Dissociative disorders are serious mental illnesses that are triggered by traumatic experiences and characterized by a feeling of detachment, memory loss, and changes in perceptions and sense of identity. These disorders arise as an involuntary way of coping with trauma. They are not healthy coping mechanisms and they cause significant dysfunction and distress. Professional diagnosis and treatment are required to help individuals face their traumatic pasts and learn new, healthier coping strategies.
What Are Dissociative Disorders?
Dissociative disorders are mental illnesses that affect and disrupt a person’s perceptions, identity, memories, and awareness of others and the world around them. These disruptions cause an individual to lose touch with reality, feel disconnected, and struggle to function normally. The dissociation from memories, thoughts, other people, or oneself are not intentional, but are triggered as a coping mechanism for dealing with a traumatic experience or extremely stressful situation. Potential symptoms include losing memories, feeling detached from one’s body, or developing additional, distinct personalities.
Dissociating may be one strategy the brain uses in some individuals to cope with trauma, but it is not healthy. Treatment is necessary to help an individual with a dissociative disorder face the traumatic experience, process it in a healthful way, and learn productive coping mechanisms. Although medications may be helpful for some, trauma-focused therapy is the main component of treatment. The process of treating a dissociative disorder can be slow, but it does work and can help resolve symptoms and restore a normal level of functioning.
Types of Dissociative Disorders
The Diagnostic and Statistical Manual of Mental Disorders lists three main types of dissociative disorders. There are two additional disorders, other specified and unspecified dissociative disorders, which can be diagnosed when symptoms don’t align well enough with one of the other three.
- Dissociative amnesia. Amnesia occurs when someone loses their personal and identifying memories. It is a severe type of memory loss, triggered by a traumatic event. It can last for any length of time, from just minutes to, more rarely, years. Some people have multiple episodes of amnesia throughout their lives, and it can occur at any age.
- Depersonalization/derealization disorder. This condition is characterized by a deep sense of detachment, either from oneself (depersonalization) or from others people and the world (derealization). Depersonalization can make someone feel as if they are watching themselves in a movie, or if their body is not their own. Someone experiencing derealization feels as if people and things around them are not real. Depersonalization and derealization may occur together or alone and is most common in children and teenagers.
- Dissociative identity disorder (DID). Once called multiple personality disorder, DID causes a person to develop one or more additional personalities, distinct from their own. Each personality is well developed with a voice, name, and unique traits. The different personalities may or may not be aware of each other, but it is common to experience amnesia as one personality takes over for another. To the person going through this it may feel like being possessed or as if there is someone else in their head, talking and controlling them.
Facts and Statistics
According to the National Alliance on Mental Health, two percent of Americans experience dissociative disorders, but nearly half will have some type of dissociative experience at least once in their lives.
- DID has long been thought to be very rare, but newer statistics indicate it may affect up to one percent of U.S. adults
- Women are more likely than men to be diagnosed with a dissociative disorder
- Personality disorders have some symptoms in common with dissociative disorders, which can complicate diagnoses
- An uncommon subtype of post-traumatic stress disorder causes individuals to experience depersonalization and derealization
- Dissociative disorders are unlike many other mental illnesses in that there is often one known cause, some type of traumatic experience
- Common risk factors or triggers for dissociative disorders include childhood abuse, sexual abuse or assault, and childhood neglect
Symptoms and Diagnosis of Dissociative Disorders
The symptoms of a dissociative disorder depend on the individual and the type of disorder. The characteristic symptoms of each are used by mental health professionals to make diagnoses. They use interviews and questionnaires, observations, and discussions with close family to determine symptoms and make a diagnosis.
Symptoms of dissociative identity disorder include:
- The presence of two or more personalities or identities distinct from each other. The identities may be self-reported or observed
- Loss of memories of events, periods of time, or traumas
- Significant distress or loss of function in several areas of one’s life
Symptoms of depersonalization/derealization disorder include:
- Feeling detached from one’s own body or mind, feeling outside the body, watching
- Feeling detached from the surroundings, as if others are not real
- A sense that the detached feelings are unusual, which causes distress
Dissociative amnesia is memory loss that can take one of three forms and awareness of lost memories can range from complete to only partial:
- Localized amnesia causes loss of memories associated with a specific period of time or event
- Selective amnesia causes memory loss of a specific aspect of an event or only some events during one period of time
- Generalized amnesia is rare and causes complete memory loss
Some other general symptoms that a person with a dissociative disorder may experience or that someone else may observe in them include:
- Feeling or acting emotionally numb
- Out-of-body experiences
- A loss of a sense of identity
- Depression, anxiety, or other mental illness and mood symptoms
- Suicidal thoughts
- Difficulty functioning at home, work, school, or in social situations
- A significant amount of stress, and difficulty coping with it
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Causes and Risk Factors
Dissociative disorders are involuntary coping mechanisms for dealing with trauma. Because identity is still forming at a young age, children are more susceptible to dissociating as a coping mechanism. Children who do develop dissociative disorders in response to trauma are more likely to do so as adults. They have unintentionally learned dissociation as a strategy for coping and may use it again in the future.
The cause of any dissociative disorder can almost always be traced back to some traumatic event or experience, which can be different depending on the individual. Not everyone who goes through a traumatic situation will develop a dissociative disorder, but experiencing trauma is a definite risk factor. The greatest risk is for individuals who went through long periods of ongoing trauma, such as childhood abuse. Other types of trauma that may trigger dissociation at any age include serious illness, natural disasters, accidents, or combat in war.
Dissociative disorders may co-occur with substance abuse, which is another unhealthy coping mechanism for trauma to which some people turn. The experience of dissociating can be extremely distressful, and the use of drugs or alcohol is not uncommon as an attempt to cope with it.
There are also several other mental illnesses that may commonly co-occur with dissociative disorders. Other trauma disorders, for instance, like posttraumatic stress disorder or acute stress disorder, may include dissociative symptoms. Personality disorders, especially borderline personality disorder, also co-occur sometimes in people with dissociative disorders. Other possibilities include depression, eating disorders, and sleep disorders.
Treatment and Prognosis of Dissociative Disorders
Dissociative disorders rarely resolve on their own, and professional treatment is required. While medications may be some help, such as using antidepressants to manage depression or anxiety, they are not the main focus of treatment. Therapy is the most useful tool for helping individuals face past trauma, process it, and stop experiencing dissociative symptoms.
Any kind of psychotherapy may be used to treat dissociative disorders, but there are specific, trauma-focused therapies that are often the most helpful. These therapies focus on remembering and facing trauma and learning healthy ways of coping with the troubling memories. One example is trauma-focused cognitive behavioral therapy. This type of therapy uses practical strategies to face traumatic memories, reframe them, and set and achieve positive goals for changing behaviors and coping mechanisms.
Eye movement desensitization therapy, or EMDT, is another unique therapy that is focused on trauma. It involves moving the eyes back and forth, guided by the therapist, while facing traumatic memories and feelings. How it works is not well understood, but something about the eye movement stimulates the brain and helps an individual process trauma and move past it.
Treatment for dissociative disorders can take time, several weeks at least. For some people it can take much longer to restore memories or to eliminate additional identities. The process can be slow, and patience and commitment are required. For those patients who do stick with treatment, the outlook is largely positive. Therapy can help individuals learn to prevent dissociative episodes, use better coping mechanisms, and most importantly face trauma head on and learn to deal with it in a healthful way that reduces stress and restores normal functioning.