Dissociative Disorders are conditions that are characterised by problems with memory, perception, identity, behaviour and awareness.
There are both physical and psychological symptoms caused by the disorders. While in many cases Dissociative Disorders are short-lived experiences, it is possible for the conditions to be long-lasting.
Regardless of duration, these disorders can cause significant distress. There are three different types of Dissociative Disorders, named as Dissociative Identity Disorder, Dissociative Amnesia and Depersonalisation Disorder. The three different disorders have some differences.
In many cases, the disorders are caused by some form of psychological trauma, though this isn’t always the case. With the right treatment and support, many people will gain a full recovery from their disorder.
Types of Dissociative Disorders
Dissociation can be defined as a way that the mind copes with too much stress, or a traumatic experience. This can lead to an individual dissociating from the world. There are three different types of Dissociative Disorders – each with their own characteristics:
Dissociative Identity Disorder (Also Known as Multiple Personality Disorder): Dissociative Identity Disorder is characterised by an individual being uncertain about their identity. They will often exhibit other identities – which may have their own name, behaviours and personal history. Gaps in memory will often exist, often as a result of a traumatic event.
Dissociative Amnesia: Dissociative Amnesia involves an individual having gaps in their memory – often leading to them forgetting information about themselves, or a skill that they have learned. It is possible for someone to be somewhere without knowing how or why they got there. This is the most common dissociative disorder, and is often caused by a traumatic event.
Depersonalisation Disorder (Also known as Derealisation Disorder): Depersonalisation Disorder is the condition where an individual will undergo a period of detachment from either themselves, or their surrounding. The individual may lose sensation of what is happening around them, sometimes believing things around them aren’t real. They may feel they are outside their own body.
If particular symptoms don’t fit into one of the above categories, an individual may be diagnosed with Other Specified Dissociative Disorder.
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Symptoms of Dissociative Disorders
The three types of Dissociative Disorders each have their own symptoms. Here we take a look at a few key symptoms of each of the three.
For a more thorough description of the symptoms of Dissociative Disorders, you can read our in-depth article on this at this link [construction].
Dissociative Identity Disorder:
- The existence of two or more distinct identities or personality states. This leads to changes and differences such as behaviour, memories and thoughts.
- Gaps in memory
- Individual may refer to themselves as “we”
- Have occasions where they cannot remember information about themselves or events in the past
- May find themselves in a strange place without knowing why they are there or how they got there in the first place
- May forget a talent or skill that they have learned.
- The person has persistent feelings of both, or either Depersonalisation or Derealisation.
- Depersonalisation is where someone feels separated from their own bodily sensations, thoughts, feelings, emotions and behaviour. The person may believe they aren’t connected to their body, and as such, may feel away from reality.
- Derealisation is the feeling or sense that what is happening around an individual isn’t real. A person may feel they are in a dream. This can cause an individual to feel alienated from those close to them.
- Low mood or anxiety
Across these three disorders, the symptoms will lead to several problems. The disorders all have the potential to cause significant functional impairment – and at the very least, a state of profound confusion.
The disorders can be difficult to live with, making treatment very important to access.
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Causes of Dissociative Disorders
Dissociative Disorders are believed to be caused by experiencing or witnessing a traumatic event, often during childhood.
Switching off from a traumatic experience is a normal action that can help an individual cope with a traumatic event.
When the event isn’t dealt with, it can cause future problems when an individual is confronted by a similar event, environment or circumstance. However, other causes have also been posited:
- Childhood Trauma: Trauma in childhood like neglect, physical, sexual or emotional abuse or witnessing or experiencing a distressing event, can all cause problems. During these traumatic events, the person may dissociate themselves, doing so to allow them to cope with a traumatic event. This process can impact brain development – something that is happening rapidly at the same time.
- Flight or Fight: During a traumatic event, the brain can release chemicals which numbs the body and mind. The fight or flight process, which is related to how an individual responds to threats, can help explain this process more.
- Brain Processes: Another theory, which is related to trauma, suggests a certain brain process is crucial. When an individual perceives a threat, the blood flow to the front of the brain may be reduced. The front of the brain is associated with thoughts and decisions. Instead, the back of the brain may be used more. The back of the brain is associated with instinct, and automatic actions. Due to this process, an individual may struggle to process what has happened. Different elements of the experience may be forgotten, or the communication between them will often be mixed up. This will lead to trouble recalling the event. This may lead an individual to believing that certain memories happened to different people.
- Other Mental Health Condition: It is possible that prior to a severe episode of dissociation, that an individual may be having a very stressful period, or suffering from Depression or Panic disorder.
- Substance Abuse: Those that suffer from substance abuse problems do have the potential to experience dissociation.
The cause of Dissociative Disorder isn’t entirely understood. It may even be the case that a combination of the above factors cause the condition.
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Diagnosis of Dissociative Disorders
Dissociative Disorders are normally diagnosed following an extensive assessment. While some medical tests may contribute to an understanding of an individual’s symptoms, generally they are not used.
