Dissociative Disorders – What is it, Symptoms and Treatments

Stress times can temporarily worsen symptoms, making them more obvious. Treatment for Dissociative Disorders may include talk therapy (psychotherapy) and medication. While treating Dissociative Disorders can be difficult, many people learn new ways to cope and lead healthy, productive lives.

Causes of Dissociative Disorders:  Dissociative Disorders often develop as a way of dealing with trauma. Dissociative Disorders usually form in children subjected to long-term physical, sexual, or emotional abuse or, less frequently, a family environment that is frightening or highly unpredictable. The stress of war or natural disasters can also bring on dissociative disorders  .

Personal identity is still forming during childhood. Thus, a child is more able than an adult to step outside of themselves and observe trauma as if it were happening to a different person. A child who learns to dissociate to endure a long period of youth may use this coping mechanism in response to stressful situations throughout life.

Symptoms of Dissociative Disorders:  Signs and symptoms depend on the type of Dissociative Disorder you have, but can include:

• Memory loss (amnesia) of certain time periods, events, people and personal information
• A sense of being separate from you and your emotions
• A perception of people and things around you as distorted and unreal
• A blurred sense of identity
• Stress or significant problems in your relationships, work, or other important areas of your life
• Inability to cope well with emotional or work stress
• Mental health issues such as depression, anxiety, and suicidal thoughts and behaviors

There are three main Dissociative Disorders defined in the Diagnostic and Statistical Manual of Mental  Disorders (DSM-5), published by the American Psychiatric Association:

• Dissociative amnesia. The main symptom is memory loss that is more severe than normal forgetfulness and cannot be explained by a medical condition. You cannot remember information about yourself or events and people in your life, especially a traumatic time. Dissociative amnesia can be event-specific at a given time, such as intense combat, or more rarely, it can involve complete memory loss about you. Sometimes it can involve confused travel or wandering away from your life (dissociative fugue). An episode of amnesia usually occurs suddenly and can last for minutes, hours, or rarely, months or years.
• Dissociative identity disorder. Formerly known as multiple personality disorder , this disorder is characterized by “switching” to alternate identities. You may feel the presence of two or more people talking or living inside your head, and you may feel as if you are possessed by other identities. Each identity can have a unique name, personal history and characteristics, including obvious differences in voice, gender, mannerisms, and even physical qualities like the need for glasses. There are also differences in the familiarity of each identity with the others. People with dissociative  identity disorder typically also have dissociative amnesia and often have dissociative fugue.
• Depersonalization – derealization disorder. This involves an ongoing or episodic feeling of detachment or being outside of oneself – observing your actions, feelings, thoughts and self from a distance, as if watching a movie (depersonalization). Other people and things around you may feel detached or foggy or dreamy, time may be slowed down or sped up, and the world may seem irreversible (derealization). You may experience depersonalization, derealization, or both. The symptoms, which can be deeply distressing, can last for just a few moments or come and go for many years.

When to See a Doctor:  Some people with Dissociative Disorder are present in a crisis with traumatic flashbacks that are overwhelming or associated with unsafe behavior. People with these symptoms should be seen in an emergency room. If you or a loved one has less urgent symptoms that could indicate a dissociative disorder, call your doctor.

Risk Factors for Dissociative Disorders:  People who experience long-term physical, sexual, or emotional abuse during childhood are at a higher risk of developing Dissociative Disorder . Children and adults who experience other traumatic events such as wars, natural disasters, kidnappings, torture or prolonged, traumatic, early childhood medical procedures can also develop these conditions.

Complications of Dissociative Disorders:  People with Dissociative Disorders are at increased risk for complications and associated disorders, such as:

• Self harm or mutilation
• Suicidal thoughts and behavior
• sexual dysfunction
• Alcoholism and drug use disorders
• Depression and anxiety disorders
• post-traumatic stress disorder
• personality disorders
• Sleep disorders, including nightmares, insomnia, and sleepwalking
• Eating disorders
• Physical symptoms, such as warts or non-epileptic seizures
• Main difficulties in personal relationships and at work

Diagnosing Dissociative Disorders:  Diagnosing Dissociative Disorders  usually involves evaluating the symptoms and ruling out any medical conditions that could cause the symptoms. Tests and diagnoses usually involve a referral to a mental health professional to determine your diagnosis. The assessment may include:

