Dissociative Disorders: Types, Symptoms, Causes, Prevention, Treatment

Dissociative Disorders

Each one of us experiences a kind of system glitch or a temporary blackout of our brain functioning once in a while. For instance, we may find ourselves driving into an unfamiliar place without knowing why, possibly due to our preoccupation with our personal problems. There are times as well when we tend to separate ourselves from the real world due to the fantastic scenes of a great movie we are watching. These scenarios are what we refer to as non-pathological dissociation. These phenomena normally happen infrequently without causing disruptions and disturbances to our normal functioning.

Individuals with dissociative disorders, however, experience serious disruptions in memory, identity, and self-perception. Dissociation among these persons usually happens in a span of several minutes to hours leading to disorientation, confusion, and failure to recognize past events in life.

What is Dissociation

Dissociation is defined as a partial or complete disturbance or disruption in the normal functioning of a person’s cognitive and psychological aspects. This can be precipitated by drug use or experiences of overwhelming stress and trauma. Individuals experiencing dissociation usually describe these events as uncontrollable, intruding into their consciousness abruptly.

What are Dissociative Disorders

Dissociative disorders are psychiatric conditions characterized by involuntary disruptions in an individual’s memory, perception, and identity. When cognitive functions are altered, symptoms of these disorders can negatively affect not only the person’s psychological operations but his/her overall body functioning as well.

Frequently caused by an individual’s chronic effort to escape from unbearable emotional pain and trauma, dissociative disorders present several symptoms varying from amnesia to serious disruptions in identity and self-concept.

Types of Dissociative Disorders

The three core manifestations of dissociative disorders include depersonalization, derealization, and psychogenic amnesia. The Diagnostic and Statistical Manual of Mental Disorders, however, has categorized dissociative disorders into five types:

Dissociative Amnesia

Also known as psychogenic amnesia, dissociative amnesia is described as a significant memory loss in the absence of a known neurobiological cause. Like other categories of dissociative disorders, this is also related to an overwhelming degree of psychological stress.

Dissociative Identity Disorder

Formerly referred to as multiple personality disorder, dissociative identity disorder exists when an individual assumes two or more different identities or personalities known as alter egos. To be considered as a dissociative identity disorder, at least two alters shall take full control of the person’s behaviors in the absence of pharmacologic intervention.

Dissociative Fugue

Dissociative fugue is a pathological defense mechanism among individuals who suffered from intensely traumatic events. This is manifested by a temporary loss of memory and identity lasting from hours to months. This may also involve an assumption of a new identity and meaningless wandering.

Depersonalization Disorder

The criteria for diagnosing depersonalization disorder include a repetitive feeling of detachment from one’s own body or consciousness. Depersonalization disorder is famously linked to childhood experiences of abuse and other traumatic events such as violence, torture, and accidents. It usually exists with other psychological conditions such as clinical depression, anxiety disorder, and bipolar disorder.

Dissociative Disorder Otherwise Not Specified

This category of dissociative disorder applies to those individuals experiencing chronic and serious dissociation but do not substantially meet the criteria specified on the other types of dissociative disorders.

History of Dissociative Disorders

Back in 1900 BC, Egyptian doctors have long identified the existence of dissociative disorder in some individuals. They refer to this condition as hysteria, a term which originated from the Greek word hystera, meaning uterus. This nomenclature was established due to their belief that the symptoms of dissociative disorder are contributed by a fetus’ abnormal movement around its mother’s womb. It was only until the 17th century that the disorder was recognized as a medical condition originating from the brain and not from the uterus.

In the 19th century, Charcot, a distinguished neurologist studied the effectiveness of hypnosis in the management of functional irregularities in the brain such as dissociative disorder. His theory was then developed by his student Pierre Janet who conceptualized the experience of dissociation in hysterical patients. He defined dissociation as an overwhelming state in which the brain does not possess the needed energy to process and perform cognitive functions such as memory, perception, and decision-making. He added further that dissociation may inhibit the individual from being fully aware of his environment and from being able to develop insights about himself.

