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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
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Dissociative Identity Disorder (Multiple Personality Disorder): Signs, Symptoms, Treatment
Written by WebMD Editorial Contributors
In this Article
- What Is Dissociative Identity Disorder?
- Who Is At Risk for DID?
- How to Recognize Dissociative Identity Disorder and Its Associated Mental Disorders
- How Is Dissociative Identity Disorder Diagnosed?
- What Other Psychiatric Illnesses Might Occur With DID?
- Are There Famous People With Dissociative Identity Disorder?
- What's the Treatment Plan for Dissociative Identity Disorder?
Dissociative identity disorder (previously known as multiple personality disorder) is thought to be a complex psychological condition that is likely caused by many factors, including severe trauma during early childhood (usually extreme, repetitive physical, sexual, or emotional abuse).
What Is Dissociative Identity Disorder?
Dissociative identity disorder is a severe form of dissociation, a mental process which produces a lack of connection in a person's thoughts, memories, feelings, actions, or sense of identity. Dissociative identity disorder is thought to stem from a combination of factors that may include trauma experienced by the person with the disorder. The dissociative aspect is thought to be a coping mechanism -- the person literally shuts off or dissociates themselves from a situation or experience that's too violent, traumatic, or painful to assimilate with their conscious self.
Who Is At Risk for DID?
Research indicates that the cause of DID is likely a psychological response to interpersonal and environmental stresses, particularly during early childhood years when emotional neglect or abuse may interfere with personality development. As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances or traumas at a sensitive developmental stage of childhood (usually before age 6).
Dissociation may also happen when there has been persistent neglect or emotional abuse, even when there has been no overt physical or sexual abuse. Findings show that in families where parents are frightening and unpredictable, the children may become dissociative. Studies indicate DID affects about 1% of the population.
How to Recognize Dissociative Identity Disorder and Its Associated Mental Disorders
Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person's behavior. With dissociative identity disorder, there's also an inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness. With dissociative identity disorder, there are also highly distinct memory variations, which may fluctuate.
Although not everyone experiences DID the same way, for some the "alters" or different identities have their own age, sex, or race.
Each has their own postures, gestures, and distinct way of talking. Sometimes the alters are imaginary people; sometimes they are animals. As each personality reveals itself and controls the individuals' behavior and thoughts, it's called "switching." Switching can take seconds to minutes to days. Some seek treatment with hypnosis where the person's different "alters" or identities may be very responsive to the therapist's requests.
Other symptoms of dissociative identity disorder may include headache, amnesia, time loss, trances, and "out of body experiences." Some people with dissociative disorders have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed). As an example, someone with dissociative identity disorder may find themselves doing things they wouldn't normally do, such as speeding, reckless driving, or stealing money from their employer or friend, yet they feel they are being compelled to do it. Some describe this feeling as being a passenger in their body rather than the driver.
In other words, they truly believe they have no choice.
There are several main ways in which the psychological processes of dissociative identity disorder change the way a person experiences living, including the following:
- Depersonalization. This is a sense of being detached from one's body and is often referred to as an "out-of-body" experience.
- Derealization. This is the feeling that the world is not real or looking foggy or far away.
- Amnesia. This is the failure to recall significant personal information that is so extensive it cannot be blamed on ordinary forgetfulness. There can also be micro-amnesias where the discussion engaged in is not remembered, or the content of a meaningful conversation is forgotten from one second to the next.
- Identity confusion or identity alteration. Both of these involve a sense of confusion about who a person is. An example of identity confusion is when a person has trouble defining the things that interest them in life, or their political or religious or social viewpoints, or their sexual orientation, or their professional ambitions.
In addition to these apparent alterations, the person may experience distortions in time, place, and situation.
It is now acknowledged that these dissociated states are not fully mature personalities, but rather they represent a disjointed sense of identity. With the amnesia typically associated with dissociative identity disorder, different identity states remember different aspects of autobiographical information. There is usually a "host" personality within the individual, who identifies with the person's real name. Ironically, the host personality is usually unaware of the presence of other personalities.
How Is Dissociative Identity Disorder Diagnosed?
Making the diagnosis of dissociative identity disorder takes time. It's estimated that individuals with dissociative disorders have spent seven years in the mental health system prior to accurate diagnosis. This is common, because the list of symptoms that cause a person with a dissociative disorder to seek treatment is very similar to those of many other psychiatric diagnoses.
In fact, many people who have dissociative disorders also have coexisting diagnoses of borderline or other personality disorders, depression, and anxiety.
The DSM-5 provides the following criteria to diagnose dissociative identity disorder:
- Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
- Amnesia must occur, defined as gaps in the recall of everyday events, important personal information, and/or traumatic events.
