Dissociative Disorders

Dissociative Disorders

Table of Contents

Dissociative disorder (DD) refers to a set of psychological conditions with mental and physical complications and symptoms. The disorder can impair cognitive functioning and affect oneโ€™s quality of life.

What Is Dissociative Disorder (DD)?

Dissociative disorders are psychiatric disorders marked by disruptions or problems in emotions, memories, surroundings, identity, perception and behavior. Some forms of DD can develop after certain traumatic experiences and resolve naturally in a few weeks or months, while some other variations can be more severe and last longer. An individual experiencing dissociative symptoms may feel a disconnection between their thoughts and behaviors, memories and identity.

These conditions can be triggered by chronic trauma during childhood and can be used by the person as a coping mechanism to manage difficult memories. One 2016 study [mfn] Brand, B. L., Sar, V., Stavropoulos, P., Krรผger, C., Korzekwa, M., Martรญnez-Taboas, A., & Middleton, W. (2016). Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder. Harvard review of psychiatry, 24(4), 257โ€“270. https://doi.org/10.1097/HRP.0000000000000100 [/mfn] claims that the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), particularly placed the chapter on DD immediately after the chapter on trauma- and stressor-related disorders, โ€œthereby acknowledging the relationship of the dissociative disorders to psychological trauma.โ€ The symptoms can even worsen temporarily when the sufferer experiences chronic stress and anxiety.

According to a 2011 study [mfn] Burger, H. (2011). Epidemiology of dissociative disorders: An overview. Publishing Open Access research journals & papers | Hindawi. https://www.hindawi.com/journals/eri/2011/404538/#conclusions [/mfn] , dissociation leads to disrupted identity, memory, consciousness and perception of reality. โ€œDissociative disorders constitute a group of clinical syndromes covering disturbances attributed to one or more of these domains. Dissociation may be sudden or gradual, transient, or chronic,โ€ adds the study. People suffering from DD experience persistent disconnection or dissociation from their reality or from themselves. It is a chronic state of mind characterized by feelings of detachment from the inner and/or outer worlds and may involve memory loss and alternate identities. As they become disconnected from their consciousness, sufferers can experience a wide range of cognitive and other mental impairments which can affect their daily functioning.

As mentioned earlier, dissociative disorder can involve different mental conditions [mfn] Kihlstrom JF. Dissociative disorders. Annu Rev Clin Psychol. 2005;1:227-53. doi: 10.1146/annurev.clinpsy.1.102803.143925. PMID: 17716088. [/mfn] such as dissociative identity disorder, dissociative amnesia, depersonalisation disorder and dissociative fugue. However, the condition can be treated effectively under the guidance of a mental health professional through a combination of therapy and medication. Moreover, some self-help and coping strategies can also be helpful.

Prevalence Of Dissociative Disorder

Research [mfn] Hunter EC, Sierra M, David AS. The epidemiology of depersonalisation and derealisation. A systematic review. Soc Psychiatry Psychiatr Epidemiol. 2004 Jan;39(1):9-18. doi: 10.1007/s00127-004-0701-4. PMID: 15022041. [/mfn] reveals that approximately 74% of the population have experienced dissociative symptoms at least once in their lifetime, while about 66% have experienced derealization or depersonalization after experiencing a traumatic event. However, only 2% of the population tend to experience repeated episodes. It was also found that around 82.6% of people with panic disorder are also likely to suffer from DD. All age groups from different backgrounds get affected and women are much more likely to be diagnosed than men.

Symptoms Of Dissociative Disorder

Dissociative disorder is a type of illness that may contribute to physical and mental health problems. Sometimes as a result of traumatic life experiences, certain types of dissociative disorder can be short-term or temporary and they go away after a few weeks or months while some can last much longer as well. Depersonalization and derealization [mfn] Hunter EC, Sierra M, David AS. The epidemiology of depersonalisation and derealisation. A systematic review. Soc Psychiatry Psychiatr Epidemiol. 2004 Jan;39(1):9-18. doi: 10.1007/s00127-004-0701-4. PMID: 15022041. [/mfn] are some of the most common symptoms of these disorders.

Depersonalization refers to feelings of being detached from self and derealization refers to feelings of being detached from the environment or reality. Dissociation can manifest itself in the form of wandering, spacing out, or glazed eyes, acting in a different way, with a different tone of voice or movements. The sudden change in feelings or responses to an event quickly, such as being scared and timid, then becoming bombastic and threatening is a way of dissociation.

