What is Dissociative Disorder?: 9 symptoms of this unsettling disorder

Thoughts, memories, behavior, mood—all of these things and more form our identity. During periods of trauma or stress, these aspects of ourselves can become disconnected. This sense of detachment is the reality for someone with a dissociative disorder. Dissociative disorders are a group of mental health conditions that profoundly impact identity, behavior, and all that makes us who we are.

What Are Dissociative Disorders?

Dissociative disorders are a group of mental disorders that affect the perception of identity, behavior, memory, and emotions. The primary characteristics of dissociative disorders are depersonalization and derealization, which is feeling detached or disconnected from oneself and the surrounding world. Someone with a dissociative disorder also suffers from memory loss known as amnesia, which causes gaps in memory related to a traumatic event. The disorder occurs in both males and females, as well as children and adults of all ages.

Dissociation: A Defense Mechanism

A traumatic event or periods of high stress are connected to dissociative disorders. While dissociation has been noted outside of a trauma, it can serve as a psychological defense mechanism. Dissociation disconnects a person from their thoughts, emotions, memories, and surroundings. After a traumatic event (i.e., abuse, witnessing war, car accident, etc.), dissociation puts unpleasant memories out of conscious awareness. However, it is maladaptive because it prevents problem-solving. Dissociative disorders develop when dissociation as a defense mechanism becomes chronic rather than a temporary manner of coping.

Symptoms of Dissociative Disorders

Dissociative disorders have a range of physiological, emotional, and physical signs and symptoms. An individual with a dissociative disorder may have any combination of the symptoms listed below:

• Depersonalization—Feeling as if reality is unreal or a sense of observing oneself outside of the body
• Amnesia—The inability to remember an event for a period of time
• Derealization—Feeling as if the surrounding world is not real
• Loss of control body control—Being unable to control body movements
• Identity confusion—Confusion is confusion or unclarity of identity or the aspects of self, such as behavior, thoughts, memories, emotions, hobbies, etc.
• Identity alteration—Alternating between multiple identities or personalities
• Difficulty concentrating—Cognitive difficulties including inattention are reported during episodes of dissociation
• Mood swings—Rapid, unexpected mood swings tend to be accompanied by depression and anxiety
• Behavioral changes—Those with dissociative disorders often have unexpected changes in behavior that is different than their norm

Dissociative Disorders and Cognitive Function

Cognitive functions are thinking processes that direct behavior and allow the completion of tasks, acquiring knowledge, and computing information through skills like memory, attention, reasoning, auditory and visual processing, language, and motor skills. Having a dissociative disorder impacts vital these cognitive functions—particularly memory and concentration.

Studies (Özdemir, et al., 2015) show that dissociative individuals have deficits in verbal memory that are only compounded if post-traumatic stress disorder is present along with the dissociative disorder. Experts hypothesize that stress hormones damage cells in the hippocampus—the area of the brain responsible for memory and the bodily response—and impede optimal cognitive performance. 

Causes and Risk Factors For Dissociative Disorders

Dissociative disorders are associated with periods of high stress and trauma. Someone who has experienced significant trauma in their life is at a higher risk, as disassociation is a coping mechanism. Stressful situations and traumatic events include physical abuse, sexual abuse, or encountering war, an accident, a natural disaster, kidnapping, or severe illness.

The International Society for the Study of Trauma and Dissociation found that 73% of people who experienced trauma exhibited signs of disassociation following the event. Dissociative disorders develop when dissociation becomes chronic and does not improve over time.

Gender and age are also risk factors. Females are more likely to develop dissociative disorders than males. Children also have increased risk because they are in the prime stage of identity development.

Types of Dissociative Disorders

There are three types of dissociative disorders. Each affects a person’s thoughts, feelings, behavior, or identity. However, their unique combination of symptoms sets them apart.

Dissociative Amnesia

Dissociative amnesia is marked by an individual’s inability to remember details and information about oneself or events that have occurred. The disorder is typically triggered after a stressful event such as childhood trauma, emotional abuse, neglect, or sexual abuse. Most are not consciously aware they are experiencing gaps in memory. They may seem confused and distressed.  

The amnesia is categorized as:

• Localized—The person is unable to remember an event for a period of time. It presents as lapses in memory ranging days to years after a stressful event.
• Selective—Someone with selective amnesia struggles to remember parts of an event.
• Generalized—Although the most rare, generalized dissociative amnesia involves difficulty recalling the details of one’s entire life and history (i.e. who they are, skills they have learned, thoughts, feelings).
• Fugue—All recollection of personal information is lost and the person has a strong desire to wander or travel from home to accept a new identity.

Dissociative Identity Disorder

Dissociative identity disorder is the most severe type of dissociative disorder. The disorder was previously referred to as multiple personality disorder because it is characterized by multiple personalities existing within a person.

Those with multiple personality disorder are unaware of the behaviors influenced by their secondary personality states. Each personality possesses its own characteristics such as language, tone, memories, and beliefs. The primary personality tends to experience episodes of dissociative identity disorder as amnesia or lapses in memory. Stress often triggers episodes.

