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Dissociative disorder: symptoms, causes and treatments

Reading time: 12 mins
Dissociative disorder symptoms, causes and treatments

Dissociative disorder is a complex syndrome involving problems with emotion, identity, body representation, consciousness, perception, behavior, and motor control. Dissociative behavior is defined by disturbances in every area of psychological functioning.

The causes of dissociative disorder are childhood trauma, brain abnormalities, and genetics. It is more likely that a combination of these causes plays a role in the development of dissociative disorder rather than a single one.

Treatments for dissociative disorder include medications, psychotherapy, and hypnosis therapy. The cornerstone of treatment for this mental illness is therapy, which also includes family or group therapy sessions.

What is dissociative disorder?

Dissociative disorder is defined as a persistent mental state indicated by feeling detached from reality, experiencing amnesia (memory loss), or being outside of one’s body.

Dissociative disorder is included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) as a category that includes three different conditions.

In order to understand the nature of dissociative disorder it is necessary to address the term dissociation. Dissociation is defined as the action of separating or disconnecting from something. It is a break in how the mind handles the situation. A person can feel a disconnect from their surroundings, memories, emotions, and thoughts.

The DSM-5 defines a dissociative state as an interruption, disruption, or/and discontinuity of the normal subjective integration of memory, identity, emotion, perception, motor control, and body perception.

A dissociative disorder is recognized as an involuntary escape from reality. This escape is characterized by a disconnection between memory, consciousness, identity, and thoughts. Anyone can develop a dissociative disorder regardless of age, ethnicity, racial, or socioeconomic background.

The most classic dissociative disorder examples are when a person dissociates after being assaulted. They go through a type of denial – a “this isn’t happening to me” kind of experience. People can switch off from reality.

They can also have numb senses as if nothing feels familiar. This can happen from experiencing religious or spiritual abuse, war, invasive surgery, etc. Dissociation helps those affected cope with that experience.

Is it normal to dissociate? Dissociation is a disconnect between a person’s actions, feelings, memories, thoughts, or sense of self. This is normal and something that everyone has experienced. But, having dissociative disorders is not normal. These are a range of conditions that can cause psychological and physical problems.

What are the types of dissociative disorder?

Types of dissociative disorder are listed below:

  • Dissociative amnesia
  • Dissociative identity disorder
  • Depersonalization-derealization disorder

1. Dissociative amnesia

Dissociative amnesia (DA), the most common dissociative disorder, is a condition that makes it difficult for a patient to recall details of a stressful or traumatic event, even if that person realizes they have memory loss.

Memory gaps involve the inability to remember personal information typically, of a stressful or traumatic nature. The memory gap from DA is too extensive to be explained by typical forgetfulness. A classic example of dissociation is when a crime victim doesn’t remember getting robbed at gunpoint. But, can remember the things they did the rest of that day.

There are different types of dissociative amnesia. They are selective, localized, systematized, generalized amnesia, and dissociative fugue.

Selective amnesia is indicated by incomplete or patchy memories of a stressful or traumatic event. In localized amnesia, the patient has no memory of a traumatic event. It is usually short-term.

Systematized amnesia refers to very specific memory loss such as not being able to remember a particular relative. In generalized amnesia, the patient has difficulty recalling the details of their entire life.

According to a Psychiatry (Edgmont) peer-reviewed journal, people have three main types of memory. Episodic memory helps us remember events, as one would recall a movie. Semantic memory is knowledge about the world. It is the memory of facts, dates, words, etc.

Procedural memory is remembering how to do regular routines like brushing the teeth. Loss of any of these memory types can happen from serious brain injuries. Memory gaps that happen from severe psychological stress are seen in DSM 5 dissociative disorders. That’s what makes dissociative amnesia different from other types of memory loss.

The main cause of dissociative amnesia is overwhelming stress caused by experiencing or witnessing a traumatic event. Any kind of trauma can lead to dissociative amnesia. Some examples are physical or sexual abuse, natural disasters, wars and accidents. However, people may have a genetic predisposition to develop dissociative amnesia. Changes in the brain, especially in areas that participate in autobiographic memories, can also contribute to the development of this type of dissociative disorder.

The main symptom of dissociative amnesia is memory loss i.e. inability to remember personal history, identity, and events. However, a person retains general information. Another symptom of dissociative amnesia is that memory loss relates to stress or trauma and it tends to come back. Sometimes certain people or events can trigger the retrieval of memory.

The best dissociative disorder treatment for DA can vary from person to person. It usually depends on the severity of the symptoms. Experts often suggest a combination of treatments such as psychotherapy, cognitive behavioral therapy, family therapy, eye movement desensitization, and reprocessing. Other treatment approaches include meditation and creative therapy, such as music or art therapy.

