Dissociative Disorders

Dissociative disorder (DD) refers to a set of psychological conditions with mental and physical complications and symptoms. The disorder can impair cognitive functioning and affect one’s quality of life.


What Is Dissociative Disorder (DD)?

Dissociative disorders are psychiatric disorders marked by disruptions or problems in emotions, memories, surroundings, identity, perception and behavior. Some forms of DD can develop after certain traumatic experiences and resolve naturally in a few weeks or months, while some other variations can be more severe and last longer. An individual experiencing dissociative symptoms may feel a disconnection between their thoughts and behaviors, memories and identity. These conditions can be triggered by chronic trauma during childhood and can be used by the person as a coping mechanism to manage difficult memories. One 2016 study 1 claims that the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), particularly placed the chapter on DD immediately after the chapter on trauma- and stressor-related disorders, “thereby acknowledging the relationship of the dissociative disorders to psychological trauma.” The symptoms can even worsen temporarily when the sufferer experiences chronic stress and anxiety.

According to a 2011 study 2 , dissociation leads to disrupted identity, memory, consciousness and perception of reality. “Dissociative disorders constitute a group of clinical syndromes covering disturbances attributed to one or more of these domains. Dissociation may be sudden or gradual, transient, or chronic,” adds the study. People suffering from DD experience persistent disconnection or dissociation from their reality or from themselves. It is a chronic state of mind characterized by feelings of detachment from the inner and/or outer worlds and may involve memory loss and alternate identities. As they become disconnected from their consciousness, sufferers can experience a wide range of cognitive and other mental impairments which can affect their daily functioning.

As mentioned earlier, dissociative disorder can involve different mental conditions 3 such as dissociative identity disorder, dissociative amnesia, depersonalisation disorder and dissociative fugue. However, the condition can be treated effectively under the guidance of a mental health professional through a combination of therapy and medication. Moreover, some self-help and coping strategies can also be helpful.

Prevalence Of Dissociative Disorder

Research 4 reveals that approximately 74% of the population have experienced dissociative symptoms at least once in their lifetime, while about 66% have experienced derealization or depersonalization after experiencing a traumatic event. However, only 2% of the population tend to experience repeated episodes. It was also found that around 82.6% of people with panic disorder are also likely to suffer from DD. All age groups from different backgrounds get affected and women are much more likely to be diagnosed than men.

Symptoms Of Dissociative Disorder

Dissociative disorder is a type of illness that may contribute to physical and mental health problems. Sometimes as a result of traumatic life experience, certain types of dissociative disorder can be short-term or temporary and they go away after a few weeks or months while some can last much longer as well. Depersonalization and derealization 5 are some of the most common symptoms of these disorders. Depersonalization refers to feelings of being detached from self and derealization refers to feelings of being detached from the environment or reality. Dissociation can manifest itself in the form of wandering, spacing out, or glazed eyes, acting in a different way, with a different tone of voice or movements. The sudden change in feelings or responses to an event quickly, such as being scared and timid, then becoming bombastic and threatening is a way of dissociation.

Some of the other common signs and symptoms of DD include:

  • Impaired sense of self and identity or identity confusion
  • Feeling disappointed and useless with no reason at all
  • Feeling disconnected from the world and people around them
  • Loss of memory or amnesia and memory lapses regarding personal information, people or events
  • Emotional numbness
  • Distorted and inaccurate perceptions regarding people, things and places
  • Difficulty with emotional regulation
  • Inability to cope with stress
  • Out-of-body experiences, depersonalization or derealization
  • Struggling with mental illness like anxiety, depression & suicidality
  • Feeling no or little physical pain
  • Unexpected and sudden mood swings and changes in behavior
  • Difficulty concentrating
  • Experiencing distinct and multiple identities
  • Problems in relationships, career and personal life

Types Of Dissociative Disorder

Dissociative disorder can be primarily categorized into five main types, namely dissociative amnesia, depersonalisation disorder, dissociative fugue, dissociative identity disorder and dissociative disorder not otherwise specified (DDNOS). Here is a closer look at some of these types of DD:

1. Dissociative Amnesia

Also called psychogenic amnesia, it is a condition where a person is unable to remember essential details from their past. According to studies 6 , sufferers may experience perceived distress in dissociative amnesia due to memory loss and the degree of that distress is influenced by their cultural perception of their own identity and their past experiences. This condition is very dissimilar to being forgetful and is shaped by emotional trauma 7 or stressful events in the past. Dissociative amnesia can be further categorized into 3 types:

  • Localized amnesia: Inability to remember a traumatic event or a certain time period
  • Selective amnesia: Inability to remember details about a traumatic event or a time period
  • Generalized amnesia: Inability to remember details about their entire life history

“Dissociative amnesia is a disorder characterized by retrospectively reported memory gaps. These gaps involve an inability to recall personal information, usually of a traumatic or stressful nature,” explains a 2006 study 8, 3(1), 51–55. )) . Amnesia episodes can last for minutes or hours for some, while it can sustain for months or years for some other people. It can cause significant functional impairment 9 , if left untreated.

