Dissociative Disorders

Overview

Dissociative disorders are mental disorders that involve experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity. People with dissociative disorders escape reality in ways that are involuntary and unhealthy and cause problems with functioning in everyday life.

Dissociative disorders usually develop as a reaction to trauma and help keep difficult memories at bay. Symptoms — ranging from amnesia to alternate identities — depend in part on the type of dissociative disorder you have. Times of stress can temporarily worsen symptoms, making them more obvious.

Treatment for dissociative disorders may include talk therapy (psychotherapy) and medication. Although treating dissociative disorders can be difficult, many people learn new ways of coping and lead healthy, productive lives.

Symptoms

Signs and symptoms depend on the type of dissociative disorders you have, but may include:

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

There are three major 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's more severe than normal forgetfulness and that can't be explained by a medical condition. You can't recall information about yourself or events and people in your life, especially from a traumatic time. Dissociative amnesia can be specific to events in a certain time, such as intense combat, or more rarely, can involve complete loss of memory about yourself. It may sometimes involve travel or confused wandering away from your life (dissociative fugue). An episode of amnesia usually occurs suddenly and may last 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 though you're possessed by other identities. Each identity may have a unique name, personal history and characteristics, including obvious differences in voice, gender, mannerisms and even such physical qualities as the need for eyeglasses. There also are differences in how familiar each identity is 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 sense of detachment or being outside yourself — observing your actions, feelings, thoughts and self from a distance as though watching a movie (depersonalization). Other people and things around you may feel detached and foggy or dreamlike, time may be slowed down or sped up, and the world may seem unreal (derealization). You may experience depersonalization, derealization or both. Symptoms, which can be profoundly distressing, may last only a few moments or come and go over many years.

When to see a doctor

Some people with dissociative disorders 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 may indicate a dissociative disorder, call your doctor.

Suicidal thoughts or behavior

If you have thoughts of hurting yourself or someone else, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

Causes

Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to long-term physical, sexual or emotional abuse or, less often, a home environment that's frightening or highly unpredictable. The stress of war or natural disasters also can bring on dissociative disorders.

Personal identity is still forming during childhood. So a child is more able than an adult to step outside of himself or herself and observe trauma as though it's happening to a different person. A child who learns to dissociate in order to endure a traumatic experience may use this coping mechanism in response to stressful situations throughout life.

Risk factors

People who experience long-term physical, sexual or emotional abuse during childhood are at greatest risk of developing dissociative disorders.

Children and adults who experience other traumatic events, such as war, natural disasters, kidnapping, torture, or extended, traumatic, early-life medical procedures, also may develop these conditions.

Complications

People with dissociative disorders are at increased risk of 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 lightheadedness or non-epileptic seizures
• Major difficulties in personal relationships and at work

Prevention

Children who are physically, emotionally or sexually abused are at increased risk of developing mental health disorders, such as dissociative disorders. If stress or other personal issues are affecting the way you treat your child, seek help.

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

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

Diagnosis

Diagnosis usually involves assessment of symptoms and ruling out any medical condition that could cause the symptoms. Testing and diagnosis often involves a referral to a mental health professional to determine your diagnosis.

Evaluation may include:

• Physical exam. Your doctor examines you, asks in-depth questions, and reviews your symptoms and personal history. Certain tests may eliminate physical conditions — for example, head injury, 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 questions about your thoughts, feelings, and behavior 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 may compare your symptoms to the criteria for diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

For diagnosis of dissociative disorders, the DSM-5 lists these criteria.

Dissociative amnesia

For dissociative amnesia:

• You've had one or more episodes in which you couldn'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 forgetfulness.
• Your episodes of memory loss don't occur only 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 they're not caused by a neurological or other medical condition, such as amnesia related to head trauma.
• You may also experience dissociative fugue, where you purposefully travel or experience confused wandering that involves amnesia — inability to remember your identity or other important personal information.
• Your symptoms cause you 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 possession that is unwanted and involuntary. Each identity has its own pattern of perceiving, relating to and thinking about yourself and the world.
• You have recurrent gaps in memory for everyday events, skills, important personal information and traumatic events that are too extensive to be explained by ordinary forgetfulness.
• Your symptoms are not a part of broadly 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 playmates or other fantasy play.
• Your symptoms cause you 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 recurrent experiences of feeling detached from yourself, as if you're an outside observer of your thoughts, sensations, actions or your body (depersonalization). Or you feel detached or experience a lack of reality for your surroundings as if you're in a dream or the world is distorted (derealization).
• While you're experiencing an episode of depersonalization or derealization, you're aware the experience is not reality.
• Your symptoms do not occur only during the course of another mental disorder, such as schizophrenia or panic disorder, or during another dissociative disorder. Your 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 you significant stress or problems in your relationships, work or other important areas of your life.

Treatment

Dissociative disorders treatment may vary based on the type of disorder you have, but generally include psychotherapy and medication.

Psychotherapy

Psychotherapy is the primary 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 in working with people who have experienced trauma.

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

Medication

Although there are no medications that specifically treat dissociative disorders, your doctor may prescribe antidepressants, anti-anxiety medications or antipsychotic drugs to help control the mental health symptoms associated with dissociative disorders.

Preparing for your appointment

As a first step, your doctor may ask you to come in for a thorough exam to rule out possible physical causes of your symptoms. However, in some cases you may be referred immediately to a psychiatrist. You may want to take a family member or friend along, if possible, to help you remember information.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

Before your appointment, make a list of:

• Any symptoms you're experiencing, including any recent behavior that caused confusion or concern for you or your loved ones.
• Key personal information, including any major stresses or recent life changes. Also note events from your past, including your childhood, that caused physical or emotional trauma. If you can't recall some periods of your life, note the time frame and anything you can remember about the period leading up to your amnesia.
• Your medical information, including other physical or mental health conditions you have. Include any medications, vitamins, herbs or other supplements you're taking, and the dosages.
• Questions to ask your doctor to make the most of your time together

Some questions to ask your doctor may include:

• What's likely causing my symptoms or condition?
• What are other possible causes?
• How will you determine my diagnosis?
• Is my condition likely temporary or long term (chronic)?
• What treatments do you recommend for this disorder?
• How much can I expect my symptoms to improve with treatment?
• How will you monitor my progress?
• I have these other health conditions. How can I best manage them together?
• Should I see a specialist?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

• What symptoms concern you or your loved ones?
• When did you or your loved ones first notice your symptoms?
• Are there periods of time in your life that you don't remember?
• Have you ever found yourself some distance away from your home or work, and not known how you got there?
• Do you ever feel as if you're outside of your body, observing yourself?
• Do you feel as though there is more than one person, or maybe many people, living inside your head?
• What other symptoms or behaviors are causing you or your loved ones distress?
• How often do you feel anxious or depressed?
• Have your symptoms caused problems in your work or your personal relationships?
• Have you ever thought about harming yourself or others?
• Do you drink alcohol or use recreational drugs?
• Do you now or have you ever served in the military?
• Have you ever been touched against your will?
• Were you physically abused or neglected as a child?
• Was anyone in your family abused during your childhood?
• Are you currently being treated for any other medical conditions, including mental health disorders?