Freud, having been able to witness the effectiveness of Charcot’s hypnosis on his patients, collaborated with Breuer and hypothesized that hysteria is a result of the suppression of painful memories in the individual’s subconscious mind. With that, he developed techniques of psychotherapy that aid in the expression of repressed thoughts and emotions into conscious awareness. This will then relieve the distinguishing symptoms of dissociative disorder, leading to the individual’s recovery and rehabilitation.

Dissociative Disorder Symptoms

Aside from presenting disruptions and disturbances to an individual’s cognitive and affective functioning, other manifestations that are common to all types of dissociative disorders include the following: 

• Poor integration in memory of events, people, and time
• Mental disturbances such as anxiety and depression
• Feeling of detachment from self
• Disruption of the perception of self and others

Dissociative Amnesia Symptoms

The most critical sign in the diagnosis of dissociative amnesia is the individual’s serious inability to recall significant information that is far more severe than usual forgetfulness. The emergence of amnesia is usually not related to a neurological disease or trauma.

Amnesia may occur in varying characteristics of onset. Acute onset of amnesia commonly happens infrequently and is characterized by the abrupt unavailability of memories for conscious recall. Patients with this type of dissociative amnesia often present disoriented, perplexed, and meaningless behaviors.

Dissociative Identity Disorder Symptoms

Typically coexisting with dissociative amnesia, dissociative identity disorder is characterized by an individual’s assumption of multiple personalities, each of which possesses a distinct name, gender, personal history, and characteristics.

To be diagnosed with dissociative identity disorder, several specifications shall be manifested as suggested by the Diagnostic and Statistical Manual of Mental Disorders. The diagnostic criteria for dissociative identity disorder include the presence of two or more identities frequently taking full control over the individual’s mental functioning. Moreover, a marked degree of amnesia not tantamount to normal forgetfulness shall be manifested. These manifestations shall also occur without the actions and side effects of pharmacologic preparations.

Dissociative Fugue Symptoms

The assumption of a new identity and wandering away from home are the hallmarks of dissociative fugue. Patients with this disorder usually experience an inability to recall information about past events and exhibit efforts in running away from an unknown subject.

Aside from the occurrence of an unexpected travel accompanied by grave episodes of amnesia, several other criteria are indicated for the diagnosis of dissociative fugue. These may include critical disturbances in social and other aspects of functioning lasting for hours or, in extreme cases, months. These symptoms shall not be related to the direct effects of drug use.

Depersonalization Disorder Symptoms

Characterized by periods of derealization, depersonalization disorder usually initiates to develop during adolescence with patients experiencing continuous symptoms. This disorder can be acute or gradual in onset and commonly coexists with anxiety and psychotic disorders.

Depersonalization disorder is manifested by recurrent experiences of detachment outside one’s body as if watching a movie. During an episode of depersonalization, perceptions of shapes and sizes of objects and environment usually change leading to identifying persons as unreal or inhuman. These events critically impair the normal cognitive functioning of the patient.

  Read more: Understanding Depersonalization and Derealization

What Causes Dissociative Disorders

The development of dissociative disorders begins in early childhood when personal identity is still being formed. Children with experiences of physical, emotional, and sexual abuse are prone to manifest disturbances in their psychological functioning. Those who live in a threatening environment also possess certain risks of developing the disorder.

Dissociative disorders develop due to an individual’s effort to escape from a very traumatic event. A child who uses dissociation as a way of coping may utilize this mechanism throughout life. Dissociation with onset in adulthood, on the other hand, occurs less frequently as a result of severe trauma and other overwhelming life events. 

What Causes Dissociative Amnesia

Based on Freudian psychology, dissociative amnesia is considered an effort for self-preservation and an alternative to suicide. In conjunction, betrayal trauma theory asserts that dissociative amnesia develops as a response to adapting from childhood abuse. When the relationship between a child and his parent becomes unhealthy, the child may shut himself down from being aware of the trauma to maintain an attachment with his parent to survive. 

