Dissociative disorders are distinguished by an uncontrolled escape from reality characterized by a detachment between thoughts, identity, consciousness, and memory. People from all age groups and racial, ethnic, and socioeconomic environments can experience a dissociative disorder. It is estimated that up to 75% of people experience at least one derealization episode in their lives, with only 2% meeting the full criteria for recurring episodes. Women are more likely than men to be diagnosed with a dissociative disorder.
The symptoms of a dissociative disorder normally first develop as a response to a traumatic event, such as abuse or military combat, to keep those memories under control. Symptoms can worsen under stressful situations and can cause problems with operating in everyday activities.
Some 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
However, the symptoms a person experiences will depend on the type of dissociative disorder that a person has. There are three types of dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM):
Dissociative Amnesia: The main symptom is trouble remembering important information about one’s self. Dissociative amnesia may encompass a particular event, such as combat or abuse, or more seldom, information about identity and life history. The incipience for an amnesic episode is usually sudden, and an episode can last minutes, hours, days, or sometimes months or years. There is no average for age-onset or percentage, and a person may undergo multiple episodes throughout their life.
Depersonalization disorder: This disorder involves ongoing feelings of detachment from actions, feelings, thoughts, and sensations as if they are watching a movie of themselves (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 even both. Symptoms can last just a matter of moments or return at times over the years. The average onset age is 16, but these episodes can start anywhere from early to mid-childhood.
Dissociative identity disorder: This disorder is classified by alternating between multiple identities. A person may feel like one or more voices are trying to take control in their head. Often these identifications may have unique names, characteristics, mannerisms, and speeches. Individuals may 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 dismiss symptoms and trauma histories, and commonly exhibit more violent behavior, rather than amnesia or fugue states, leading to elevated false-negative diagnosis.
Dissociative disorders usually develop as a way of dealing with trauma or shock. Dissociative disorders most often appear in children exposed to long-term physical, sexual or emotional abuse. Other factors, such as natural disasters and combat can also cause dissociative disorders to develop.
Doctors diagnose dissociative disorders based on a study 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. 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, paralysis, or sensory loss. In surroundings where possession is part of cultural beliefs, the 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. In cultures with highly restrictive social conditions, amnesia is frequently triggered by severe psychological stress such as conflict caused by oppression. Finally, intentionally induced states of depersonalization can be a part of thoughtful practices prevailing in many religions and cultures, and should not be diagnosed as a disorder.
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 combine the different identities into one functional person. Medications are most often used to combat additional symptoms that commonly occur with dissociative disorders.
Different psychotherapies are used to treat dissociative episodes to decrease symptom frequency as well as improve coping strategies for the experience of dissociation. Some of the more common therapies include:
Cognitive-behavioral therapy helps change the negative thinking and behavior associated with depression. The goal is to recognize thoughts and to teach coping strategies
Dialectical behavioral therapy centers on teaching coping skills to combat destructive urges, regulate emotions and improve relationships while adding validation.
Eye movement desensitization and reprocessing are designed to ease the suffering associated with traumatic memories. It combines the CBT procedures of re-learning thought patterns with visual stimulation exercises to access traumatic memories and replace the associated negative beliefs with positive ones.