10 Apr DISSOCIATIVE DISORDERS

What Are Dissociative Disorders?

Dissociative disorders involve problems with memory, identity, emotion, perception, behavior and sense of self. Dissociative symptoms can potentially disrupt every area of mental functioning.

Examples of dissociative symptoms include the experience of detachment or feeling as if one is outside one’s body, and loss of memory or amnesia. Dissociative disorders are frequently associated with previous experience of trauma.

There are three types of dissociative disorders:

• Dissociative identity disorder
• Dissociative amnesia
• Depersonalization/derealization disorder

The Sidran Institute, which works to help people understand and cope with traumatic stress and dissociative disorders, describes the phenomenon of dissociation and the purpose it may serve as follows:

Dissociation is a disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is. This is a normal process that everyone has experienced. Examples of mild, common dissociation include daydreaming, highway hypnosis or “getting lost” in a book or movie, all of which involve “losing touch” with awareness of one’s immediate surroundings.

During a traumatic experience such as an accident, disaster or crime victimization, dissociation can help a person tolerate what might otherwise be too difficult to bear. In situations like these, a person may dissociate the memory of the place, circumstances or feelings about of the overwhelming event, mentally escaping from the fear, pain and horror. This may make it difficult to later remember the details of the experience, as reported by many disaster and accident survivors.

Dissociative Identity Disorder

Dissociative identity disorder is associated with overwhelming experiences, traumatic events and/or abuse that occurred in childhood. Dissociative identity disorder was previously referred to as multiple personality disorder.

Symptoms of dissociative identity disorder (criteria for diagnosis) include:

• • The existence of two or more distinct identities (or “personality states”). The distinct identities are accompanied by changes in behavior, memory and thinking. The signs and symptoms may be observed by others or reported by the individual.
  • Ongoing gaps in memory about everyday events, personal information and/or past traumatic events.
  • The symptoms cause significant distress or problems in social, occupational or other areas of functioning.

In addition, the disturbance must not be a normal part of a broadly accepted cultural or religious practice. As noted in the DSM-5¹, in many cultures around the world, experiences of being possessed are a normal part of spiritual practice and are not dissociative disorders.

The attitude and personal preferences (for example, about food, activities, clothes) of a person with dissociative identity disorder may suddenly shift and then shift back. The identities happen involuntarily and are unwanted and cause distress. People with dissociative identity disorder may feel that they have suddenly become observers of their own speech and actions, or their bodies may feel different (e.g., like a small child, like the opposite gender, huge and muscular).

The Sidran Institute notes that a person with dissociative identity disorder “feels as if she has within her two or more entities, each with its own way of thinking and remembering about herself and her life. It is important to keep in mind that although these alternate states may feel or appear to be very different, they are all manifestations of a single, whole person.” Other names used to describe these alternate states including “alternate personalities,” “alters,” “states of consciousness” and “identities.”

For people with dissociative identity disorder, the extent of problems functioning can vary widely, from minimal to significant problems. People often try to minimize the impact of their symptoms.

Risk Factors and Suicide Risk

People who have experienced physical and sexual abuse in childhood are at increased risk of dissociative identity disorder. The vast majority of people who develop dissociative disorders have experienced repetitive, overwhelming trauma in childhood. Among people with dissociative identity disorder in the United States, Canada and Europe, about 90 percent had been the victims of childhood abuse and neglect.

Suicide attempts and other self-injurious behavior are common among people with dissociative identity disorder. More than 70 percent of outpatients with dissociative identity disorder have attempted suicide.¹

Treatment

With appropriate treatment, many people are successful in addressing the major symptoms of dissociative identity disorder and improving their ability to function and live a productive, fulfilling life.

Treatment typically involves psychotherapy. Therapy can help people gain control over the dissociative process and symptoms. The goal of therapy is to help integrate the different elements of identity. Therapy may be intense and difficult as it involves remembering and coping with past traumatic experiences. Cognitive behavioral therapy and dialectical behavioral therapy are two commonly used types of therapy. Hypnosis has also been found to be helpful in treatment of dissociative identity disorder.

There are no medications to directly treat the symptoms of dissociative identity disorder. However, medication may be helpful in treating related conditions or symptoms, such as the use of antidepressants to treat symptoms of depression.

This information is courtesy of the American Psychiatric Association.

For more information and other topics, please visit:  The AMERICAN PSYCHIATRIC ASSOCIATION