Dissociative disorder psychology definition

Dissociative disorders - Symptoms and causes

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.

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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 call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor.

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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.

By Mayo Clinic Staff

Associated Procedures

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Dissociative Disorders | NAMI: National Alliance on Mental Illness

Dissociative disorders are characterized by an involuntary escape from reality characterized by a disconnection between thoughts, identity, consciousness and memory. People from all age groups and racial, ethnic and socioeconomic backgrounds can experience a dissociative disorder.

Up to 75% of people experience at least one depersonalization/derealization episode in their lives, with only 2% meeting the full criteria for chronic episodes. Women are more likely than men to be diagnosed with a dissociative disorder.

The symptoms of a dissociative disorder usually first develop as a response to a traumatic event, such as abuse or military combat, to keep those memories under control. Stressful situations can worsen symptoms and cause problems with functioning in everyday activities. However, the symptoms a person experiences will depend on the type of dissociative disorder that a person has.

Treatment for dissociative disorders often involves psychotherapy and medication. Though finding an effective treatment plan can be difficult, many people are able to live healthy and productive lives.

Symptoms

Symptoms and signs of dissociative disorders include:

Significant memory loss of specific times, people and events
Out-of-body experiences, such as feeling as though you are watching a movie of yourself
Mental health problems such as depression, anxiety and thoughts of suicide
A sense of detachment from your emotions, or emotional numbness
A lack of a sense of self-identity

The symptoms of dissociative disorders depend on the type of disorder that has been diagnosed. There are three types of dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM):

Dissociative Amnesia. The main symptom is difficulty remembering important information about one’s self. Dissociative amnesia may surround a particular event, such as combat or abuse, or more rarely, information about identity and life history. The onset for an amnesic episode is usually sudden, and an episode can last minutes, hours, days, or, rarely, months or years. There is no average for age onset or percentage, and a person may experience multiple episodes throughout her life.
Depersonalization disorder. This disorder involves ongoing feelings of detachment from actions, feelings, thoughts and sensations as if they are watching a movie (depersonalization). Sometimes other people and things may feel like people and things in the world around them are unreal (derealization). A person may experience depersonalization, derealization or both. Symptoms can last just a matter of moments or return at times over the years. The average onset age is 16, although depersonalization episodes can start anywhere from early to mid childhood. Less than 20% of people with this disorder start experiencing episodes after the age of 20.

Dissociative identity disorder. Formerly known as multiple personality disorder, this disorder is characterized by alternating between multiple identities. A person may feel like one or more voices are trying to take control in their head. Often these identities may have unique names, characteristics, mannerisms and voices. People with DID will experience gaps in memory of every day events, personal information and trauma. Women are more likely to be diagnosed, as they more frequently present with acute dissociative symptoms. Men are more likely to deny symptoms and trauma histories, and commonly exhibit more violent behavior, rather than amnesia or fugue states. This can lead to elevated false negative diagnosis.

Causes

Dissociative disorders usually develop as a way of dealing with trauma. Dissociative disorders most often form in children exposed to long-term physical, sexual or emotional abuse. Natural disasters and combat can also cause dissociative disorders.

Diagnosis

Doctors diagnose dissociative disorders based on a review of symptoms and personal history. A doctor may perform tests to rule out physical conditions that can cause symptoms such as memory loss and a sense of unreality (for example, head injury, brain lesions or tumors, sleep deprivation or intoxication). If physical causes are ruled out, a mental health specialist is often consulted to make an evaluation.

Many features of dissociative disorders can be influenced by a person’s cultural background. In the case of dissociative identity disorder and dissociative amnesia, patients may present with unexplained, non-epileptic seizures, paralyses or sensory loss. In settings where possession is part of cultural beliefs, the fragmented identities of a person who has DID may take the form of spirits, deities, demons or animals. Intercultural contact may also influence the characteristics of other identities. For example, a person in India exposed to Western culture may present with an “alter” who only speaks English. In cultures with highly restrictive social conditions, amnesia is frequently triggered by severe psychological stress such as conflict caused by oppression. Finally, voluntarily induced states of depersonalization can be a part of meditative practices prevalent in many religions and cultures, and should not be diagnosed as a disorder.

Treatment

Dissociative disorders are managed through various therapies including:

Psychotherapies such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)
Eye movement desensitization and reprocessing (EMDR)
Medications such as antidepressants can treat symptoms of related conditions

Related Conditions

Because dissociative disorders appear on the trauma spectrum, many patients may have conditions associated with trauma, as well as additional trauma-based conditions.

