Dissociative Disorders
WHAT ARE DISSOCIATIVE DISORDERS?
Dissociative disorders are a group of disorders characterized by a strange feeling of being detached from reality. By definition, the word “dissociate” refers to a mental state in which a person blocks out memories, fails to recognize surroundings, or even fails to recognize his or her own identity. Typically, this group of problems includes dissociative amnesia, dissociative fugue, depersonalization disorder, and dissociative identity disorder.1 (A fugue is a longer period of dissociation during which a person forgets all or most of his or her personal identity.) In each of these disorders, some form of dissociation takes place.
Most people experience mild dissociation on a regular basis,2, 3 like when they daydream. However, what makes this common experience different from a dissociative disorder is the severity and length of the dissociation. When a person experiences some form of dissociative disorder, the experience is very disturbing and beyond the person’s control.
For example, a person struggling with dissociative amnesia or a dissociative fugue might not remember a significant part of his or her life, which goes beyond normal forgetfulness or old age. People struggling with depersonalization disorder often feel detached from their bodies, as if they were watching themselves in a movie. And lastly, people with dissociative identity disorder also experience pieces of missing time that they can’t account for, but in addition, they also feel as though a number of distinct personalities are living inside of them. Formerly, this problem was known as “multiple personality disorder.”
ARE THERE OTHER PROBLEMS RELATED TO DISSOCIATIVE DISORDERS?
Many people suffering with a dissociative disorder also have other mental health problems, like borderline personality disorder, depression, or drug or alcohol abuse.4, 5
WHO IS AFFECTED BY DISSOCIATIVE DISORDERS?
The prevalence of dissociative disorders is unknown. The best estimates vary widely from 5 to 58 percent of psychiatric hospital patients4-6 and from 2 to 6 percent of the general population.7, 8
WHAT CAUSES DISSOCIATIVE DISORDERS?
Sadly, many people who struggle with dissociative disorders have also suffered from extreme traumas in their lives, such as physical and sexual abuse as children,4, 9-11 rape,12 war,13 natural disasters,14 witnessing a murder,15 and other such frightening experiences.16 In these cases, some researchers believe that dissociation acts as a protective psychological defense, preventing the victim from being overwhelmed by the experience or memories of the experience.17 However, other research has indicated that less traumatic events might also trigger dissociative disorders.
In one study,18 patients who were diagnosed with a dissociative disorder had all recently experienced difficulties getting their basic needs met, such as health, safety, love, self-esteem, and self-determination.19, 20 They had all experienced difficulties in their relationships, marriages, or employment, and later, as their difficulties improved, their dissociative problems also lessened. Here, too, dissociation might have been a mechanism protecting the person from the overwhelming pain of the frustrating experiences.
WHAT TREATMENTS ARE EFFECTIVE FOR DISSOCIATIVE DISORDERS?
Unfortunately, the research on treating dissociative disorders is not as extensive as the treatment literature for other problems. This might be because some mental health care professionals don’t think dissociative disorders are a true, verifiable problem.21, 22 Therefore, people who suspect that they have a dissociative disorder and who are seeking treatment should search for a mental health care professional who has experience treating these problems.
Fortunately, there have been several effective treatments reported. Some people may be treated on an outpatient basis, while those with more severe cases may require a hospital stay.23 The common goal of most of these successful treatments is to help people recover lost memories, integrate disconnected elements of their personality, and ground them in the present moment when they start to dissociate.
Some successes have been achieved using psychodynamic treatments,24 hypnotherapy,25, 26 eye-movement desensitization and reprocessing,27 cognitive behavioral therapy,28, 29 antidepressants, antianxiety medications,30 and diazepam (Valium).31
Below is specific information on each of the dissociative disorders.
DISSOCIATIVE AMNESIA AND DISSOCIATIVE FUGUE
What Are Dissociative Amnesia and Dissociative Fugue?
Dissociative amnesia and dissociative fugue are two similar disorders characterized by a person’s inability to remember significant episodes of his or her life.1 These memory losses aren’t caused by brain damage, old age, normal forgetting, or the use of drugs, medication, or alcohol. Instead, they usually follow a traumatic experience.
Dissociative amnesia is characterized by the mysterious loss of memories. In its most severe form, this loss is very disturbing because it can involve many memories of various aspects of the person’s life. As described earlier, most people who experience this loss of memory do so after being involved in a severe trauma, such as an accident, a crime, or combat. This loss of memories can appear either quickly and unexpectedly, such as after a trauma, or one day the person may simply notice that there’s an inexplicable gap in the memory of his or her life.
