Dissociative Disorders

What is a dissociative disorder?

Dissociative disorders involve problems with memory, identity, sense of self, perception, emotion, and behavior. Symptoms of a dissociative disorder include the experience of feeling detached from reality, feeling outside one’s body, and a loss of memory or amnesia. Dissociative disorders are frequently associated with previous experiences of trauma.

There are several different diagnostic categories of dissociative disorders. These include:

  • Depersonalization or Derealization
  • Dissociative Identity Disorder
  • Dissociative Amnesia
  • Other Specified Dissociative Disorder
  • Unspecified Dissociative Disorder
What is Depersonalization or Derealization Disorder?

A person with depersonalization disorder feels persistently or repeatedly detached or estranged from one’s self. Patients with this condition may report feeling like they are on automatic pilot or as if they are watching themselves in a movie. Similar to this is derealization disorder, when a person feels detached from their environment or detached from reality.  A person may feel a lack of connection and emotion with the outside world, as if they are dreaming or in a trance. 

Temporary experiences of depersonalization and derealization are extremely common in normal populations. In fact, they are the third most commonly reported psychiatric symptoms, after depression and anxiety.

What causes Depersonalization or Derealization Disorder?

Approximately one-third to one-half of patients with depersonalization disorder report histories of significant trauma. Among accident victims, as many as 60 percent with a life-threatening experience report at least transient depersonalization during the event or immediately after it. Military training studies find that symptoms of depersonalization and derealization are commonly caused by stress and fatigue.

Symptoms of depersonalization disorder are also common in:

  • Seizure patients and migraine sufferers
  • After mild to moderate head injury, when little or no loss of consciousness occurs, but are much less likely if unconsciousness lasts for more than 30 minutes. lasts for more than 30 minutes.
  • After life-threatening experiences, with or without serious bodily injury

They can also occur:

  • As a result of a medical condition or neurological condition
  • After intoxication or withdrawal from illicit drugs, including marijuana, cocaine, LSD, mescaline, and other psychostimulants.
  • As a side effect of medications, such as anticholinergic agents
  • As a symptom of panic attacks, PTSD, acute stress disorder, phobias, schizophrenia, or other dissociative disorder
What are the treatments for Depersonalization or Derealization Disorder?

Patients with depersonalization/derealization disorder are often challenging to treat. Many different types of psychotherapy have been used to treat depersonalization disorder, including psychodynamic, cognitive, cognitive-behavioral, hypnotherapy, and supportive therapy. However, many patients do not have a strong response to these types of standard psychotherapy. Stress management strategies, distraction techniques, reduction of sensory stimulation, relaxation training, and physical exercise may be somewhat helpful in some patients.

As far as pharmacotherapy, there are mixed results. Some evidence indicates that SSRI antidepressants, such as fluoxetine (Prozac), may be helpful. Recent studies, however, found no efficacy for fluvoxamine (Luvox) and lamotrigine (Lamictal) for depersonalization disorder. Some patients with depersonalization disorder respond sporadically and partially to the usual groups of psychiatric medications, singly or in combination: antidepressants, mood stabilizers, typical and atypical neuroleptics, anticonvulsants, etc.

What is Dissociative Identity Disorder (Multiple Personality Disorder)?

Dissociative identity disorder, formerly known as multiple personality disorder, is a complex psychological condition characterized by two or more distinct personality states. The disruption in identity involves a marked separation from a person’s sense of self, accompanied by changes in affect, behavior, thoughts, consciousness, memory, perception, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

A person with this condition has recurrent gaps in the recall of everyday events, personal information, and/or traumatic events that are inconsistent with ordinary forgetting. The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures). In children, the symptoms are not better explained by imaginary playmates or other fantasy play.

What causes Dissociative Identity Disorder?

Dissociative identity disorder is strongly linked to sever experiences of early childhood trauma, usually abuse. Physical and sexual abuses are the most frequently reported sources of childhood trauma. The disorder is thought to be more common during natural disasters, wartime, or times of major social dislocation.

What are the treatments for Dissociative Identity Disorder?

Various types of treatment approaches may be required to treat a patient with dissociative identity disorders. Options include psychoanalytic psychotherapy, cognitive therapy, behavioral therapy, hypnotherapy, electroconvulsive therapy, group therapy, family therapy, self-help groups, art therapy, movement therapy, and eye movement desensitization and reprocessing. Pharmacotherapy often includes antidepressant and anti-anxiety medications to treat depression and PTSD symptoms.

What is Dissociative Amnesia?

Dissociative amnesia is an inability to recall important biographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Dissociative amnesia is reported in approximately 2 to 6 percent of the general population. The forgetting may be limited to a specific event or events, or resemble more of a general amnesia, aswhen someone forgets their identity and life history. A diagnosis of dissociative amnesia is given when the symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms cannot be attributable to the physiological effects of a substance (e.g., alcohol, other drug of abuse, or medication) or a neurological or other medical condition. The amnesia also is not better explained by dissociative identity disorder, post-traumatic stress disorder (PTSD), acute stress disorder, somatic symptom disorder, or other neurocognitive condition.

What are the treatments for Dissociative Amnesia?

Treatments that may be helpful for amnesia include cognitive therapy, hypnosis, and group psychotherapy.

Can brainwashing, indoctrination or acute stress cause a dissociative disorder?

Yes. Individuals who have been subjected to intense coercive persuasion may have prolonged changes in, or conscious questioning of, their identity. Examples of situations that can cause this include including brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, and recruitment by sects/cults or terror organizations. Temporary periods of acute stress can also cause changes in consciousness, depersonalization, detachment from reality, perceptual disturbances, short-term amnesia, and/or changes in sensory-motor functioning (e.g., analgesia, paralysis). These types of conditions would be diagnosed as “other specific dissociative disorder.”

What is the diagnosis for Other Specified Dissociative Disorder?

A diagnosis of “other specified dissociative disorder” is given when an individual has symptoms characteristic of a dissociative disorder that cause significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any of specific dissociative disorder. Examples of situations where the “other” designation could be used include:

  • Chronic and recurrent mixed dissociative symptoms. This includes patients who may experience a less severe loss of sense of self or a changed identity with no dissociative amnesia.
  • Identity disturbance due to prolonged and intense coercive persuasion. This may apply to individuals who have been subjected to intense coercive persuasion, including brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, or recruitment by sects/cults or terror organizations.
  • Acute dissociative reactions to stressful events typically lasting less than 1 month, and sometimes only a few days or hours. These conditions are characterized by a change of consciousness, depersonalization, derealization, perceptual changes (e.g., time slowing, macropsia), micro-amnesias, transient stupor, and/or alterations in sensory-motor functioning (e.g., paralysis or inability to feel pain).
  • Dissociative trance, when an individual experiences a narrowing or complete loss of awareness of immediate surroundings.
What is the diagnosis for Unspecified Dissociative Disorder?

A diagnosis of “unspecified dissociative disorder” applies to symptoms characteristic of a dissociative disorder that cause significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any specific dissociative disorder. The unspecified dissociative disorder category is used in situations when there is not enough information to make a more specific diagnosis, such as in emergency room settings.

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Mental Health Library Sources:
Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.
Disclaimer:
Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.
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