Some of the other common signs and symptoms of DD include:

  • Impaired sense of self and identity or identity confusion
  • Feeling disappointed and useless with no reason at all
  • Feeling disconnected from the world and people around them
  • Loss of memory or amnesia and memory lapses regarding personal information, people or events
  • Emotional numbness
  • Distorted and inaccurate perceptions regarding people, things and places
  • Difficulty with emotional regulation
  • Inability to cope with stress
  • Out-of-body experiences, depersonalization or derealization
  • Struggling with mental illness like anxiety, depression & suicidality
  • Feeling no or little physical pain
  • Unexpected and sudden mood swings and changes in behavior
  • Difficulty concentrating
  • Experiencing distinct and multiple identities
  • Problems in relationships, career and personal life

Types Of Dissociative Disorder

Dissociative disorder can be primarily categorized into five main types, namely dissociative amnesia, depersonalization disorder, dissociative fugue, dissociative identity disorder and dissociative disorder not otherwise specified (DDNOS). Here is a closer look at some of these types of DD:

1. Dissociative Amnesia

Also called psychogenic amnesia, it is a condition where a person is unable to remember essential details from their past. According to studies [mfn] Staniloiu, A., & Markowitsch, H. J. (2012). The remains of the day in dissociative amnesia. Brain sciences, 2(2), 101โ€“129. https://doi.org/10.3390/brainsci2020101 [/mfn] , sufferers may experience perceived distress in dissociative amnesia due to memory loss and the degree of that distress is influenced by their cultural perception of their own identity and their past experiences. This condition is very dissimilar to being forgetful and is shaped by emotional trauma [mfn] Joseph R. The neurology of traumatic “dissociative” amnesia: commentary and literature review. Child Abuse Negl. 1999 Aug;23(8):715-27. doi: 10.1016/s0145-2134(99)00048-4. PMID: 10477233. [/mfn] or stressful events in the past. Dissociative amnesia can be further categorized into 3 types:

  • Localized amnesia: Inability to remember a traumatic event or a certain time period
  • Selective amnesia: Inability to remember details about a traumatic event or a time period
  • Generalized amnesia: Inability to remember details about their entire life history

โ€œDissociative amnesia is a disorder characterized by retrospectively reported memory gaps. These gaps involve an inability to recall personal information, usually of a traumatic or stressful nature,โ€ explains a 2006 study [mfn] Leong, S., Waits, W., & Diebold, C. (2006). Dissociative Amnesia and DSM-IV-TR Cluster C Personality Traits. Psychiatry (Edgmont (Pa. : Township[/mfn], 3(1), 51โ€“55. [/mfn] . Amnesia episodes can last for minutes or hours for some, while it can sustain for months or years for some other people. It can cause significant functional impairment [mfn] Staniloiu A, Markowitsch HJ. Dissociative amnesia. Lancet Psychiatry. 2014 Aug;1(3):226-41. doi: 10.1016/S2215-0366(14)70279-2. Epub 2014 Jul 2. PMID: 26360734. [/mfn] , if left untreated.

2. Depersonalization-derealization disorder

This type of dissociative disorder can cause episodes of detachment or disassociation making the person feel that they are watching a movie about themselves. They feel detached from their own thoughts, feelings and actions and observe themselves as a mentally separate individual (depersonalization [mfn] Heydrich, L., Marillier, G., Evans, N., Seeck, M., & Blanke, O. (2019). Depersonalization- and derealization-like phenomena of epileptic origin. Annals of clinical and translational neurology, 6(9), 1739โ€“1747. https://doi.org/10.1002/acn3.50870 [/mfn] ). The sufferer feels like they are simply an observer in their own life instead of being a participant.

Moreover, they may also believe that their friends and family, other people, their environment and the world they live in may not be real (derealization). A 2004 study [mfn] Simeon D. Depersonalisation disorder: a contemporary overview. CNS Drugs. 2004;18(6):343-54. doi: 10.2165/00023210-200418060-00002. PMID: 15089102. [/mfn] explains โ€œDepersonalisation disorder is characterised by prominent depersonalisation and often derealisation, without clinically notable memory or identity disturbances.โ€