A mental health professional will attempt to make a diagnosis by asking an individual a series of questions regarding their feelings and behaviour.
The first step involved is to see a doctor. At an appointment, a doctor will ask an individual about their symptoms. If they suspect a Dissociative Disorder may be present, they will refer the individual to a mental health specialist for a full assessment.
The mental health specialist will carry out a full assessment of symptoms, and aim to make a diagnosis. They will ask further questions, and ask how the individual is feeling, and probe any past traumatic experiences.
Questions about past or present drug use will also be asked. It is crucial that in order to receive an accurate diagnosis that the patient answers each question truthfully.
In terms of the actual symptoms, each Dissociative disorder has a different diagnostic criterion. These can be accessed on the individual pages for each type.
The diagnosis an individual receives will be based on their symptoms, the impact they have, and the certain experiences the individual has while dissociating.
Sometimes, an alternative condition, like Post-Traumatic Stress Disorder or Borderline Personality Disorder will be made, if the symptoms are better-suited.
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Treatment of Dissociative Disorders
Dissociative Disorders can be treated. All three types of Dissociative Disorder are treated primarily by some form of psychotherapy. On occasion, medication can be used.
The exact treatment plan depends on the individual circumstances of the person with the disorder.
There are a wide range of talking therapies that can be used to treat Dissociative Disorders, with certain therapies effective in certain disorders. The aim of all therapies is to allow an individual to gain control over their dissociation. Specific objectives are dependent on which type of dissociative disorder is present. Some potential types of therapy may include:
Eye Movement Desensitisation and Reprocessing (EMDR): While more of a newer treatment, EMDR is an exciting intervention that has helped many people cope with trauma-based conditions. This therapy involves an individual moving their eyes from side-to-side, with the therapist directing their eye movements. During this, the individual recalls their traumatic experience. EMDR is believed to help an individual change how they think about the traumatic event, with the therapist aiming to facilitate change.
Jungian Therapy: Also known as Jungian analysis, this therapy is based on Carl Jung’s theory on the mind. The aim of this therapy is to bring the conscious and unconscious parts of the mind together, which should lead to a more balanced state of mind. It can be used for a variety of conditions. The therapy tries to look at the real person, rather than the person seen by the outside world. The therapist will use different techniques to elicit responses.
Psychoanalytical Psychotherapy: Psychoanalytical Psychotherapy is a talking therapy that aims to help uncover and resolve unconscious beliefs that cause psychiatric conditions. Traumatic experiences that may or may not be buried in the unconscious mind can be highlighted and processed. Psychoanalytical psychotherapy involves talking to a trained therapist. The therapist can show the individual how early memories and past traumas have affected their thinking, behaviour and attitude in the modern day. Psychoanalytical psychotherapy is especially useful for any condition that involves past trauma. Renowned neurologist Sigmund Freud developed this therapy, which is typically completed over a long-term basis.
No specific medication is licensed to treat dissociation. However, if an individual experiences low mood, depression, anxiety or panic attacks as part of their symptoms, it is possible for antidepressants to be prescribed. Antipsychotics at a low dose could also feasibly be prescribed. Disappointingly, neither antidepressants nor antipsychotics have proven to be markedly helpful in the treatment of Dissociative disorders . On occasions where memory gaps haven’t been filled, the barbiturate Pentothal can be used.
Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.
Antipsychotics: Antipsychotics (also known as neuroleptics) block the effect of dopamine – a chemical in the brain that is heavily linked to psychotic symptoms like hallucinations. They can also be useful for stabilising mood, and treating anxiety. They are not suitable for everyone however, and are often associated with many side effects like weight gain, dizziness and dry mouth.
Barbiturates: Barbiturates are a class of sedatives that result in brain functioning decreasing, and a calming effect. Sodium Pentothal is a well-known barbiturate. By decreasing brain functioning, this can lead to an individual freely talking about something which they may often keep withheld, making them useful in the treatment of Dissociative Disorders.
Many treatment options are available for Dissociative Disorders. In many cases, a full recovery is possible.
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Living with Dissociative Disorders
Dissociative Disorders are very difficult to live with, and can cause significant distress. Not only is an individual likely to be an intense state of confusion, they may have been involved in a traumatic event.
It is not their fault they are in a dissociative state – it is a natural response. It is very important for someone who is struggling with dissociation to seek treatment for their symptoms.
Help is available, and an improvement in quality of life can be secured. It will be difficult to discuss past experiences, but in the long-term, it is for the greater good.
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Dissociative Disorders are complex conditions. However, the prognosis of each condition is generally good.
Full recovery is possible; however, this depends on a range of factors – such as adherence to medication, response to therapy, and nature of the cause.
Dissociative Disorders however can be linked to suicide, which affects the prognosis.
While many will see an improvement in their symptoms, others will be able to go on to make a full recovery. But as alluded to, several factors affect this overall.
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