In the case of traumas, the time span that’s often forgotten is the period during which the trauma took place. The person’s memory can be either completely blank or only partially impaired. In addition, the length of time that is forgotten can range from minutes to years.1 In one case study, a fifty-one-year-old woman couldn’t remember the twelve-year time span between the ages of thirty-seven and forty-nine, a memory loss caused by a car accident.25
Dissociative fugue involves a different form of incomprehensible memory loss. People experiencing a dissociative fugue will forget all or most of their personal information, such as their name, family, and job. In addition, they often inexplicably travel to a new place far from where they once lived. During this period of forgetfulness, they act and appear normal. However, quite suddenly, they may become very confused and distressed by their disconnection from their original personal identity and memories. It’s at this point that the problem usually becomes identifiable.1
In most cases of reported dissociative fugues, the person doesn’t take on a new name and identity.1 However, it has been known to happen. Following recovery from a dissociative fugue, the person may have no memory of what happened when he or she was in the fugue state.
Who Is Affected by Dissociative Amnesia and Dissociative Fugue?
It’s unknown how many people experience dissociative amnesia in the general population. However, in one very small study of psychiatric hospital patients, 42 percent of them met the criteria for dissociative amnesia, but only one of the patients had experienced a dissociative fugue.5 Similarly, in the general population, less than 1 percent is estimated to experience a dissociative fugue.1 Both disorders may occur at any age, but most cases of fugue are reported in adults.1
What Causes Dissociative Amnesia and Dissociative Fugue?
Both dissociative amnesia and dissociative fugue are often associated with the experience of a severe trauma, such as combat, accidents, abuse, and crimes.1 Stressful life events, such as relationship and job difficulties, also have been known to trigger these disorders.18
What Treatments Are Effective for Dissociative Amnesia and Dissociative Fugue?
As previously stated, dissociative amnesia and dissociative fugue have been successfully treated using many common psychotherapeutic techniques. Often, these techniques can help recover lost memories and resolve conflicts that might have led to the memories’ original departure.
DEPERSONALIZATION DISORDER
What Is Depersonalization Disorder?
Depersonalization disorder is a problem characterized by a feeling of being disconnected from one’s body and/or thoughts.1 Some people who struggle with depersonalization disorder feel as though they’re watching themselves from outside their bodies or that they’re watching themselves perform on television. Yet despite these feelings, people suffering from depersonalization disorder aren’t hallucinating. They’re able to distinguish reality from their dissociation, and they find the experience very disturbing.32 The disorder can come on quite suddenly, within hours, or it can slowly worsen over the course of weeks or months.33
In a large study of people with depersonalization disorder, many of them reported feeling as if their surroundings were not real.33-35 In addition, they also felt like they were looking at the world through a fog, as if their bodies didn’t belong to them, and as though once-familiar places were suddenly foreign. Some of them even reported that on occasion they felt as if they were outside of their bodies looking at themselves or that they didn’t recognize themselves when looking in a mirror.
In addition, people with this problem often feel emotionally and physically numb, isolated, without motivation, unable to concentrate, unable to remember things, weightless, and dizzy.36 They might also experience a distortion of their senses, like the loss of sound, color, or taste. Or they may feel as though the world is two-dimensional or not solid.36
Are There Other Problems Related to Depersonalization Disorder?
People with depersonalization disorder often suffer with other problems, such as depression, panic disorder, phobias, generalized anxiety disorder, and drug or alcohol abuse.33
Who Is Affected by Depersonalization Disorder?
Many people experience this type of depersonalization phenomena at least once in their lives. In studies of the general population, 34 to 70 percent of the people interviewed had experienced some type of depersonalization, usually caused by stress, exhaustion, exposure to a life-threatening situation, or drug use.1, 37-40
However, in depersonalization disorder, the episodes of dissociation are more severe. They are continual and upsetting, and they interfere with the person’s life. Unfortunately, the number of people suffering from depersonalization disorder is unknown.1
In a study of 117 people with depersonalization disorder, men and women were affected equally, the average age of onset for the illness was sixteen years old, and the people interviewed had been suffering with the illness for as little as three months to as long as fifty-eight years.33
What Causes Depersonalization Disorder?
One study of depersonalization disorder found that there were some common triggers that brought on the feeling of being disconnected from one’s body and/or thoughts.33 These triggers included stress, fear, depression, and the use of marijuana or hallucinogenic drugs. However, as with the other dissociative disorders, depersonalization disorder is also strongly associated with the experience of severe traumas, such as combat, accidents, childhood emotional abuse, and crimes.1, 41 Factors such as stress, depression, fatigue, and alcohol and drug use are reported to make the feelings of disconnection worse.33
What Treatments Are Effective for Depersonalization Disorder?