The symptoms [mfn] Michal, M., Adler, J., Wiltink, J., Reiner, I., Tschan, R., Wรถlfling, K., Weimert, S., Tuin, I., Subic-Wrana, C., Beutel, M. E., & Zwerenz, R. (2016). A case series of 223 patients with depersonalization-derealization syndrome. BMC psychiatry, 16, 203. https://doi.org/10.1186/s12888-016-0908-4 [/mfn] can be deeply distressing and can last from a few minutes to months or years. They may have difficulty with memory & concentration and feel out of control at times. Depersonalization-derealization disorder is also closely related to depression & anxiety disorders, according to research [mfn] Michal M, Beutel ME. Depersonalisation/Derealisation- Krankheitsbild, Diagnostik und Therapie [Depersonalisation/derealization – clinical picture, diagnostics and therapy]. Z Psychosom Med Psychother. 2009;55(2):113-40. German. doi: 10.13109/zptm.2009.55.2.113. PMID: 19402018. [/mfn] . Age of onset can be early childhood but most patients tend to experience the symptoms by the age of 16. A recent 2020 study [mfn] Bรผetiger, J. R., Hubl, D., Kupferschmid, S., Schultze-Lutter, F., Schimmelmann, B. G., Federspiel, A., Hauf, M., Walther, S., Kaess, M., Michel, C., & Kindler, J. (2020). Trapped in a Glass Bell Jar: Neural Correlates of Depersonalization and Derealization in Subjects at Clinical High-Risk of Psychosis and Depersonalization-Derealization Disorder. Frontiers in psychiatry, 11, 535652. https://doi.org/10.3389/fpsyt.2020.535652 [/mfn] explains that depersonalization & derealization are primarily symptoms of perceptual integration impairment that causes โ€œan altered quality of subjective experiences such as feelings of unreality and detachment from the self or the surroundings.โ€

3. Dissociative fugue

Alternatively called psychogenic fugue [mfn] Coons PM. Psychogenic or dissociative fugue: a clinical investigation of five cases. Psychol Rep. 1999 Jun;84(3 Pt 1):881-6. doi: 10.2466/pr0.1999.84.3.881. PMID: 10408212. [/mfn] or fugue state, it is regarded as a variation of dissociative amnesia. It is a rare [mfn] Raval, C. M., Upadhyaya, S., & Panchal, B. N. (2015). Dissociative fugue: Recurrent episodes in a young adult. Industrial psychiatry journal, 24(1), 88โ€“90. https://doi.org/10.4103/0972-6748.160944 [/mfn] and severe mental illness marked by varying and unstable amnesia related to personality, memories, identity and other traits associated with self. According to a 2013 study [mfn] Igwe M. N. (2013). Dissociative fugue symptoms in a 28-year-old male Nigerian medical student: a case report. Journal of medical case reports, 7, 143. https://doi.org/10.1186/1752-1947-7-143 [/mfn] , โ€œDissociative fugue is a psychiatric disorder characterized by amnesia coupled with sudden unexpected travel away from the individualโ€™s usual surroundings and denial of all memory of his or her whereabouts during the period of wandering.โ€ The condition [mfn] Mamarde, A., Navkhare, P., Singam, A., & Kanoje, A. (2013). Recurrent dissociative fugue. Indian journal of psychological medicine, 35(4), 400โ€“401. https://doi.org/10.4103/0253-7176.122239 [/mfn] develops due to excessive psychological trauma or other medical conditions. The sufferer may experience memory loss and forget information related to their personal history and individuality.

As the person may suddenly lose memories [mfn] Clouden T. A. (2020). Dissociative Amnesia and Dissociative Fugue in a 20-Year-Old Woman With Schizoaffective Disorder and Post-Traumatic Stress Disorder. Cureus, 12(5), e8289. https://doi.org/10.7759/cureus.8289 [/mfn] related to their past, they feel the need to develop a new identity. However, they may not be aware of their memory loss. They may even travel long distances during episodes which can leave them feeling confused once the fugue state is lifted. An episode can last between a few hours and a few months. Hence, the sufferer may not have any idea about their new identity once they get out of a dissociative fugue episode.โ€œDissociative fugue is a rare disorder which has been described as sudden, unexpected, travel away from home or one’s customary place of daily activities, with the inability to recall some or all of one’s past,โ€ explains a 2015 study [mfn] Raval CM, Upadhyaya S, Panchal BN. Dissociative fugue: Recurrent episodes in a young adult. Ind Psychiatry J. 2015 Jan-Jun;24(1):88-90. doi: 10.4103/0972-6748.160944. PMID: 26257491; PMCID: PMC4525440. [/mfn] .