- The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
- The disturbance is not part of normal cultural or religious practices.
- The symptoms cannot be due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures).
The distinct personalities may serve diverse roles in helping the individual cope with life's dilemmas. For instance, there's an average of two to four personalities present when the patient is initially diagnosed. Then there's an average of 13 to 15 personalities that can become known over the course of treatment. Environmental triggers or life events cause a sudden shift from one alter or personality to another.
What Other Psychiatric Illnesses Might Occur With DID?
Along with the dissociation and multiple or split personalities, people with dissociative disorders may experience a number of other psychiatric problems, including symptoms:
- Depression
- Mood swings
- Suicidal tendencies
- Sleep disorders (insomnia, night terrors, and sleep walking)
- Anxiety, panic attacks, and phobias (flashbacks, reactions to stimuli or "triggers")
- Alcohol and drug abuse
- Compulsions and rituals
- Psychotic-like symptoms (including auditory and visual hallucinations)
- Eating disorders
Are There Famous People With Dissociative Identity Disorder?
Famous people with dissociative identity disorder include comedienne Roseanne Barr, Adam Duritz, and retired NFL star Herschel Walker.
Walker wrote a book about his struggles with DID, along with his suicide attempts, explaining he had a feeling of disconnect from childhood to the professional leagues. To cope, he developed a tough personality that didn't feel loneliness, one that was fearless and wanted to act out the anger he always suppressed. These "alters" could withstand the abuse he felt; other alters came to help him rise to national fame. Treatment helped Walker realize that these alternate personalities are part of dissociative identity disorder, which he was diagnosed with in adulthood.
What's the Treatment Plan for Dissociative Identity Disorder?
There are currently no formal, evidence-based guldelines to treat DID. Many treatments are based on case reports or are even controversial.
While there's also no "cure" for dissociative identity disorder, long-term treatment can be helpful, if the patient stays committed. Effective treatment includes:
- Psychotherapy: Also called talk therapy, the therapy is designed to work through whatever triggered and triggers the DID.
The goal is to help “fuse” the separate personality traits into one consolidated personality that can control the triggers. This therapy often includes family members in the therapy. - Hypnotherapy. Used in conjunction with psychotherapy, clinical hypnosis can be used to help access repressed memories, control some of the problematic behaviors which accompany DID as well as help integrate the personalities into one.
- Adjunctive therapy. Therapies such as art or movement therapy have been shown to help people connect with parts of their mind that they have shut off to cope with trauma.
There are no established medication treatments for dissociative identity disorder, making psychologically-based approaches the mainstay of therapy. Treatment of co-occurring disorders, such as depression or substance use disorders, is fundamental to overall improvement. Because the symptoms of dissociative disorders often occur with other disorders, such as anxiety and depression, medicines to treat those co-occurring problems, if present, are sometimes used in addition to psychotherapy.
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What students need from universities in the 21st century
Varvara Grankova for Vedomosti
Employers look puzzled at the gulf between the skills they need and the skills that potential employees can offer them. Just under 30% of companies say they have the right digital talent, according to the World Economic Forum, and The Wall Street Journal survey found that 89% of managers find it difficult to select candidates with the required set of social and psychological skills such as teamwork, communication and adaptability.
Higher education has yet to reach a new level and overcome this gap. A huge number of students have little to learn from the training, and too many - 40% - do not complete four-year programs in six years.
One of the reasons for these inconclusive results is that schools do not understand what students hope to achieve by going to university. In other words, universities did not consider the task that applicants set for themselves.
Harvard Business School professor Clayton Christensen formulated the Jobs to Be Done theory. In his book The Law of Successful Innovation. Why does a client “hire” your product and how does knowledge about it help new developments, ”he writes:“ By purchasing a product, we, in fact, “contract” it to perform a particular job, i.e. we strive to achieve a result in which - a life situation.
The theory of Jobs to Be Done was formed on the basis of many years of research that one of the authors (Bob Moesta) conducted together with Christensen since the middle of the 1990s Another author (Michael Horn) has helped apply Christensen's work to the education sector since co-founding the Christensen Institute in 2007 and co-authoring the book Disrupting Class in 2008.
, believe that university students are not given good theoretical knowledge, and 52% of respondents note a lack of practical training. The survey involved 500 business leaders. The main personnel problems they face are the lack of highly qualified workers and engineers (mentioned by 51% and 42% of respondents, respectively) and mid-level specialists: site foremen, technologists, foremen (30%)
Theory is useful in that it allows you to predict how people will actually act in certain circumstances (rather than how they are going to do something in words), and focuses on the motives for this or that choice. In essence, people buy products and services not as such, but as a means to an end. This truth led the late Harvard Business School professor Theodore Levitt to his famous formula: People don't need a quarter-inch drill, they need a quarter-inch hole.
