By definition, the word “dissociation” refers to the disconnection one can have from others, themselves or the world around them. However, as more people than you might have guessed can attest, dissociative disorders are characterized by persistent or perpetual feelings of detachment or memory loss.
The National Alliance on Mental Illness (NAMI) reports that about 2% of the population meet the full criteria for chronic dissociative episodes, while upwards of 75% will have at least one episode of depersonalization/derealization (more on that in a bit) at some point in their lives. Despite the prevalence of these episodes across all ages, races, ethnicities, and socioeconomic backgrounds — these conditions don’t discriminate — much confusion still exists regarding what dissociative disorders really are and how they impact the lives of those who struggle with them.
Today, we’ll help to clarify that confusion by exploring dissociative disorders deeper, including the specifics behind their symptoms, causes, how mental health professionals diagnose them, and how to treat them effectively.
Types of Dissociative Disorders
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a taxonomic and diagnostic tool published by the American Psychiatric Association, there are three main types of dissociative disorders:
Dissociative amnesia – While forgetfulness is something many of us encounter from time to time, the memory loss associated with dissociative amnesia is far more severe and frequent. In many cases, dissociative amnesia relates to a specific event or experience, like what soldiers undergo during battle, which can cause a complete loss of memory. These bouts of amnesia usually occur suddenly and can last from minutes to months, or even years. Because this type of dissociative disorder remains connected with an event or period of time, people who experience it may not recall basic information about their lives or the people in them during that traumatic time. As NAMI reports, dissociative amnesia can occur at any time, as there is no average age onset or percentage. Additionally, one may have multiple episodes at various points in their life.
Dissociative identity disorder – Once commonly referred to as “multiple personality disorder,” dissociative identity disorder involves the act of one frequently switching or changing to alternate identities. Someone who experiences dissociative identity disorder may feel like multiple people exist inside their head or may feel possessed by more than one identity. This disorder is particularly challenging because each of those identities may have a unique name, background, and characteristics like speaking voice and tone, or physical mannerisms. Of note, it’s common for someone with dissociative identity disorder also to endure dissociative amnesia and dissociative fugue. This confusion may cause a person to travel or wander away from their life without explanation. Though dissociative disorders of this type can occur in both men and women, NAMI writes men are more likely to deny symptoms and trauma history. Notably, that denial can lead to exhibiting violent behavior and false negative diagnoses.
Depersonalization-derealization disorder – As mentioned earlier, episodes of this type occur in some 75% of people. Depersonalization-derealization disorder comprises a sense of detachment from one’s self. With the depersonalization aspect of this type, the person may feel like they are watching a movie, viewing their own actions and behaviors as if they were an outside source. For those experiencing derealization, their day-to-day livelihood may be accompanied by fogginess or dreamlike sensations. In contrast, others may perceive time at a different speed than what is actually occurring in reality. We should also note that it’s possible to experience one or both depersonalization and derealization. As far as the duration of this condition, someone can experience symptoms for as brief as just a few minutes or as long as many years. Interestingly, depersonalization typically occurs in younger people, with the average onset age at 16. NAMI also reports that less than 20% of people with this type of dissociative disorder will start experiencing episodes beyond the age of 20.
Risk Factors of Dissociative Disorders
As you might expect, the risk factors for the different dissociative disorders can vary by type. However, the American Psychiatric Association (APA) writes that the most common thread across risk factors for all types is “repetitive, overwhelming trauma in childhood.”
Further, the APA writes, “Among people with dissociative identity disorder in the United States, Canada, and Europe, about 90 percent had been the victims of childhood abuse and neglect.” Additionally, more than 70% of outpatients battling dissociative identity disorder have attempted suicide, as self-injurious behavior is common in people with the condition.
Symptoms of Dissociative Disorders
We’ve already touched on many signs of dissociative disorders, but given the complexities involved, it bears repeating the most commonly cited symptoms.
Though the type and severity of the condition will impact what someone with dissociative disorder experiences, most people with one of these conditions will feel a sense of disconnection from their authentic selves. In addition, one may find it challenging to cope with intense or unexpected emotions. Sudden, unanticipated and unexplainable changes in mood are likely to occur, including feeling sad or remorseful for no real reason. Additionally, those sensations will often beget feelings of depression, anxiety, or, sometimes, both.
In a vacuum, the symptoms of dissociative disorders can be uncomfortable; but in aggregate, and when compiled together, they can be overwhelming for people. Sufferers may feel that the world they’re living in is not real or is a distorted version of reality. They can forget basic details about their personal lives. Worse, people with dissociative disorders may feel compelled to act a certain way, even if that behavior is a stark departure from their normal behavior. In many cases, that altered behavior can be offensive or distasteful, damaging personal, familial, and career-related relationships.
Causes of Dissociative Disorders
Generally speaking, dissociative disorders originate from traumatic events that cause someone to want to dissociate from reality. These events and stressors can be anything from time served in a war to a violent assault to a harrowing automobile accident. Even after the person has survived the event, dissociating from reality is used to cope when they aren’t able to process the trauma.
In many cases, that trauma occurs during childhood or adolescence when the person’s brain is still developing. While not everyone who experiences childhood trauma will ultimately develop a dissociative disorder, there are a few intricacies that increase the risk of it happening.
As we said, the younger someone is, the more challenging it can be for them to cope with the reality of their experiences. Abuse or neglect that is severe or repeated over an extended period can also significantly contribute to developing a dissociative disorder. Other significant factors include abuse or neglect that is physically painful, the lack of a support system to comfort and help them cope, when the person’s parents dissociate themselves, when the person hears consistent denials that abuse or neglect ever happened, and when the abuse or neglect is at the hands of someone the person trusts.