What Causes Dissociative Identity Disorder

Since a high percentage of individuals diagnosed with dissociative identity disorder report childhood abuse, dissociative identity disorder is strongly linked to experiences of abuse. Integrated with inadequate nurturing and the child’s ability to dissociate one’s memories and identity from conscious awareness, the likelihood of developing dissociative identity disorder is further increased.

Children develop their sense of identity from a variety of sources and experiences. Instead of forming a cohesive self-image and self-concept, abused children became overwhelmed by trauma contributing to the chronic separation of the fragments of their identity. Such children may develop distinct self-states in time as an effort to tolerate maltreatment and abuse.

What Causes Dissociative Fugue

Dissociative fugue involves similar causes as dissociative amnesia. Additional etiologic factors include the existence of interpersonal conflict, chronic and intense stress, and a persistent desire to escape from one’s life.

Dissociative fugue is regarded as a person’s means of withdrawing self from distressful realities. A financially burdened executive, for example, may opt to live on a farm and then continue to endure his demanding life. Fugues can also develop as a defense mechanism to depart from embarrassing events and unbearable stress and as a substitute for suicidal ideations. 

What Causes Depersonalization Disorder

Until today, the exact causative factor of depersonalization disorder continues to be unknown. Several bio-psycho-social aspects, however, have been considered as contributing factors to the development of the disease.

Like any other type of dissociative disorder, a history of childhood trauma and abuse is identified as a primary influence in the progression of depersonalization disorder. Depersonalization can also occur when facing life-threatening events and experiencing the effects of pharmacologic intoxication.

How are Dissociative Disorders Diagnosed

The patient’s medical record is one of the tools necessary for diagnosing dissociative disorders. Initially, thorough assessments and tests shall be performed to dismiss the presence of physical conditions contributing to the emergence of manifestations similar to those of dissociative disorders. Conditions that can produce signs of memory loss and delusions include neurological diseases, sleep deprivation, and drug intoxication.

To facilitate the diagnosis of dissociative disorders, psychiatrists and mental health professionals usually utilize pharmacologic interventions and hypnosis. Such actions enable the determination of alternate identities and the identification of repressed thoughts and memories. 

How is Dissociative Amnesia Diagnosed

Several tests and medical examinations are integrated to diagnose dissociative amnesia. One of the diagnostic exams includes magnetic resonance imaging (MRI) which is performed to reject the possible existence of structural problems in the brain. Electroencephalography (EEG) is also done to rule out the presence of seizure disorders while blood and urine tests are performed to determine possible use of drugs that can present certain degrees of memory loss.

How is Dissociative Identity Disorder Diagnosed

Dissociative identity disorder is one of the mental disorders frequently misdiagnosed by psychiatrists. Statistics show that patients have already been diagnosed with at least three different mental conditions before being appropriately diagnosed and treated for dissociative identity disorder.

Psychiatrists, to provoke a shift of personalities within the patient, may implement prolonged interviews, hypnosis, and administration of drugs such as barbiturates and benzodiazepines. These interventions are significant to determine possible interrelationships between or among distinct identities. 

How is Dissociative Fugue Diagnosed

The diagnosis of dissociative fugue usually involves a retrospective evaluation of the patient’s fugue episodes. Immediately after the occurrence of fugue, patients usually feel dazed and confused regarding their identity and their experiences of the past.

Due to the abrupt and unexpected onset of the disorder, dissociative fugue is not recognized easily. In establishing a diagnosis of the disorder, clinicians commonly rely on documentations and reports providing details regarding the circumstances before, during, and after the fugue episode. 

How is Depersonalization Disorder Diagnosed

Similar to the methods indicated for the diagnosis of dissociative amnesia, diagnosing depersonalization disorder requires the performance of tests and examinations such as MRI, EEG, and blood and urine chemistry. Psychological tests and special interviews are also conducted to determine the patient’s extent of deviation from normal cognitive and psychological functioning.