4. Dissociative identity disorder (DID)

According to researchers [mfn] Mitra P, Jain A. Dissociative Identity Disorder. [Updated 2021 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568768/ [/mfn] , โ€œDissociative identity disorder (DID) is a rare disorder associated with severe behavioral health symptoms. DID was previously known as Multiple Personality Disorder (MPD) till 1994.โ€ Also identified as split personality, this psychological condition is marked by at least 2 separate and reasonably stable personality states and involves switching from one identity or personality to another alternate identity.

The person may experience memory gaps during episodes. Patients can also feel as if they are under possession by other, more dominating identities. The alternate identities tend to have separate names, characteristics, behavior, mannerisms, mindset, body language, voice tone, memories and even certain physical qualities. An individual with dissociative identity disorder may also experience symptoms of dissociative fugue and dissociative amnesia.

The prevalence of this form of dissociative disorder is about 0.1-1% of the general population [mfn] Priya, S. S., & Siva, N. (2013). Dissociative identity disorder: An uncommon psychiatric disorder reported. Indian journal of psychiatry, 55(4), 403โ€“404. https://doi.org/10.4103/0019-5545.120565 [/mfn] and most patients are often misdiagnosed as borderline personality disorder, schizophrenia etc. Studies [mfn] Dorahy MJ, Brand BL, Sar V, Krรผger C, Stavropoulos P, Martรญnez-Taboas A, Lewis-Fernรกndez R, Middleton W. Dissociative identity disorder: An empirical overview. Aust N Z J Psychiatry. 2014 May;48(5):402-17. doi: 10.1177/0004867414527523. PMID: 24788904. [/mfn] have found that the condition may be caused by a โ€œcomplex combinationโ€ of cultural and developmental factors, such as childhood trauma, abuse, attachment styles etc. Individuals suffering from DID tend to be hyper sensitive towards rejection issues and interpersonal trust, which can create challenges in treatment [mfn] Gillig P. M. (2009). Dissociative identity disorder: a controversial diagnosis. Psychiatry (Edgmont (Pa. : Township[/mfn], 6(3), 24โ€“29. [/mfn] . If left untreated, a patient can develop self-injurious behavior, substance use disorders and even suicidal thoughts and behaviors.

Causes Of Dissociative Disorder

Although the specific cause for the onset of this disorder has not yet been identified, mental health experts believe that a combination of different factors may influence the development of this condition. Here are some of the factors that may influence the onset of dissociative disorder:

1. Traumatic experiences

Research [mfn] Spiegel, D., Loewenstein, R. J., Star, V., & Kewis-fenandez, R. (2011). (PDF) Dissociative disorders in DSM5DMS (Vol 28, PG E17, 2011). ResearchGate. https://www.researchgate.net/publication/279040156_Dissociative_disorders_in_DSM5DMS_vol_28_pg_E17_2011 [/mfn] shows that these disorders are primarily caused by repetitive and overwhelming trauma experienced during early childhood. Childhood abuse, whether emotional, physical or sexual, can increase the likelihood of DD. As the person becomes unable to overcome or forget the horrifying experiences, they tend to lose the ability to understand what is happening around them.

Moreover, children are often ill-equipped to process abuse or trauma and lack the right coping skills unlike knowledgeable adults. This can also be influenced by a lack of support, caring and unhealthy attachments. One study [mfn] Middleton, W., & Butler, J. (1998). Dissociative identity disorder: An Australian series. Australian & New Zealand Journal of Psychiatry, 32(6), 794-804. https://doi.org/10.3109/00048679809073868 [/mfn] states that this is a โ€œcomplex syndrome associated with a history of severe ongoing developmental trauma dating from early childhood.โ€ Apart from childhood trauma, dissociative disorders can also emerge due to a previous traumatic experience during adulthood such as war, natural disaster, crime, kidnapping, a fatal accident etc.

Such experiences can compel a person to โ€œdisassociateโ€ from their reality, especially in times of severe stress. Detachment and reconnection serves as a natural defence mechanism and acts as a type of denial, as the mind tries to cope with the traumatic events or experiences. Although denial is normal for most people when facing a trauma, DD patients tend to remain disconnected even when the traumatic event has passed.

