DISSOCIATIVE DISORDERS

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.

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 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 amnesia involves not being able to recall information about oneself (not normal forgetting). This amnesia is usually related to a traumatic or stressful event and may be:

o localized – unable to remember an event or period of time (most common type)

o selective – unable to remember a specific aspect of an event or some events within a period of time

o generalized – complete loss of identity and life history (rare)

Dissociative amnesia is associated with having experiences of childhood trauma, and particularly with experiences of emotional abuse and emotional neglect. People may not be aware of their memory loss or may have only limited awareness. And people may minimize the importance of memory loss about a particular event or time.

· 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.

Symptoms of dissociative identity disorder (criteria for diagnosis) include:

The existence of two or more distinct identities (or “personality states”). The distinct identities are accompanied by changes in behavior, memory and thinking. The signs and symptoms may be observed by others or reported by the individual.

Ongoing gaps in memory about everyday events, personal information and/or past traumatic events.

The symptoms cause significant distress or problems in social, occupational or other areas of functioning.

In addition, the disturbance must not be a normal part of a broadly accepted cultural or religious practice. As noted in the DSM-5¹, in many cultures around the world, experiences of being possessed are a normal part of spiritual practice and are not dissociative disorders.

The attitude and personal preferences (for example, about food, activities, clothes) of a person with dissociative identity disorder may suddenly shift and then shift back. The identities happen involuntarily and are unwanted and cause distress. People with dissociative identity disorder may feel that they have suddenly become observers of their own speech and actions, or their bodies may feel different (e.g., like a small child, like the opposite gender, huge and muscular).

· 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.

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.