically for individuals with a traumatic past, encouragement and support of friends and family is very important. NAMI offers several resources, including the NAMI Peer-to-Peer education program and NAMI Connection support groups.
The Sidran Institute is one of the biggest trauma education and advocacy organizations in the country, and has many resources available.
The International Society for the Study of Trauma and Dissociation seeks to advance clinical, scientific, and societal understanding about the prevalence and consequences of chronic trauma and dissociation. They offer a wealth of information and resources on the topic.