2. Genetics

Dissociative disorder may have genetic predisposition [mfn] Wolf, E. J., Rasmusson, A. M., Mitchell, K. S., Logue, M. W., Baldwin, C. T., & Miller, M. W. (2014). A genome-wide association study of clinical symptoms of dissociation in a trauma-exposed sample. Depression and anxiety, 31(4), 352โ€“360. https://doi.org/10.1002/da.22260 [/mfn] and may run in families. You may have a high risk of developing DD, if your parents, siblings or relatives experienced either types of dissociative disorders or associated conditions. One 2004 study [mfn] Becker-Blease KA, Deater-Deckard K, Eley T, Freyd JJ, Stevenson J, Plomin R. A genetic analysis of individual differences in dissociative behaviors in childhood and adolescence. J Child Psychol Psychiatry. 2004 Mar;45(3):522-32. doi: 10.1111/j.1469-7610.2004.00242.x. PMID: 15055371. [/mfn] found that genetic factors may possibly โ€œcontribute to dissociative tendencies in children and adolescents.โ€ Another 2011 study [mfn] Pieper S, Out D, Bakermans-Kranenburg MJ, van Ijzendoorn MH. Behavioral and molecular genetics of dissociation: the role of the serotonin transporter gene promoter polymorphism (5-HTTLPR). J Trauma Stress. 2011 Aug;24(4):373-80. doi: 10.1002/jts.20659. Epub 2011 Jul 21. PMID: 21780190. [/mfn] found that the people with SS genotype of 5-HTTLPR tend to have more higher dissociative symptoms than people with other genotypes.

3. Stress

Excessive stress [mfn] Gentile, J. P., Snyder, M., & Marie Gillig, P. (2014). STRESS AND TRAUMA: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder. Innovations in clinical neuroscience, 11(7-8), 37โ€“41. [/mfn] , overthinking and worrying about certain issues including family problems, exam tension or relationship stress can also contribute to the onset of this condition. According to a 2018 study [mfn] Sperandeo, R., Monda, V., Messina, G., Carotenuto, M., Maldonato, N. M., Moretto, E., Leone, E., De Luca, V., Monda, M., & Messina, A. (2017). Brain functional integration: an epidemiologic study on stress-producing dissociative phenomena. Neuropsychiatric disease and treatment, 14, 11โ€“19. https://doi.org/10.2147/NDT.S146250 [/mfn] , prolonged exposure to stressful experiences can result in dissociative phenomena. โ€œMental disorders and psychopathologic experiences of patients can configure the chronic stress condition that produces functional damage to the adaptive executive system,โ€ adds the study.

Comorbid Conditions

A patient with dissociative disorder can also suffer from a number of other co-occurring mental health illnesses, such as:

1. Depression

Research [mfn] Molina-Serrano A, Linotte S, Amat M, Souery D, Barreto M. Dissociation in major depressive disorder: a pilot study. J Trauma Dissociation. 2008;9(3):411-21. doi: 10.1080/15299730802139311. PMID: 19042786. [/mfn] shows that depression is associated with dissociative disorders and around 7% of people with major depressive disorder (MDD) tend to suffer from dissociative symptoms. It found that DD can manifest during MDD and may influence the course of depression. โ€œThese findings indicate that dissociative phenomena should not be overlooked in MDD,โ€ add the researchers. One 2016 study [mfn] Prasko, J., Grambal, A., Kasalova, P., Kamardova, D., Ociskova, M., Holubova, M., Vrbova, K., Sigmundova, Z., Latalova, K., Slepecky, M., & Zatkova, M. (2016). Impact of dissociation on treatment of depressive and anxiety spectrum disorders with and without personality disorders. Neuropsychiatric disease and treatment, 12, 2659โ€“2676. https://doi.org/10.2147/NDT.S118058 [/mfn] found that dissociation can significantly influence the โ€œtreatment effectivenessโ€ of depression and anxiety. Another 2020 study [mfn] Pettorruso, M., d’Andrea, G., Martinotti, G., Cocciolillo, F., Miuli, A., Di Muzio, I., Collevecchio, R., Verrastro, V., De-Giorgio, F., Janiri, L., di Giannantonio, M., Di Giuda, D., & Camardese, G. (2020). Hopelessness, Dissociative Symptoms, and Suicide Risk in Major Depressive Disorder: Clinical and Biological Correlates. Brain sciences, 10(8), 519. https://doi.org/10.3390/brainsci10080519 [/mfn] found a positive correlation between dissociative symptoms, hopelessness and suicidality.