No one knows exactly why someone would physiologically opt to dissociate from an experience, but there are a few different theories at play. The first involves fight or flight, the instinctual reaction that occurs in humans when an event or action is considered frightening or stressful. In these scenarios, our body’s sympathetic nervous system triggers a stress response to either combat the threat or flee from it. The problem that often occurs with dissociative disorders is that the person in the throes of the stressful event is too young to either fight or flee. In turn, they may either freeze or flop.
A freeze response is when the body becomes limp or immobile and releases chemicals that act as a numbing agent, prompting feelings of paralysis. Meanwhile, the flop response is when the body’s ability to think logically is essentially disabled. Muscles become “floppy,” and the person follows orders with little response or resistance.
Fight or flight vs. freeze or flop is also related to how blood flows throughout our brain. Here’s London-based mental health charity, Mind, on why:
“One theory suggests that whenever we think there is a threat, our body reduces blood flow to areas in the front of our brain (the thinking, analytical, rational part) and ‘turns on’ areas in the back of our brain (the automatic, instinctive part). Using the back of our brain to freeze or flop helps protect us from trauma that we can’t prevent or run away from. But reducing the blood flow to the front of our brain can make it more difficult to process what happens and may mean we experience dissociation.”
Further, Mind suggests you should know that the front of our brain is essential for enabling us to understand where we are in time and space, how to use language and speech, the act of feeling connected to our body, the storing of memories, and ways to make sense of information received through our five senses. Given the role taken on by the front of our brains, it’s easy to see the impact that reducing blood flow to this area can have on the state of our mental health.
Diagnosis of Dissociative Disorders
Before we talk about diagnosing dissociative disorders, we want to make it clear that anyone experiencing symptoms that include thoughts of suicide or self-harm should immediately reach out to a trusted friend or family member, visit the emergency room, call 911, or call 988, the National Suicide Prevention Lifeline. For those with mild and non-self-injurious symptoms, the first step in diagnosing a dissociative disorder is visiting their primary care doctor for an exam to rule out any physical conditions that may be causing the symptoms.
In this visit, the person’s primary care doctor will ask questions about what they’re feeling and what may have prompted those feelings, in addition to performing tests related to head and brain injuries or sleep deprivation that could initiate feelings of dissociation. Before the appointment, it’s a good idea for the person to think about moments of their life that could have caused severe trauma or periods that are hard to remember. The person should also note any vital medical information, including any current medications taken and any physical or mental conditions of importance. Some of the questions the doctor may ask during this visit include:
- What symptoms are concerning to you or your friends and family?
- Have you ever traveled away from home and not been able to recall how you got there?
- Do you ever feel like you’re observing yourself from the outside?
- How often do you experience anxiety or depression?
- Were you ever abused or neglected as a child?
- Do you ever feel as if more than one person is living or communicating inside your head?
The primary care doctor may also refer the person to a mental health professional to further explore their thoughts and feelings. Ultimately, the findings from those two appointments, paired with the symptoms outlined in the criteria for diagnosis in the DSM-5, will be used to diagnose a dissociative disorder.
Upon hearing a diagnosis, it’s a good idea for the person to ask questions of the doctor or mental health professional, like:
- How did you determine my diagnosis?
- Do you know what is contributing to my symptoms?
- Is this condition temporary or a long-term problem?
- What treatment do you recommend?
- How do we monitor progress during treatment?
- Are there any materials available to help me better understand dissociative disorders?
Treatment of Dissociative Disorders
Just as symptoms and causes of dissociative disorders can and will vary based on type and severity, so will treatment. Yet just like we discussed with symptoms and causes, there are some commonalities across how mental health professionals treat these conditions.
The primary treatment for dissociative disorders is what’s called psychotherapy. This type of treatment, also known as talk therapy or counseling, involves verbalizing the details of the condition and any related feelings or symptoms to a specially trained therapist. During these sessions, the therapist will work to help the person understand the root cause of their trauma and how (and why) it has impacted their life in the manner it has. Additionally, the therapist will guide them through some new coping mechanisms that should empower them to leave dissociating in the past. This counseling aims to help the person acknowledge their actual reality and move beyond any prior traumatic experiences.
Some mental health professionals may also recommend certain medications for people suffering from dissociative disorders. While no medications are designed explicitly for treating these conditions, antidepressant, anti-anxiety, and antipsychotic medications can be beneficial when used in tandem with talk therapy and to alleviate the symptoms that accompany other mental health ailments. Conditions like chronic anxiety and depression often interconnect with dissociative disorders.
Rising Phoenix Understands How to Navigate Mental Health Treatment
Because the team of mental health professionals at Rising Phoenix Wellness Services has decades of experience in mental health treatment, we understand that each person’s symptoms and circumstances are unique. That’s why we design tailored treatment programs for every mental health diagnosis, including dissociative disorders, personality disorders, and complex trauma.
After the intake process, our clients receive both a clinical and psychiatric assessment that partially informs us on how to proceed with treatment. We believe strongly in the power of psychotherapy, both in an individual and group setting. We aim to help the client develop coping skills, insight and education, enhanced life skills, and mindfulness that sets them on a course of healthy and productive living.
The support and understanding of loved ones are essential to an individual’s long-term recovery, so we include family members in the rehabilitation process.
If you or a loved one is struggling with a dissociative disorder, our admissions advisor is available 24-7 to assist with verifying insurance benefits and answer any questions you may have. If you’re ready to take the first step in healthy living, we encourage you to contact us today.