Dissociative disorders involve problems with memory, identity, sense of self, perception, emotion, and behavior. Symptoms of a dissociative disorder include the experience of feeling detached from reality, feeling outside one’s body, and a loss of memory or amnesia. Dissociative disorders are frequently associated with previous experiences of trauma.
There are several different diagnostic categories of dissociative disorders. These include:
A person with depersonalization disorder feels persistently or repeatedly detached or estranged from one’s self. Patients with this condition may report feeling like they are on automatic pilot or as if they are watching themselves in a movie. Similar to this is derealization disorder, when a person feels detached from their environment or detached from reality. A person may feel a lack of connection and emotion with the outside world, as if they are dreaming or in a trance.
Temporary experiences of depersonalization and derealization are extremely common in normal populations. In fact, they are the third most commonly reported psychiatric symptoms, after depression and anxiety.
Approximately one-third to one-half of patients with depersonalization disorder report histories of significant trauma. Among accident victims, as many as 60 percent with a life-threatening experience report at least transient depersonalization during the event or immediately after it. Military training studies find that symptoms of depersonalization and derealization are commonly caused by stress and fatigue.
Symptoms of depersonalization disorder are also common in:
They can also occur:
Patients with depersonalization/derealization disorder are often challenging to treat. Many different types of psychotherapy have been used to treat depersonalization disorder, including psychodynamic, cognitive, cognitive-behavioral, hypnotherapy, and supportive therapy. However, many patients do not have a strong response to these types of standard psychotherapy. Stress management strategies, distraction techniques, reduction of sensory stimulation, relaxation training, and physical exercise may be somewhat helpful in some patients.
As far as pharmacotherapy, there are mixed results. Some evidence indicates that SSRI antidepressants, such as fluoxetine (Prozac), may be helpful. Recent studies, however, found no efficacy for fluvoxamine (Luvox) and lamotrigine (Lamictal) for depersonalization disorder. Some patients with depersonalization disorder respond sporadically and partially to the usual groups of psychiatric medications, singly or in combination: antidepressants, mood stabilizers, typical and atypical neuroleptics, anticonvulsants, etc.
Dissociative identity disorder, formerly known as multiple personality disorder, is a complex psychological condition characterized by two or more distinct personality states. The disruption in identity involves a marked separation from a person’s sense of self, accompanied by changes in affect, behavior, thoughts, consciousness, memory, perception, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
A person with this condition has recurrent gaps in the recall of everyday events, personal information, and/or traumatic events that are inconsistent with ordinary forgetting. The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures). In children, the symptoms are not better explained by imaginary playmates or other fantasy play.
Dissociative identity disorder is strongly linked to sever experiences of early childhood trauma, usually abuse. Physical and sexual abuses are the most frequently reported sources of childhood trauma. The disorder is thought to be more common during natural disasters, wartime, or times of major social dislocation.
Various types of treatment approaches may be required to treat a patient with dissociative identity disorders. Options include psychoanalytic psychotherapy, cognitive therapy, behavioral therapy, hypnotherapy, electroconvulsive therapy, group therapy, family therapy, self-help groups, art therapy, movement therapy, and eye movement desensitization and reprocessing. Pharmacotherapy often includes antidepressant and anti-anxiety medications to treat depression and PTSD symptoms.
Dissociative amnesia is an inability to recall important biographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Dissociative amnesia is reported in approximately 2 to 6 percent of the general population. The forgetting may be limited to a specific event or events, or resemble more of a general amnesia, aswhen someone forgets their identity and life history. A diagnosis of dissociative amnesia is given when the symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms cannot be attributable to the physiological effects of a substance (e.g., alcohol, other drug of abuse, or medication) or a neurological or other medical condition. The amnesia also is not better explained by dissociative identity disorder, post-traumatic stress disorder (PTSD), acute stress disorder, somatic symptom disorder, or other neurocognitive condition.
Treatments that may be helpful for amnesia include cognitive therapy, hypnosis, and group psychotherapy.
Yes. Individuals who have been subjected to intense coercive persuasion may have prolonged changes in, or conscious questioning of, their identity. Examples of situations that can cause this include including brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, and recruitment by sects/cults or terror organizations. Temporary periods of acute stress can also cause changes in consciousness, depersonalization, detachment from reality, perceptual disturbances, short-term amnesia, and/or changes in sensory-motor functioning (e.g., analgesia, paralysis). These types of conditions would be diagnosed as “other specific dissociative disorder.”
A diagnosis of “other specified dissociative disorder” is given when an individual has symptoms characteristic of a dissociative disorder that cause significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any of specific dissociative disorder. Examples of situations where the “other” designation could be used include:
A diagnosis of “unspecified dissociative disorder” applies to symptoms characteristic of a dissociative disorder that cause significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any specific dissociative disorder. The unspecified dissociative disorder category is used in situations when there is not enough information to make a more specific diagnosis, such as in emergency room settings.