Read More About Major Depressive Disorder ( Depression ) Here

2. Post-Traumatic Stress Disorder (PTSD)

PTSD [mfn] Mann SK, Marwaha R. Posttraumatic Stress Disorder. [Updated 2021 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559129/ [/mfn] is a debilitating mental condition that occurs as a result of being subjected to actual or threatened harm, death, or sexual abuse. It’s linked to both functional and cognitive issues. DD and PTSD are closely associated. In fact, a dissociative subtype [mfn] van Huijstee J, Vermetten E. The Dissociative Subtype of Post-traumatic Stress Disorder: Research Update on Clinical and Neurobiological Features. Curr Top Behav Neurosci. 2018;38:229-248. doi: 10.1007/7854_2017_33. PMID: 29063485. [/mfn] of post-traumatic stress disorder is incorporated in American Psychiatric Associationโ€™s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Reports [mfn] Kim, D., Kim, D., Lee, H., Cho, Y., Min, J. Y., & Kim, S. H. (2019). Prevalence and clinical correlates of dissociative subtype of posttraumatic stress disorder at an outpatient trauma clinic in South Korea. European journal of psychotraumatology, 10(1), 1657372. https://doi.org/10.1080/20008198.2019.1657372 [/mfn] show that dissociative subtype of posttraumatic stress disorder (d-PTSD) has a high prevalence in a clinical population. Another 2018 study [mfn] Burton, M. S., Feeny, N. C., Connell, A. M., & Zoellner, L. A. (2018). Exploring evidence of a dissociative subtype in PTSD: Baseline symptom structure, etiology, and treatment efficacy for those who dissociate. Journal of consulting and clinical psychology, 86(5), 439โ€“451. https://doi.org/10.1037/ccp0000297 [/mfn] found that the presence of dissociative symptoms in posttraumatic stress disorder can influence treatment of PTSD.

Read More About Post-Traumatic Stress Disorder Here

3. Suicidal tendencies or self harm

Most patients with DD are prone to self-injury and suicidal behavior [mfn] Calati R, Bensassi I, Courtet P. The link between dissociation and both suicide attempts and non-suicidal self-injury: Meta-analyses. Psychiatry Res. 2017 May;251:103-114. doi: 10.1016/j.psychres.2017.01.035. Epub 2017 Jan 17. PMID: 28196773. [/mfn] . According to a 2008 study [mfn] Foote B, Smolin Y, Neft DI, Lipschitz D. Dissociative disorders and suicidality in psychiatric outpatients. J Nerv Ment Dis. 2008 Jan;196(1):29-36. doi: 10.1097/NMD.0b013e31815fa4e7. PMID: 18195639. [/mfn] , โ€œit is common for patients with dissociative disorders to report a history of suicide attempts.โ€ However, the study found that suicidal patients usually tend to have multiple diagnoses along with DD, such as posttraumatic stress disorder (PTSD), borderline personality disorder, substance use etc. One study [mfn] Ross CA, Norton GR. Suicide and parasuicide in multiple personality disorder. Psychiatry. 1989 Aug;52(3):365-71. doi: 10.1080/00332747.1989.11024458. PMID: 2772094. [/mfn] found that about 70% of patients with dissociative identity disorder (DID) tend to have self-harm and suicidality as a symptom. Suicide attempts and self-injurious behaviors can also be observed in adolescents [mfn] Kฤฑlฤฑรง, F., CoลŸkun, M., Bozkurt, H., Kaya, ฤฐ., & ZoroฤŸlu, S. (2017). Self-Injury and Suicide Attempt in Relation with Trauma and Dissociation among Adolescents with Dissociative and Non-Dissociative Disorders. Psychiatry investigation, 14(2), 172โ€“178. https://doi.org/10.4306/pi.2017.14.2.172 [/mfn] with dissociation and trauma.

Apart from these, dissociative disorders are also associated with some other psychiatric disorders such as –

  • Anxiety
  • Panic attacks
  • Personality disorders
  • Sexual dysfunction
  • Substance use disorder
  • Sleep disorders
  • Eating disorders

In fact, dissociative identity disorder (DID) or multiple personality disorder (MPD) โ€œcan be found comorbid with many other psychiatric conditions,โ€ revealed one study [mfn] Fink D. The comorbidity of multiple personality disorder and DSM-III-R axis II disorders. Psychiatr Clin North Am. 1991 Sep;14(3):547-66. PMID: 1946024. [/mfn] .

Read More About Eating Disorders Here

Diagnosis Of Dissociative Disorder

Diagnosis is typically made only when the symptoms of the patient meet the criteria of diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. The rising prevalence of dissociative disorders has resulted in the development of a number of diagnostic techniques [mfn] Allen JG, Smith WH. Diagnosing dissociative disorders. Bull Menninger Clin. 1993 Summer;57(3):328-43. PMID: 8401385. [/mfn] .