Posttraumatic stress disorder (PTSD)
Borderline personality disorder (BPD)
Substance use disorders / Dual Diagnosis
Depression
Anxiety

What is Dissociative Identity Disorder?

Dissociative Identity Disorder is a mental disorder characterized by either having two or more personalities, or a state of disconnection from the outside world, one's identity, and an inability to recall certain daily life events and important personal information. This disorder is often mistaken for depression, anxiety, or psychosis. Long before our days, this condition was called possession, and it was treated with exorcism. In the 19th century, this disorder was called hysteria, and in the 20th century it was called multiple personality disorder or multiple personality disorder.

Types of dissociative personality disorder

There are several types of dissociative disorders, which are characterized by different symptoms and manifestations. One of them is dissociative fugue, a disorder in which a person can find himself in a completely unfamiliar place and not remember how he got there. In this case, a person may forget some important information about himself and not even remember his name. At the same time, memory for some information, such as literature, science, and other things, can be preserved. In a state of fugue, a person assumes a different personality and identity with a different character, mannerisms and behavior. While in this identity, a person can lead an outwardly normal life. A dissociative fugue can last for hours or years. After that, a person may find himself in a completely unfamiliar place and at the same time not remember anything that happened to him in a state of fugue.

A person who has a dissociative disorder is actually suffering a lot from their condition.

Another type of dissociative disorder is the presence of several personalities in which a person finds himself in turn or simultaneously. At such moments, he disconnects from himself and stops feeling his own body, and also cannot see himself from the outside. Personalities within a person can have different ages, genders, nationalities, mental abilities, temperaments, and behave in completely different ways. Often these personalities can even have different physiological manifestations. For example, while in one personality, a person can see poorly and wear glasses, and in another, have excellent vision and walk without glasses or lenses (or think that he sees perfectly and does without glasses). Just as in the case of dissociative fugue, when switching, one person cannot remember what happened to the person during immersion in another.

Manifestations of dissociative identity disorder

This disease affects both children (adolescents) and adults and presents with similar symptoms. However, dissociative disorder with multiple personalities in adolescents is quite rare. In old age, dissociation practically does not develop. When a specialist suspects a person of dissociative identity disorder, he usually asks if it happened that the person suddenly found himself in some place and did not understand how he got there. Also, the patient may suddenly speak in a completely different voice, he may have a different handwriting. For example, a person who has one of his personalities as a child may suddenly begin to write in a child's handwriting. Such phenomenal manifestations can be evoked in a patient suffering from dissociative personality disorder, and in a state of hypnosis. That is why the French psychiatrist Jean-Martin Charcot at one time mistakenly believed that hypnosis is a pathological condition that causes hysteria and the manifestation of multiple personalities. However, later it turned out that hypnosis is only superficially similar to dissociative personality disorder, but does not cause it, and the disease itself develops without any connection with hypnosis.

See also

Myths about hypnosis

A person who has a dissociative disorder is, in fact, suffering greatly from his condition. He sees the negative or dismissive attitude of those around him: they look at him strangely, they reject him, no one finds a common language with him, because of him the family can collapse, and so on. At the moment of a dissociative state, a person does not have the opportunity to critically look at himself and his own behavior. That is, in a situation where one of the alternative personalities appears, he is in an inadequate state.

The main theory about the origin of this disease is based on the fact that in childhood such people experienced a traumatic situation, usually bullying or violence.

Dissociation is one of three conditions in which the patient is exempt from criminal liability, along with psychosis and mental retardation. There were cases when people in a dissociative state committed murder and rape. In such situations, even taking into account the severity of the crimes, patients are not sent to prison, but are sent to a psychiatric hospital or, in extreme cases, to a special ward of the psychiatric department of the prison.

Causes of dissociative identity disorder

Scientists have not yet found the genetic causes of dissociative identity disorder. The main theory about the origin of this disease is based on the fact that in childhood such people experienced a traumatic situation, usually bullying or violence. However, even this theory does not explain all 100% of cases of dissociative states. There are patients who, without an overt or identified traumatic situation in childhood, suffer from dissociative personality disorder. With regard to the physiological manifestations of this disorder, there is an assumption that in such patients certain areas of the brain stop working and others turn on. However, none of the theories suggesting physiological causes of dissociation currently explains all cases of the disease.

Diagnosis of dissociative identity disorder

Diagnosis of dissociative identity disorder is made through clinical interviews with several specialists. Sometimes the diagnosis requires not one, but several meetings with psychologists and psychiatrists, so that they have the opportunity to identify different aspects of the disorder, look at the patient's condition from several points of view and assemble a consultation. However, the specialist who identifies this disorder must have a great deal of experience and qualifications, since this disease can often be confused with others. In its manifestations, it can be similar to depression, anxiety or psychosis. It is also common for patients with dissociative identity disorder to be diagnosed with schizophrenia. Dissociation is a rare disorder and not every mental health professional can diagnose this condition.

