Dissociative disorders

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, 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 depends on the type of dissociative disorder they have.

Treatment for dissociative disorders often includes psychotherapy and medication. Though finding an effective treatment plan can be difficult, many people are able to live healthy and productive lives.

Symptoms

Signs and symptoms 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 emotions or emotional numbness.

A lack of a sense of self-identity.

These symptoms depend on the type of dissociative disorder that has been diagnosed.

Types of dissociative disorders

There are three types of dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM):

Dissociative amnesia

The main symptom of dissociative amnesia is difficulty remembering important information about one's self. Dissociative amnesia may surround a particular event, such as combat, abuse, or information about identity and life history. The onset for an amnesic episode is usually sudden, and an episode can last minutes, hours, days, or even months to years. There is no average for age onset or percentage. A person may experience multiple amnesic 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 (depersonalization). Sometimes other people and things in the world around them may feel 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 can start anywhere from early to mid childhood. Less than 20% of people with this disorder experience episodes for the first time after the age of 20.

Dissociative identity disorder

Formally 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 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 an amnesia state. This can lead to elevated false negative diagnosis.

What causes dissociative disorders?

Dissociative disorders usually develop as a way of coping with trauma. Dissociative disorders most often form in children exposed to long-term physical, sexual, or emotional abuse. Natural disasters or combat can also trigger dissociative disorders.

Diagnosis

Doctors diagnose dissociative disorders based on a review of symptoms and personal history. A doctor may preform tests to rule out physical conditions that can cause symptoms such as memory loss and 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.

Treatment

Dissociative disorders are treated using various therapies including:

Psychotherapy

Such as cognitive behavioral therapy (CBT) and dialectal behavioral therapy (DBT).

Eye movement desensitization and reprocessing (EMDR).

Medication

Antidepressants can treat symptoms

For many people, symptoms of dissociative disorders are hard to put into words and communicate to others. This can add the feeling that they don't exist or are simply "going crazy."

But they are not alone. Help and support is out there. Mental health professionals can help develop a stable treatment plan and friends or groups can help offer support.