Healthcare experts typically use a variety of modern approaches, including screening instruments, formal interviews, psychological examination, and hypnosis, as well as the importance of including the patient as an active participant in the evaluation process. Diagnosis normally entails evaluating symptoms and sorting out any medical conditions that could be causing them. The evaluation includes:

1. Psychiatric exam

While discussing the symptoms the therapists may ask questions about the patientโ€™s thoughts and feelings to better understand their emotional and mental states. The doctor may also evaluate the patientโ€™s family history, medical history and ask questions about their childhood and personal history as well.

2. Physical Exam

A doctor may conduct certain physical tests, such as lab tests or blood tests, to determine if the symptoms are caused by any underlying conditions. This is important as certain physical healthy issues like head injury, brain diseases, sleep deprivation or substance use can cause symptoms, such as memory loss and a sense of unreality. After the doctor has ruled out other causes, they will analyze the patientโ€™s case in detail and devise a treatment plan. Treatment process may vary if the patient has a dual diagnosis and suffers from other psychiatric conditions other than DD.

Treatment Of Dissociative Disorder

Dissociative disorders can be treated effectively with different treatment approaches involving psychotherapies and medications. However, patients and their family members need to be patient as complete recovery may take several years.

Some of the common treatment approaches for dissociative disorder includes the following:

1. Psychotherapy

Therapy, also known as talk therapy, can enable the sufferers to gain better control over themselves and their lives by managing the symptoms and the dissociative process. Psychotherapy [mfn] Gentile JP, Dillon KS, Gillig PM. Psychotherapy and pharmacotherapy for patients with dissociative identity disorder. Innov Clin Neurosci. 2013 Feb;10(2):22-9. PMID: 23556139; PMCID: PMC3615506. [/mfn] focuses on different aspects of identity and thought processes and aims to help the patient cope with and overcome past trauma. According to a 2013 study [mfn] Gentile, J. P., Dillon, K. S., & Gillig, P. M. (2013). Psychotherapy and pharmacotherapy for patients with dissociative identity disorder. Innovations in clinical neuroscience, 10(2), 22โ€“29. [/mfn] , โ€œPsychotherapy is the cornerstone of a multidisciplinary treatment plan for dissociative disorders and other trauma-related disorders and must be incorporated into the interventional strategy.โ€

Mental health professionals typically recommend cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) for DD treatment. Both these therapies help to cope with the sufferersโ€™ conscious intellectual actions and behavior. Studies [mfn]Subramanyam, A. A., Somaiya, M., Shankar, S., Nasirabadi, M., Shah, H. R., Paul, I., & Ghildiyal, R. (2020). Psychological Interventions for Dissociative disorders. Indian journal of psychiatry, 62(Suppl 2), S280โ€“S289. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_777_19 [/mfn] reveal that cognitive behavioral therapy can be an effective psychological intervention for dissociative disorders.

Apart from these, hypnosis and Eye Movement Desensitization and Reprocessing (EMDR) can also be used as effective treatment approaches for better recovery. Research [mfn] Mitra P, Jain A. Dissociative Identity Disorder. [Updated 2021 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568768/ [/mfn] shows that hypnosis can be highly effective for DD, especially for DID patients. It was also observed that such patients are โ€œconsidered autohypnotic.โ€ EMDR [mfn] Fine CG, Berkowitz AS. The wreathing protocol: the imbrication of hypnosis and EMDR in the treatment of dissociative identity disorder and other dissociative responses. Eye Movement Desensitization Reprocessing. Am J Clin Hypn. 2001 Jan-Apr;43(3-4):275-90. doi: 10.1080/00029157.2001.10404282. PMID: 11269630. [/mfn] can also prove to be beneficial in the recovery process as it focuses on improving memories associated with trauma and abuse, which influence the development of psychological disorders.

2. Medication

There are no specific medications for the treatment of dissociative disorders. Doctors might suggest some antidepressants or antipsychotic drugs to control symptoms of other mental illnesses, like anxiety and depression, connected with dissociative disorder.