2. Dissociative identity disorder

Dissociative identity disorder (DID) is a complex, post-traumatic developmental disorder wherein a person has two or more separate personalities. Different identities control a person’s behavior at different times. Until 1994, DID was referred to as a multiple personality disorder.

The most notable dissociative identity disorder examples are when a patient assumes different identities to their own sex, age, or race. Each of these identities has a unique way of talking, gestures, and postures. These are a complete contrast to how that patient usually acts.

As every personality or identity reveals itself, it controls the patient’s thoughts and behavior. This is called “switching”. Switching with DID disorder can last for a couple of seconds, minutes, to days. Simply put, the patient often finds themselves doing things they wouldn’t normally do, like reckless driving, stealing, and speeding.

Dissociative identity disorder isn’t the same thing as schizophrenia. The main difference is that schizophrenia involves hearing or seeing things that aren’t there due to impaired perception of reality whereas DID includes two or more personalities. It doesn’t involve hallucinations or delusions like schizophrenia. DID differs from other dissociative disorders because it revolves around having different personalities, which other conditions don’t have. What they do have in common are dissociation and detachment.

This is a rare disorder affecting around 1.5% of the population internationally, according to a post published on the National Library of Medicine website. DID personality disorder is connected to severe behavioral health symptoms. Often those affected with a dissociative personality disorder, use substances or have self-harming behavior.

Experts believe that DID causes are likely a psychological response to environmental and interpersonal stresses. The split personality is seen as a coping mechanism. The affected individual is trying to completely dissociate themselves from an experience or situation that causes them too much pain.

Signs of multiple personality disorder can include switching between multiple personalities or identities and feeling like one or more voices control the head. People with this disorder also exhibit self-sabotage, self-persecution, or violent behavior. Additionally, the identities can have unique mannerisms, characteristics, names, and voices. A person with this disorder tends to have small gaps in memory of trauma, personal information and daily events.

The main feature of split personality disorder is a severe form of dissociation. This is a mental process, which creates a lack of connection with the patient’s actions, memories, thoughts, or sense of identity. Dissociative personality is believed to come from a range of factors, like trauma.

It’s important to mitigate the DID symptoms. Treatments for dissociative identity disorder include hypnosis, psychotherapy, and medication. Psychotherapy, as the primary treatment approach for DID, focuses on identifying and working through past trauma or abuse. Through therapy, patients also learn to manage sudden behavioral changes and merge separate identities into a single identity.

While there is no cure for dissociative identity disorder, a combination of different treatments can reduce the symptoms. Treatment for DID may also include avoiding triggers that cause personality changes, managing substance abuse, or taking medications for underlying mental health disorders such as anxiety or depression.

3. Depersonalization-derealization disorder

Depersonalization-derealization disorder is when a person repeatedly or persistently has the feeling they’re observing themselves from outside of the body or they have a sense that things around them aren’t real.

When it comes to a dissociative state, a patient can experience derealization, depersonalization, or both. This type of dissociative disorder involves ongoing feelings of detachment from sensations, actions, and thoughts. There is a major difference between derealization and depersonalization.

If the feelings, thoughts, and sensations of detachment feel like you are floating in the air above yourself – this is depersonalization. These are experiences of detachment from one’s body, self, or mind. Those affected feel as if they are watching the event happen to them. But, they are outside their body.

Derealization is an experience of unreality from the patient’s surroundings. Those affected can feel like other things or people are unreal. During these altered experiences, even though the patient can appear unemotional or unreactive, they are still very distressed.

The exact causes of the depersonalization-derealization disorder are unclear. Some people are more vulnerable to depersonalization and derealization than others due to environmental and genetic factors. Trauma and heightened stress can trigger episodes of depersonalization and derealization. Good examples are childhood trauma, car accidents, or other types of life-threatening experiences.

Symptoms of depersonalization and derealization disorders occur in episodes during which a person is aware their sense of detachment is a feeling, not reality. The average age of onset of symptoms of this disorder is in mid-to-late adolescence or early adulthood. The disorder is rare in young children and older adults.

Symptoms of depersonalization are feeling like a robot i.e. being unable to control movement or speech and feeling like an outsider or observer of one’s own body, emotions, thoughts, etc. Depersonalization also manifests itself through feeling like memories lack emotion and that they might or might not be yours. Feeling like your arms, legs, or body seem bigger, smaller, or distorted, feeling like the head is wrapped in cotton, and physical or emotional numbness are also symptoms of depersonalization.