2. Depersonalization-derealization disorder

This type of dissociative disorder can cause episodes of detachment or disassociation making the person feel that they are watching a movie about themselves. They feel detached from their own thoughts, feelings and actions and observe themselves as a mentally separate individual (depersonalization 10 ). The sufferer feels like they are simply an observer in their own life instead of being a participant. Moreover, they may also believe that their friends and family, other people, their environment and the world they live in may not be real (derealization). A 2004 study 11 explains “Depersonalisation disorder is characterised by prominent depersonalisation and often derealisation, without clinically notable memory or identity disturbances.”

The symptoms 12 can be deeply distressing and can last from a few minutes to months or years. They may have difficulty with memory & concentration and feel out of control at times. Depersonalization-derealization disorder is also closely related to depression & anxiety disorders, according to research 13 . Age of onset can be early childhood but most patients tend to experience the symptoms by the age of 16. A recent 2020 study 14 explains that depersonalization & derealization are primarily symptoms of perceptual integration impairment that causes “an altered quality of subjective experiences such as feelings of unreality and detachment from the self or the surroundings.”

3. Dissociative fugue

Alternatively called psychogenic fugue 15 or fugue state, it is regarded as a variation of dissociative amnesia. It is a rare 16 and severe mental illness marked by varying and unstable amnesia related to personality, memories, identity and other traits associated with self. According to a 2013 study 17 , “Dissociative fugue is a psychiatric disorder characterized by amnesia coupled with sudden unexpected travel away from the individual’s usual surroundings and denial of all memory of his or her whereabouts during the period of wandering.” The condition 18 develops due to excessive psychological trauma or other medical conditions. The sufferer may experience memory loss and forget information related to their personal history and individuality.

As the person may suddenly lose memories 19 related to their past, they feel the need to develop a new identity. However, they may not be aware of their memory loss. They may even travel long distances during episodes which can leave them feeling confused once the fugue state is lifted. An episode can last between a few hours and a few months. Hence, the sufferer may not have any idea about their new identity once they get out of a dissociative fugue episode.“Dissociative fugue is a rare disorder which has been described as sudden, unexpected, travel away from home or one’s customary place of daily activities, with the inability to recall some or all of one’s past,” explains a 2015 study 20 .

4. Dissociative identity disorder (DID)

According to researchers 21 , “Dissociative identity disorder (DID) is a rare disorder associated with severe behavioral health symptoms. DID was previously known as Multiple Personality Disorder (MPD) till 1994.” Also identified as split personality, this psychological condition is marked by at least 2 separate and reasonably stable personality states and involves switching from one identity or personality to another alternate identity. The person may experience memory gaps during episodes. Patients can also feel as if they are under possession by other, more dominating identities. The alternate identities tend to have separate names, characteristics, behavior, mannerisms, mindset, body language, voice tone, memories and even certain physical qualities. An individual with dissociative identity disorder may also experience symptoms of dissociative fugue and dissociative amnesia.

The prevalence of this form of dissociative disorder is about 0.1-1% of the general population 22 and most patients are often misdiagnosed as borderline personality disorder, schizophrenia etc. Studies 23 have found that the condition may be caused by a “complex combination” of cultural and developmental factors, such as childhood trauma, abuse, attachment styles etc. Individuals suffering from DID tend to be hyper sensitive towards rejection issues and interpersonal trust, which can create challenges in treatment 24, 6(3), 24–29. )) . If left untreated, a patient can develop self-injurious behavior, substance use disorders and even suicidal thoughts and behaviors.