In our research over the past few years, we have collected more than 200 detailed stories of students choosing some form of higher education, from four-year university programs to community colleges and from online learning to programming courses.
We analyzed the data and identified the main tasks that, from the perspective of students, higher education should solve.
We found that there are five tasks for which people enter universities. Each of these reasons consists of decision-driven incentives that range from functional considerations (“if I get another major, I will get a promotion that will justify the cost”) to emotional and social aspects. These five tasks are:
1. Get into a top school
Students with this challenge typically want a classic university experience with a beautiful campus and a prestigious name so they can reinvent themselves – surrounded by new people, with who had rarely met before. However, such students rarely think about what they will do after enrollment. For them, success is acceptance.
A math student with this problem would say something like, "I want to get a degree in math from Harvard." Progress for this group is to be in one of the best universities (in their understanding).
What should educational institutions do: many universities are ready to solve this problem, because many students are striving to get a traditional university education. However, the number of institutions that can succeed in this task is limited.
2. Meet the expectations
These students want to meet the expectations of parents, friends, counselors, teachers, mentors, or their community, for example. Like those who aspire to get into the best educational institution, they understand university education as the next logical step on the path of life. They also don't have any other options (or don't see them). Although these students are indifferent to their choice, they reassure themselves that education will provide them with some kind of safety cushion and support in the future.
A student with this problem thinks, for example, like this: "My mother said that I was good at mathematics, so I decided to enter here." Often these students set themselves the task of getting into the best university, but failed to get into the university of their dreams, and then saw no other option but to do what was expected of them.
What Schools Should Do: Consider offering students a one-year break, or position yourself as a transitional institution, a temporary destination for students on their way to their desired institution.
3. Find a way out
Students with this task want to leave their office work, get rid of a habit, leave home, relatives or the city, break off relationships in a couple. They want to find a place where they will have support and a tick in the column "higher education".
A math student with this problem will say, "I'm good at math, so I'll choose a math major to find a way out of this situation." The main thing is to break out of the routine, and as soon as this happens, the person understands that the task has been solved. As a rule, few people thought about what to do next, so they spend too much time, effort and money on the chosen educational process.
What schools should do: Redesign the first year curriculum to help students develop their passions and learn what they like and don't like.
4. Take a step forward step forward and get better. They usually feel that time is running out, they are afraid to think what will happen if they do nothing. They know that specific practical skills or certifications will help them get back into the process. A student with such a task might want to become a data analyst because it pays well and he understands that specializing in mathematics will be the ticket to this profession.
What educational institutions should do: create programs with a fixed set of educational formats that will allow you to achieve the desired results with the least difficulty.
5. Take the leap
Students with this challenge are eager to learn more and challenge themselves, wanting to follow a clear plan and gain specific practical skills or certifications. In life, they are generally satisfied with everything, and now they can allocate time and budget to realize their vision.
Such a student is interested in mathematics because it will help him to better work with existing clients or because of the desire for deeper knowledge.
The student is interested in the discipline being studied, while he does not have the same urgent need to improve his level, as in the previous described scenario.
What schools should do: To attract applicants, make the program (as far as possible) less risky and make the learning process individual. In this case, it will correspond to the emotional reasons for which the students chose it.
Conclusions for Universities
Just because students in each of the above tasks have chosen mathematics does not mean that all universities should accept them for mathematics programs and that all of them will in all cases meet the needs of students. Yet this is the way most colleges think and act. In an effort to please everyone, most institutions of higher education have developed one-size-fits-all offerings that are far from satisfying and incur significant costs in trying to cater to students with vastly different motivations for enrolling.
Instead, universities have to make hard choices.
They need to determine what need they will satisfy and what appropriate learning process they must offer to help students successfully complete their tasks. This will determine how universities should be organized, what they should do well and what they should do intentionally badly. It would also mean that they should not accept students whose plans do not match those of the institution.
Until universities understand what students want in terms of admissions and reorganize their work accordingly, the results of the entire education sector will be disappointing, and students, employers and society will have to pay for it.
About the Authors: Michael Horn is co-author of Choosing College: How to Make Better Learning Decisions Throughout Your Life, Director of Strategic Management at the Entangled Group and Senior Partner at Entangled Solutions, Co-Founder and Distinguished Fellow of the Clayton Christensen Institute for Disruptive Innovation. Bob Moesta is co-author of Choosing College: How to Make Better Learning Decisions Throughout Your Life, co-founder and president of the ReWired Group, fellow at the Clayton Christensen Institute for Disruptive Innovation, and visiting lecturer at Harvard Business School, the MIT Sloan School of Entrepreneurship, and the MIT School of Management.