• Physical exam. Your doctor examines you, asks detailed questions, and reviews your symptoms and personal history. Certain tests can rule out physical conditions – for example, head injuries, certain brain diseases, sleep deprivation or intoxication – that can cause symptoms such as memory loss and a sense of unreality.
• Psychiatric exam. Your mental health professional asks you questions about your thoughts, feelings and behaviors and discusses your symptoms. With your permission, information from family members or others may be helpful.
• Diagnostic criteria in the DSM-5. Your mental health professional can compare your symptoms to the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. For the diagnosis of Dissociative Disorders , the DSM-5 lists these criteria.

Dissociative Amnesia:  For dissociative amnesia:

• You’ve had one or more episodes where you can’t remember important personal information – usually something traumatic or stressful – or you can’t remember your identity or life history. This memory loss is too extensive to be explained by ordinary forgetting.
• Your memory loss episodes don’t just occur during the course of another mental health disorder, such as post-traumatic stress disorder. Also, your symptoms are not due to alcohol or other drugs and are not caused by one neurological condition or another, such as amnesia related to head trauma.
• You can also experience dissociative fugue, where you travel on purpose or experience confused sluts that involve amnesia – an inability to remember your identity or other important personal information.
• Your symptoms cause significant stress or problems in your relationships, work, or other important areas of your life.

Dissociative Identity Disorder:  For dissociative identity disorder:

• You display, or others observe, two or more distinct identities or personalities, which may be described in some cultures as an unwanted and involuntary possession. Each identity has its own pattern of perceiving, relating and thinking about you and the world.
• You have recurring gaps in memory for everyday events, skills, important personal information, and traumatic events that are too extensive to be explained by ordinary forgetting.
• Its symptoms are not part of widely accepted cultural or religious practice.
  Your symptoms are not due to alcohol or other drugs, or a medical condition. In children, symptoms are not due to imaginary peers or other fantasy games.
• Your symptoms cause significant stress or problems in your relationships, work, or other important areas of your life.

Depersonalization – Derealization Disorder:  For Depersonalization – Derealization Disorder:

• You have persistent or recurring experiences of feeling separate from yourself, as if you are an outside observer of your thoughts, sensations, actions, or your body (depersonalization). Either you feel detached or experience a lack of reality to your surroundings, as if you are in a dream or the world is distorted (derealization).
• While you are experiencing an episode of depersonalization or derealization, you are aware that the experience is not reality.
• Your symptoms don’t just occur during the course of another mental disorder, such as schizophrenia or panic disorder  , or during another dissociative disorder. Symptoms are also not explained by the direct effects of alcohol or other drugs, or a medical condition such as temporal lobe epilepsy.
• Your symptoms cause significant stress or problems in your relationships, work, or other important areas of your life.

Treatments for Dissociative Disorders:  Treatments for Dissociative Disorders can vary depending on the type of disorder  you have, but generally includes psychotherapy and medication.

Psychotherapy:  Psychotherapy is the main treatment for Dissociative Disorders . This form of therapy, also known as talk therapy, counseling, or psychosocial therapy, involves talking about your disorder and related issues with a mental health professional. Look for a therapist with advanced training or experience working with people who have experienced trauma.

Your therapist will work to help you understand the cause of your condition and form new ways of dealing with stressful circumstances. Over time, your therapist can help you talk more about the trauma you have experienced, but usually only when you have the coping and relationship skills with your therapist to have these conversations safely.

Medication:  While there are no medications that specifically treat Dissociative Disorders , your doctor may prescribe antidepressants, anti-anxiety medications, or antipsychotic medications to help manage the mental health symptoms associated with Dissociative Disorders .

Preventing Dissociative Disorders:  Children who are physically, emotionally, or sexually abused are at a higher risk of developing mental health disorders such as Dissociative Disorder . If stress or other personal issues are affecting the way you treat your child, get help.

• Talk to a trusted person, such as a friend, your doctor, or a leader in your faith community.
• Ask for help locating resources like support groups for parents and family therapists.
• Look for churches and community education programs that offer parenting classes that can also help you learn a healthier parenting style.

If your child has been abused or has experienced another traumatic event, see a doctor right away. Your doctor may refer you to a mental health professional who can help your child recover and adopt healthy coping skills.