Causes Of Dissociative Disorder

Although the specific cause for the onset of this disorder has not yet been identified, mental health experts believe that a combination of different factors may influence the development of this condition. Here are some of the factors that may influence the onset of dissociative disorder:

1. Traumatic experiences

Research 25 shows that these disorders are primarily caused by repetitive and overwhelming trauma experienced during early childhood. Childhood abuse, whether emotional, physical or sexual, can increase the likelihood of DD. As the person becomes unable to overcome or forget the horrifying experiences, they tend to lose the ability to understand what is happening around them. Moreover, children are often ill-equipped to process abuse or trauma and lack the right coping skills unlike knowledgeable adults. This can also be influenced by a lack of support, caring and unhealthy attachments. One study 26 states that this is a “complex syndrome associated with a history of severe ongoing developmental trauma dating from early childhood.” Apart from childhood trauma, dissociative disorders can also emerge due to a previous traumatic experience during adulthood such as war, natural disaster, crime, kidnapping, a fatal accident etc.

Such experiences can compel a person to “disassociate” from their reality, especially in times of severe stress. Detachment and reconnection serves as a natural defence mechanism and acts as a type of denial, as the mind tries to cope with the traumatic events or experiences. Although denial is normal for most people when facing a trauma, DD patients tend to remain disconnected even when the traumatic event has passed.

2. Genetics

Dissociative disorder may have genetic predisposition 27 and may run in families. You may have a high risk of developing DD, if your parents, siblings or relatives experienced either types of dissociative disorders or associated conditions. One 2004 study 28 found that genetic factors may possibly “contribute to dissociative tendencies in children and adolescents.” Another 2011 study 29 found that the people with SS genotype of 5-HTTLPR tend to have more higher dissociative symptoms than people with other genotypes.

3. Stress

Excessive stress 30 , overthinking and worrying about certain issues including family problems, exam tension or relationship stress can also contribute to the onset of this condition. According to a 2018 study 31 , prolonged exposure to stressful experiences can result in dissociative phenomena. “Mental disorders and psychopathologic experiences of patients can configure the chronic stress condition that produces functional damage to the adaptive executive system,” adds the study.

Comorbid Conditions

A patient with dissociative disorder can also suffer from a number of other co-occurring mental health illnesses, such as:

1. Depression

Research 32 shows that depression is associated with dissociative disorders and around 7% of people with major depressive disorder (MDD) tend to suffer from dissociative symptoms. It found that DD can manifest during MDD and may influence the course of depression. “These findings indicate that dissociative phenomena should not be overlooked in MDD,” add the researchers. One 2016 study 33 found that dissociation can significantly influence the “treatment effectiveness” of depression and anxiety. Another 2020 study 34 found a positive correlation between dissociative symptoms, hopelessness and suicidality.

2. Post-Traumatic Stress Disorder (PTSD)

PTSD 35 is a debilitating mental condition that occurs as a result of being subjected to actual or threatened harm, death, or sexual abuse. It’s linked to both functional and cognitive issues. DD and PTSD are closely associated. In fact, a dissociative subtype 36 of post-traumatic stress disorder is incorporated in American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Reports 37 show that dissociative subtype of posttraumatic stress disorder (d-PTSD) has a high prevalence in a clinical population. Another 2018 study 38 found that the presence of dissociative symptoms in posttraumatic stress disorder can influence treatment of PTSD.

3. Suicidal tendencies or self harm

Most patients with DD are prone to self-injury and suicidal behavior 39 . According to a 2008 study 40 , “it is common for patients with dissociative disorders to report a history of suicide attempts.” However, the study found that suicidal patients usually tend to have multiple diagnoses along with DD, such as posttraumatic stress disorder (PTSD), borderline personality disorder, substance use etc. One study 41 found that about 70% of patients with dissociative identity disorder (DID) tend to have self-harm and suicidality as a symptom. Suicide attempts and self-injurious behaviors can also be observed in adolescents 42 with dissociation and trauma.

Apart from these, dissociative disorders are also associated with some other psychiatric disorders such as –

  • Anxiety
  • Panic attacks
  • Personality disorders
  • Sexual dysfunction
  • Substance use disorder
  • Sleep disorders
  • Eating disorders

In fact, dissociative identity disorder (DID) or multiple personality disorder (MPD) “can be found comorbid with many other psychiatric conditions,” revealed one study 43 .

Diagnosis Of Dissociative Disorder

Diagnosis is typically made only when the symptoms of the patient meet the criteria of diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. The rising prevalence of dissociative disorders has resulted in the development of a number of diagnostic techniques 44 . Healthcare experts typically use a variety of modern approaches, including screening instruments, formal interviews, psychological examination, and hypnosis, as well as the importance of including the patient as an active participant in the evaluation process. Diagnosis normally entails evaluating symptoms and sorting out any medical conditions that could be causing them. The evaluation includes:

1. Psychiatric exam

While discussing the symptoms the therapists may ask questions about the patient’s thoughts and feelings to better understand their emotional and mental states. The doctor may also evaluate the patient’s family history, medical history and ask questions about their childhood and personal history as well.