Depersonalization disorder, its causes, and its treatment are still not fully understood.33 Unfortunately, not much research has been done to investigate effective treatments. However, among the little research that does exist, one study found cognitive behavioral therapy to be somewhat effective.42-43
Cognitive behavioral treatment for depersonalization disorder attempts to analyze the catastrophic thoughts that accompany episodes of depersonalization and to correct any behaviors that might contribute to the illness, such as behaviors formed to ward off the episodes of depersonalization.36 In a study of this treatment, patients reported significant improvements in the severity of their symptoms.42 (Click here for instructions on using cognitive behavioral skills to challenge catastrophic thoughts.)
In addition, other smaller studies have had success using psychodynamic therapy,44 family therapy,45 hypnotherapy, and the use of antidepressant and antianxiety medications.33
DISSOCIATIVE IDENTITY DISORDER
What Is Dissociative Identity Disorder?
Dissociative identity disorder is a problem characterized by severe splits in a person’s sense of self.1 Formerly, dissociative identity disorder was called multiple personality disorder.
When people are suffering with dissociative identity disorder, they experience two or more distinct alternative personalities in their body that emerge at certain times. In reported cases, the number of personalities has ranged from two to over a hundred, but most people report ten or fewer.1 Often, the appearance of these alternative personalities is triggered by stressful situations.1 These alternative personalities are far different than the normal shifts in behavior a person makes to adapt to new situations in life. Usually, the alternative personalities in dissociative identity disorder have their own unique names, behaviors, memories, and traits. In addition, the individual alternative personalities are often unaware of each other,46 and they’re also unaware of information learned by other personalities.47, 48
It’s often the case that the alternative personalities display behaviors that are quite unlike the original personality. For instance, one of the alternative personalities might like to go to parties and dance, while the original personality is more of a shy homebody. Even more puzzling, the alternative personalities might insist that they are a different age, gender, race, or sexual orientation than the original personality.49
When a person is suffering from dissociative identity disorder, others might remark on the person’s strange behavior or frequently observe that the person isn’t acting like himself or herself. People with this problem might also experience episodes of lost time, when they find themselves in strange situations and have no idea how they got there.47 It might also be true that there are lengthy periods of their childhood that they can’t remember.50 These types of amnesia are key characteristics of dissociative identity disorder.1 And again, as with the other dissociative disorders, these memory losses are not caused by brain damage, old age, normal forgetting, or the use of drugs, medication, or alcohol.
Are There Other Problems Related to Dissociative Identity Disorder?
Often, people suffering from dissociative identity disorder also suffer from other problems, such as depression and suicidal thoughts,51 anxiety, substance abuse, somatization disorders52 (which affect the body), borderline personality disorder,53 post-traumatic stress disorder,1 and auditory hallucinations.54
Who Is Affected by Dissociative Identity Disorder?
The rate of dissociative identity disorder in the general population is unknown. However, in studies of psychiatric patients in hospitals, estimates have ranged from less than 1 percent to 12 percent,6, 55 and in one very small study of psychiatric patients, the rate was 25 percent.5 In case studies, women are frequently diagnosed with dissociative identity disorder more often than men.1, 30
What Causes Dissociative Identity Disorder?
Dissociative identity disorder has been called the most severe type of dissociative disorder.56 Sadly, it’s often associated with cases of severe childhood trauma, such as physical abuse, sexual abuse, a dysfunctional home environment, and parental rejection.3, 56-59 As a result, some researchers believe that the process of dissociating and creating multiple personalities is an unintentional defensive act to protect oneself from both the trauma and memories of the trauma.57 However, the exact causes of the disorder are unknown.
What Treatments Are Effective for Dissociative Identity Disorder?
Dissociative identity disorder has been successfully treated using many forms of psychotherapeutic techniques, such as cognitive behavioral therapy, psychodynamic therapy, hypnotherapy, and eye-movement desensitization and reprocessing, as well as medication. However, the research literature doesn’t support one treatment as being better than another. In general, the goal of all of these treatments is to provide education to the person struggling with the disorder, as well as the person’s friends and family, to help bring relief from the symptoms associated with the disorder, and to help the person incorporate the many personalities into one integrated whole.28 (Click here for more information about the treatment of dissociative identity disorder.)
REFERENCES FOR DISSOCIATIVE DISORDERS
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58. Lewis, D. O., C. A. Yeager, Y. Swica, J. H. Pincus, and M. Lewis. 1997. Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder. American Journal of Psychiatry 154: 1703-1710.
59. Scroppo, J. C., S. L. Drob, J. L. Weinberger, and P. Eagle. 1998. Identifying dissociative identity disorder: A self-report and projective study. Journal of Abnormal Psychology 107: 272-284.