Depersonalization-Derealization Disorder

Depersonalization-Derealization disorder is a dissociative disorder in which an individual is detached from their identity and life in general. They are disconnected from their own thoughts and emotions as if the world around them is not real. The disorder is marked by a “spacey” feeling. It is not uncommon to experience false perceptions of the body such as perceiving the body to be a different size than it actually is or being unable to recognize themselves in the mirror.

Conditions Related To Dissociative Disorders

Having a dissociative disorder increases the risk of the below health conditions:

• Post-traumatic stress disorder—A disorder in which an individual has flashbacks, negative memories, and mood changes after witnessing or enduring a traumatic event. Symptoms can begin immediately or even years after the event.
• Sleep disorders—Dissociation is related to sleep disturbances and sleep disorders such as insomnia, nightmares, and hypersomnia.
• Depression—Feelings of sadness, hopelessness, and apathy occurring longer than two weeks is considered depression as defined by the DSM-5. Past studies (Sar, 2015) noted that 41.3% of females with major depression also had a dissociative disorder.
• Anxiety and phobias—Anxiety is classified as excessive worry or fear disproportionate to the situation. Dissociation is often a coping mechanism for anxiety towards a stressful event.
• Obsessive-compulsive disorder (OCD)—An anxiety disorder characterized by intrusive thoughts, rituals, and compulsions. It is associated with dissociative disorders because those with OCD begin to distrust their own realities, which creates false perceptions common in dissociation.

Diagnosing Dissociative Disorders

Diagnosis of a dissociative disorder relies on a physical exam performed by a medical doctor. They take a thorough medical history to rule out other conditions that mimic symptoms of dissociative disorders. This includes a traumatic brain injury, seizures, or mental conditions like depression, anxiety, and post-traumatic stress disorder.

A mental health professional then evaluates the patient’s symptoms, thoughts, and feelings based on the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Treatment For Dissociative Disorders

Because dissociative disorders vary in presentation, treatment is tailored to the individual based on their symptoms. In most cases, psychotherapy is the first line treatment in conjunction with pharmaceutical options. Treatment requires support from mental health professionals, medical doctors, and family and friends.

Psychotherapy

Psychotherapy treatment uncovers multiple personalities out of the patient’s conscious awareness to begin the process of integrating the personalities to a single identity. They also apply techniques to reveal past traumas that have been forgotten or those in which the traumatic memory is contributing to the psychopathology. The two main forms of psychotherapy applied to treat dissociative disorders are cognitive behavioral therapy and dialectic behavior therapy.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy is therapy with the goal of recognizing beliefs leading to negative behaviors under the premise that our thoughts and feelings affect behavior. The therapist assists the patient in identifying these false beliefs, along with the reasons why, and then replacing them with those that are accurate.

Dialectic Behavior Therapy

Dialectic behavior therapy is a subset of cognitive-behavioral therapy that heavily focuses on skills training. The therapist instills the necessary skills for the person to change maladaptive behaviors. It is divided into individual therapy, group skills training, phone coaching, and communicating with a team of medical professionals. Dialectic behavior therapy can be adapted to manage dissociative disorders.

Studies published in the American Journal of Psychotherapy (Foote et al., 2016) suggest that to treat dissociative disorders through dialectic behavior therapy, the first stage of the therapy should center around dangerous behaviors prior to addressing underlying trauma in stage two. These behaviors include suicidality and self-harm. The later stages involve the patient switching between personalities in order to merge them together eventually. Dialectic behavior therapy is effective for the most severe mental disorders.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is an effective treatment for dissociative disorders with post-traumatic stress disorder as a comorbidity. It entails recalling the details of a traumatic recent while simultaneously performing a series of rapid, repetitive eye movements for 20 to 30 seconds. The repetitive eye movements stimulate the brain to alter negative emotional reactions to an event.

Medications

There are no medications that specifically treat the dissociation experienced by those with dissociative disorders. Medications are successful in managing other symptoms. For example, antidepressants stabilize mood while treating comorbid depression. Antianxiety medications reduce anxiety levels but must be taken with caution because they can exacerbation episodes of dissociation in some cases. Beta-blockers and anti-psychotics also stabilize mood.

References

Foote, B., & Van Orden, K. (2016). Adapting Dialectical Behavior Therapy for the Treatment of Dissociative Identity Disorder. American journal of psychotherapy, 70(4), 343–364. https://doi.org/10.1176/appi.psychotherapy.2016.70.4.343

International Society for the Study of Trauma and Dissociation. Guidelines for Treating Dissociative Identity Disorder in Adults, Journal of Trauma & Dissociation Third Revision. 2012;12:115–187.

Sar, V. (2015) Dissociative Depression is Resistant to Treatment-As-Usual. J Psychol Clin Psychiatry 3(2): 00128. DOI: 10.15406/jpcpy.2015.03.00128

Cheyanne Perry

Cheyanne is currently studying psychology at North Greenville University. As an avid patient advocate living with Ehlers Danlos Syndrome, she is interested in the biological processes that connect physical illness and mental health. In her spare time, she enjoys immersing herself in a good book, creating for her Etsy shop, or writing for her own blog.