2. Physical Exam

A doctor may conduct certain physical tests, such as lab tests or blood tests, to determine if the symptoms are caused by any underlying conditions. This is important as certain physical healthy issues like head injury, brain diseases, sleep deprivation or substance use can cause symptoms, such as memory loss and a sense of unreality. After the doctor has ruled out other causes, they will analyze the patient’s case in detail and devise a treatment plan. Treatment process may vary if the patient has a dual diagnosis and suffers from other psychiatric conditions other than DD.

Treatment Of Dissociative Disorder

Dissociative disorders can be treated effectively with different treatment approaches involving psychotherapies and medications. However, patients and their family members need to be patient as complete recovery may take several years.

Some of the common treatment approaches for dissociative disorder includes the following:

1. Psychotherapy

Therapy, also known as talk therapy, can enable the sufferers to gain better control over themselves and their lives by managing the symptoms and the dissociative process. Psychotherapy 45 focuses on different aspects of identity and thought processes and aims to help the patient cope with and overcome past trauma. According to a 2013 study 46 , “Psychotherapy is the cornerstone of a multidisciplinary treatment plan for dissociative disorders and other trauma-related disorders and must be incorporated into the interventional strategy.” Mental health professionals typically recommend cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) for DD treatment. Both these therapies help to cope with the sufferers’ conscious intellectual actions and behavior. Studies 47 reveal that cognitive behavioral therapy can be an effective psychological intervention for dissociative disorders.

Apart from these, hypnosis and Eye Movement Desensitization and Reprocessing (EMDR) can also be used as effective treatment approaches for better recovery. Research 48 shows that hypnosis can be highly effective for DD, especially for DID patients. It was also observed that such patients are “considered autohypnotic.” EMDR 49 can also prove to be beneficial in the recovery process as it focuses on improving memories associated with trauma and abuse, which influence the development of psychological disorders.

2. Medication

There are no specific medications for the treatment of dissociative disorders. Doctors might suggest some antidepressants or antipsychotic drugs to control symptoms of other mental illnesses, like anxiety and depression, connected with dissociative disorder.

3. Self-help strategies

As stress and trauma plays a crucial role in the onset of dissociative disorders, certain copings strategies can help in the recovery process. Here are certain self-help strategies that can be helpful:

  • Talking to a trusted friend or family member openly about any issues or problems
  • Seeking professional help and consulting a doctor
  • Joining a support group

Coping with Dissociative Disorder

Dissociation is considered as a natural coping mechanism 50 used by the mind for dealing with trauma, abuse, high stress levels, and also as an avoidant knowledge acquisition method. Apart from therapy and medications, here are some simple strategies for dealing with the condition and recover:

1. Mindfulness

Mindfulness can be beneficial in minimizing dissociation and facilitating adaptive functioning 51 in clinical practise. By increasing understanding of dissociative processes, mindfulness can help anticipate and manage dissociation. Mindfulness-based interventions may thus be beneficial in addressing dissociative pathology 50 and facilitating healthy development.

2. Healthy eating habits

Having a balanced nutritious diet 52 is very essential for recovering from dissociative disorder. It is important to eat nutritious food and avoid junk food, alcohol and nicotine in order to recover faster.

3. Exercise

Regular physical activity can also help a person to deal with and alleviate symptoms of DD. Research 53 shows that psychiatric patients engaging in regular exercise reported better mental health outcomes and higher quality of life in a cross sectional study.

4. Adequate sleep

Getting enough sleep 54 for around 7-9 hours every day is required so that one can calm their mind. It can help to overcome stress, anxiety and overthinking.

5. Socialize

Regularly socializing with friends and family is also important for developing a healthy mindset and being grounded with your reality. As social withdrawal and isolation 55 can worsen the symptoms so make sure to talk with others and keep yourself busy.

Recovery Is Possible

Appropriate treatment can help the sufferer to manage symptoms of dissociative disorder, enhance their functioning abilities and help them live a more fulfilling & productive life. Once the patient is committed to getting better, then with the help of therapies, healthy lifestyle and support of family members, the patient can overcome all the shortcomings on the way. The process might be long but with patience it will all pass and the outcome will be revealed.

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