3. Self-help strategies

As stress and trauma plays a crucial role in the onset of dissociative disorders, certain copings strategies can help in the recovery process. Here are certain self-help strategies that can be helpful:

  • Talking to a trusted friend or family member openly about any issues or problems
  • Seeking professional help and consulting a doctor
  • Joining a support group

Coping With Dissociative Disorder

Dissociation is considered as a natural coping mechanism [mfn] Sharma, T., Sinha, V. K., & Sayeed, N. (2016). Role of mindfulness in dissociative disorders among adolescents. Indian journal of psychiatry, 58(3), 326โ€“328. https://doi.org/10.4103/0019-5545.192013 [/mfn] used by the mind for dealing with trauma, abuse, high stress levels, and also as an avoidant knowledge acquisition method. Apart from therapy and medications, here are some simple strategies for dealing with the condition and recover:

1. Mindfulness

Mindfulness can be beneficial in minimizing dissociation and facilitating adaptive functioning [mfn] Sharma, T., Sinha, V. K., & Sayeed, N. (2016). Role of mindfulness in dissociative disorders among adolescents. Indian journal of psychiatry, 58(3), 326โ€“328. https://doi.org/10.4103/0019-5545.192013 [/mfn] in clinical practise. By increasing understanding of dissociative processes, mindfulness can help anticipate and manage dissociation. Mindfulness-based interventions may thus be beneficial in addressing dissociative pathology [mfn] Sharma, T., Sinha, V. K., & Sayeed, N. (2016). Role of mindfulness in dissociative disorders among adolescents. Indian journal of psychiatry, 58(3), 326โ€“328. https://doi.org/10.4103/0019-5545.192013 [/mfn] and facilitating healthy development.

2. Healthy eating habits

Having a balanced nutritious diet [mfn] Bremner, J. D., Moazzami, K., Wittbrodt, M. T., Nye, J. A., Lima, B. B., Gillespie, C. F., Rapaport, M. H., Pearce, B. D., Shah, A. J., & Vaccarino, V. (2020). Diet, Stress and Mental Health. Nutrients, 12(8), 2428. https://doi.org/10.3390/nu12082428 [/mfn] is very essential for recovering from dissociative disorder. It is important to eat nutritious food and avoid junk food, alcohol and nicotine in order to recover faster.

3. Exercise

Regular physical activity can also help a person to deal with and alleviate symptoms of DD. Research [mfn] Zschucke, E., Gaudlitz, K., & Strรถhle, A. (2013). Exercise and physical activity in mental disorders: clinical and experimental evidence. Journal of preventive medicine and public health = Yebang Uihakhoe chi, 46 Suppl 1(Suppl 1), S12โ€“S21. https://doi.org/10.3961/jpmph.2013.46.S.S12 [/mfn] shows that psychiatric patients engaging in regular exercise reported better mental health outcomes and higher quality of life in a cross sectional study.

4. Adequate sleep

Getting enough sleep [mfn] Scott, A. J., Webb, T. L., & Rowse, G. (2017). Does improving sleep lead to better mental health? A protocol for a meta-analytic review of randomised controlled trials. BMJ open, 7(9), e016873. https://doi.org/10.1136/bmjopen-2017-016873 [/mfn] for around 7-9 hours every day is required so that one can calm their mind. It can help to overcome stress, anxiety and overthinking.

5. Socialize

Regularly socializing with friends and family is also important for developing a healthy mindset and being grounded with your reality. As social withdrawal and isolation [mfn] Wang, J., Lloyd-Evans, B., Giacco, D., Forsyth, R., Nebo, C., Mann, F., & Johnson, S. (2017). Social isolation in mental health: a conceptual and methodological review. Social psychiatry and psychiatric epidemiology, 52(12), 1451โ€“1461. https://doi.org/10.1007/s00127-017-1446-1 [/mfn] can worsen the symptoms so make sure to talk with others and keep yourself busy.

Recovery Is Possible

Appropriate treatment can help the sufferer to manage symptoms of dissociative disorder, enhance their functioning abilities and help them live a more fulfilling & productive life. Once the patient is committed to getting better, then with the help of therapies, healthy lifestyle and support of family members, the patient can overcome all the shortcomings on the way. The process might be long but with patience it will all pass and the outcome will be revealed.

Dissociative Disorder At A Glance

  1. Dissociative Disorders (DD) are marked by disruptions or problems in emotions, memories, surroundings, identity, perception and behavior.
  2. Approximately 74% of the population have experienced dissociative symptoms at least once in their lifetime.
  3. Women are much more likely to be diagnosed than men.
  4. These conditions can be triggered by chronic trauma during childhood and can be used by the person as a coping mechanism to manage difficult memories.
  5. People suffering from DD experience persistent disconnection or dissociation from their reality or from themselves.
  6. The condition can be treated effectively under the guidance of a mental health professional through a combination of therapy and medication.
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