On the other hand, symptoms of derealization include emotional disconnection from people that you care about, colorless, blurry, distorted, or artificial surroundings, and heightened clarity and awareness of your surroundings. People also experience a distorted perception of time, shape, distance, and size of objects, and they feel unfamiliar or alienated from their surroundings.

Passing feelings of derealization vs. dissociation may be common and not a problem. But, if these feelings are severe and ongoing, consult a specialist.

The main treatment approach for this disorder is psychotherapy. Psychotherapy or talk therapy can help control the symptoms and lessen their impact. Two most common types of therapy for treatment of depersonalization–derealization disorder are cognitive-behavioral therapy and psychodynamic therapy.

What are the symptoms of dissociative disorder?

woman eating with eyes closed with measuring tape

Symptoms of dissociative disorder depend on the specific condition. The most common symptoms are listed below:

  • Amnesia: memory loss, failing to remember certain events, time periods, people, and other personal information
  • Disconnection: the feeling of being detached or disconnected from oneself and the world around them. A person may feel detached from their body or what they feel, even experiences can feel unreal
  • Blurred sense of identity: feeling detached from one’s identity and creating new personalities as a result
  • Mental health problems: people with dissociative disorders also experience other mental health problems such as depression, anxiety, as well as suicidal thoughts and behaviors
  • Impaired quality of life: people with dissociative disorders experience problems in relationships, at work, and in other aspects of life
  • Difficulty to cope: dissociative disorders manifest themselves through the inability to cope with stressful situations and other negative stimuli

What are the causes of dissociative disorder?

The causes of the dissociative disorder are listed below:

  • Trauma: leads to dissociation due to the way our mind responds to threats. For many patients, dissociative disorders develop due to their inability to cope with trauma in other ways or they have no physical escape from trauma, according to a paper from the Delaware Journal of Public Health. Dissociation, depersonalization, and derealization become coping mechanisms, especially for people who have experienced or witnessed chronic trauma i.e. prolonged or severe trauma. These can include emotional abuse, severe neglect, sexual abuse, and physical abuse Very Well Mind explained. Dissociative disorders tend to form in childhood. At that point, personal identity is still developing. That explains why a child finds it easier than an adult to step outside of oneself or detach from reality.
  • Brain abnormalities: although this subject requires further research, patients with dissociative disorders may have abnormalities in brain structures. For example, people with DID show smaller cortical and subcortical volumes in the hippocampus and other structures linked to fear learning and movement execution as well as perception and personal awareness, according to a paper from the European Journal of Trauma and Dissociation. A paper from the Current Psychiatry Reports suggested that dissociative states are associated with altered (co)activity in brain areas involved in memory and emotion processing (amygdala, hippocampus, middle/superior temporal gyrus, and parahippocampal gyrus), self-referential processes (posterior cingulate cortex and precuneus), cognitive control (anterior cingulate cortex, medial prefrontal cortex) and interception and attention regulation (insula).
  • Genetics: people may have a genetic predisposition to develop dissociative behaviors. A review from the journal Genes reported that dissociative symptoms are associated with genes involved in serotonergic, dopaminergic, and peptidergic transmission, neural plasticity, and sensitivity of cortisol receptors. Family life also plays a role because a child can learn to cope with trauma in an unhealthy manner from people around them.

What are the risk factors for dissociative disorder?

Risk factors for dissociative disorder are listed below:

  • Sexual abuse by a caretaker: people who were victims of sexual abuse by a caretaker in childhood are at a higher risk of developing dissociative disorder. To cope with the event, patients tend to dissociate from reality, which explains why experiencing and surviving sexual trauma can lead to dissociative symptoms, according to a study from the National Library of Medicine.
  • Being a witness to sexual violence as a child: people who witnessed sexual violence in childhood are at a higher risk of dissociative disorder. Being a witness to sexual violence is a traumatic experience for a child. The USA Today reported that witnessing abuse carries the same risk of harm to children’s mental health as if the children were abused directly.
  • History of adult rape: adult victims of sexual abuse are also at a higher risk of dissociative disorder due to trauma they experienced, according to a post published on the website of the American Psychological Association.
  • Inconsistent treatment from a caretaker: growing up or being in a household or environment that is dysfunctional, turbulent, or unsafe can increase the risk of dissociative disorder. This is particularly emphasized in children who may cope with their situation by stepping out of themselves or their reality i.e. dissociating.
  • Other traumatic experiences: wars, natural disasters, torture, kidnapping, early-life medical procedures, and other stressful or traumatic experiences can increase the risk of dissociative disorder.

How common is dissociative disorder?