Medications do not cure dissociative identity disorder, but only relieve some of the symptoms.

See also

Mental norm and pathology

A separate task for a specialist in the process of diagnosing dissociation in a child is to distinguish diseases from the presence of imaginary friends in a child, which very often appear in perfectly healthy children at a certain age. To do this, a specialist must be highly qualified in the field of developmental psychology and clearly be able to recognize a dissociative disorder not only in adults, but also in children.

Treatment of dissociative identity disorder

The main treatment for dissociative personality disorder is hypnosis. Sometimes specialists connect methods of psychoanalysis or cognitive-behavioral psychotherapy to treatment. Also, in some cases, medication is used to relieve symptoms. Drugs are prescribed if the disorder is accompanied by depression, panic attacks, drug or alcohol addiction. Medications do not cure dissociative identity disorder, but only relieve some of the symptoms. If a child suffers from this disease, then specialists carry out separate work with his parents, provide them with methods of proper communication with the child to improve the results of his treatment.

If you do not treat dissociative personality disorder, but let the disease take its course, then in the case of multiple personalities, a person in an inadequate state can commit some extremely negative actions in relation to others, for example, violent ones. In the case of a dissociative fugue, a person may get lost and never return home - it will simply be impossible to find him.

Diseases and disorders

Dissociative identity disorder - treatment, consultations, help. Empathy

As a result of the change from one personality to another, the currently active personality cannot remember what the personality that was active before the "switch" was doing.

Dissociation, being a psychological defense mechanism, often occurs as a response to serious psychological trauma that occurred in childhood, to physical, sexual and emotional abuse. The disorder in question is an extreme manifestation of dissociation, as a result of which a person is protected from excessive emotions, since he perceives what happened as if it happened not to himself, but to someone else.

Symptoms

It is worth noting that dissociative disorder has nothing to do with schizophrenia, but is often aggravated by factors such as depression, panic attacks, phobias, anxiety, suicide attempts, eating and sleep disorders.

To make a diagnosis according to ICD-10 (the classification of diseases adopted in the Russian Federation), the patient must have the following symptoms:

Simultaneous manifestation of one personality at a particular moment in the existential presence of two or more different personalities of the patient.
Each personality has its own memory block, its priority values and behavioral patterns, as well as the ability to completely control the patient's actions from time to time.
A person sometimes cannot remember important events or information for her, which goes beyond the usual forgetfulness or absent-mindedness.
Signs are not due to the use of psychotropic substances or disorders of a mental (eg, epileptic) nature.

According to the DSM-IV-TR criteria (used in the United States and other English-speaking countries, a manual of mental disorders), a diagnosis of dissociative identity disorder is made when four features are present:

1. Having two or more distinct identities or personal states, each with its own perception of reality and its own mentality.
2. At least two identities alternately control the patient's life.
3. The inability of the patient to remember and evoke important memories of himself, and much more serious and deeper than with ordinary forgetfulness.
4. Such manifestations are not the result of alcohol or drug abuse, and also cannot be somatic manifestations. In childhood, such signs should not be elements of the game with an imaginary friend or other fantasy games.

In addition to the main symptoms of dissociative identity disorder mentioned above, patients may experience anxiety and depression. Depression can lead to suicide attempts, cause physiological disturbances, sleep problems. With dissociation, a person cannot completely abstract from reality, a person continues to be himself, while the number of other personalities can multiply over time. In an unconscious attempt to protect themselves and isolate themselves from stressors, each time new, the patient forms new entities, completely different, with different names, intonation, mannerisms and, most importantly, life values, which, as a rule, are unaware of the existence of each other. Over the years, the situation can only get worse: there are feelings of the impossibility of controlling one's own actions, the real vision of the world is distorted.

Treatment of dissociative identity disorder

To weaken the negative impact of the disorder, to a certain extent, to secure the patient's life and promote social adaptation, treatment can be started on time.

Antidepressants are used to alleviate the pronounced manifestations of depression and anxiety in dissociative disorder. Also, as the main method of treatment, psychotherapy and its fundamental methods are widely used - such as the cognitive-behavioral method, hypnosis, the practice of family therapy, the insight method (defining conflict and overcoming the traumatic syndrome). Any chosen method of psychotherapy works to determine the causal relationship of the defense mechanism and the need to recreate multiple identities, and the main task of treating dissociative identity disorder is to combine several identities into one whole personality and its subsequent life integration.

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