Dissociative disorder is not as common as other mental health conditions. Dissociative disorders have a 2% prevalence in the US, the Cleveland Clinic reports.

Just like the other types of dissociative disorders, DID is very rare, affecting roughly 1.5% of the global population. It can happen at any age or sex. But, women tend to have higher odds of experiencing DID than men.

Dissociative amnesia is a rare disorder, as well. But, because of its 1.8% prevalence rate, it is the most common form of dissociative disorder. About 1% of men and 2.6% of women have dissociative amnesia. Most of those affected with DA are 20 to 40 years old, stated Cureus.

Another 2022 review from the Journal of Trauma Dissociation evaluated the prevalence of Depersonalization-Derealization disorder (DDD). Experts categorized 23 papers into 3 groups of patients. This included the outpatient/mixed-in samples, the general population, and patients with specific disorders. The prevalence of DDD ranged from 5-20% in outpatients, 0-1.9% in the general population, and 17.5-41.9% in inpatients.

The biggest rates were found in people who went through sexual, physical, or psychological abuse. Dissociative mental health can play a major part in the development of DDD. DDD is more common in adolescents and young adults including patients with mental disorders.

How is dissociative disorder diagnosed?

Dissociative disorder is diagnosed by performing a physical exam, a psychiatric exam, and evaluating DSM-5 criteria.

The purpose of a physical exam is to rule out any physical cause of dissociation as well as any medications you might be using. For example, sleep deprivation, brain lesions, head injury, tumors, and intoxication can all lead to a sense of unreality or memory loss.

If the cause of the symptoms isn’t physical, a healthcare provider refers a patient to a mental health specialist. A mental health expert will carry out a psychiatric exam to discuss symptoms, emotions, thoughts, and behaviors. They may suggest interviewing family members to get more information regarding a patient’s symptoms and behaviors.

A mental health professional compares the patient’s symptoms to DSM-5 guidelines and diagnoses them with a specific dissociative disorder if they meet the criteria.

How to prevent dissociative disorder?

Dissociative disorder cannot be prevented. But, spotting the dissociative identity disorder symptoms early on and getting proper treatment could help control the symptoms. Caregivers, parents, and teachers should watch for any signs of a dissociated person in young children.

Starting treatment right after a traumatic episode could help prevent the condition from getting worse. Mental health experts can help patients to spot the triggers and gain some control over their identity or personality changes.

For some patients with DID, substance use or stress can trigger the dissociative disorder. Tackling the drug addiction and finding the right ways to manage the stress decrease the frequency of these different identities by controlling the patient’s behavior.

What effects does dissociative disorder have on a person’s life?

man having sleep problems

The effects of dissociative disorder on a person’s life are listed below:

  • Sleeping problems, like insomnia
  • Severe depression or anxiety
  • Eating disorders
  • Problematic alcohol or drug use
  • Potential to self-harm
  • Life difficulties such as finding it hard to keep a stable relationship or a job
  • Sexual dysfunction

What are the treatments available for dissociative disorder?

man at a dissociative disorder therapy session

Treatment available for dissociative disorder varies based on the different dissociation types. They are listed below:

  • Psychotherapy: the cornerstone of treating dissociative disorders. The therapist relies on psychosocial or counseling therapy to help patients understand the causes of their condition. The therapist can show patients novel coping mechanisms that can mitigate those symptoms.
  • Clinical hypnosis: one of the most talked-about dissociative identity disorder treatments. It teaches the patient to use deep relaxation to work on their psychological problem. People get to access their repressed memories and mitigate their mental boundaries. When used alongside psychotherapy and with the help of a trained specialist, it proves to be a useful treatment for multiple personality disorders.
  • Family or group therapy: for a patient to receive better treatment outcomes, the family has to understand the changes that the patient is going through. This can help create a better at-home environment. Through therapy, family members can help spot the signs of recurrence.
  • Medication: There is no drug specifically designed for dissociative disorders. But, anxiolytics and antidepressants can help manage mood disorders.

Is it possible to treat dissociative disorder?

No, it is not possible to treat dissociative disorder in a way to fully cure it. That being said, it is possible to manage this condition, reduce the risk and frequency of dissociative episodes, and improve a person’s quality of life.

A dissociation disorder is usually treated with medication or therapy. At the moment, there are no medications that treat dissociative disorders specifically. A healthcare professional may prescribe medications to manage specific symptoms such as depression and anxiety. This is very important for patients with a tendency to self-harm. With proper treatment, people can learn to control their behavior more effectively. If you or anyone else in your family is struggling with a dissociative disorder, be sure to talk to a specialist.