How to Prevent Dissociative Disorders

Childhood experiences of abuse have frequently become the leading causative factor in the development of behavioral and affective disorders such as dissociative disorders. It is therefore logical that to prevent the occurrence of dissociative disorders, collaborative efforts to decrease or even fully eradicate incidences of child abuse shall be exerted.

Early recognition of presenting signs and symptoms also plays a significant contribution to the prevention of dissociative disorders. It is certainly everyone’s responsibility to be proactive in reporting cases of childhood abuse and maltreatment to appropriate authorities and institutions. Doing so will not only help the victimized child but will also facilitate the implementation of programs that will develop nurturing skills among parents and caregivers.

Parents and caregivers also have corresponding obligations that, when accomplished, will promote the child’s holistic well-being thus preventing the emergence of interpersonal issues when the child reaches adulthood. It is a courageous move for abusive parents to admit what they have done wrong and to communicate their need for social help and support.

Doctors and mental health professionals, most importantly, share a critical part in the promotion of a mentally healthy community. Establishing correct diagnoses and providing appropriate treatments are just a couple of tasks that they can do to prevent complications, and to facilitate the patient to recovery.

How to Treat Dissociative Disorders

Several techniques and treatment approaches are utilized by mental health professionals in managing dissociative disorders. Psychotherapy, the primary treatment in this condition, and other treatment options however focus on a similar main objective, and that is, to facilitate healthy coping mechanisms to trauma and life’s other stresses.

Other than psychotherapy, there are many other therapeutic methods that are integrated into the care of patients with dissociative disorders. These include:

Creative Art Therapy. Individuals who experience difficulties in expressing deep-seated thoughts and feelings can utilize the opportunities for self-expression there are in creative arts. Through this, patients can enhance their awareness of self and coping abilities. Creative art therapy may be executed in the form of dance, art, music, and poetry.

Cognitive Therapy. Cognitive therapy is a subcategory of psychotherapy that involves the transformation of negative perceptions into positive and healthy ones. Based on the theory that our thoughts dictate our behavior, patients enrolled in this type of talk therapy are trained on how to positively behave when faced with negative situations.

How to Treat Dissociative Amnesia

Treatment approaches for dissociative amnesia usually depend on the duration of the memory loss. For short-term dissociative amnesia, the provision of a supportive environment will usually be sufficient especially when patients do not manifest signs of confusion and disorientation.

Dissociative amnesia occurring in longer duration commonly needs the careful implementation of more rigorous interventions to therapeutically restore the patient’s sense of identity and self-perception. In addition to supportive treatment, patients with dissociative amnesia may need to undergo hypnosis to facilitate the recollection of events. Once the amnesia is relieved, the focus of the treatment shifts to the resolution of problems that have led to the amnestic event.

How to Treat Dissociative Identity Disorder

The cohesion of identities and alter egos is the primary goal of treatment for dissociative identity disorder. Regular psychotherapeutic sessions may be integrated with medication administration to allay symptoms of anxiety, depression, and impulsivity.

Above other objectives of treatment, the provision of safety and security comes as a top priority. While being provided with continuous medical support, psychiatrists and other mental health professionals shall focus as well on addressing the patient’s painful and traumatic memories through psychotherapy.

Hypnosis is also helpful in gaining access to alter egos and initiating a means of communication with them. Once a hypnotic state is achieved, psychotherapists shall interpret the meaning and existence of multiple, distinct identities.

How to Treat Dissociative Fugue

The nature of interventions implemented to address dissociative fugue differs during fugue states and after fugue states. When individuals are still in a fugue, it is necessary to determine the person’s identity with the help of law enforcement agencies and social services personnel. The patient shall then be supported for the restoration of memory and identity.

Psychotherapy is only initiated once a fugue episode is over. The main purpose of psychotherapy for patients experiencing dissociative fugue involves the assessment of precipitating factors and the evaluation of means of coping implemented by these patients when conflicts and distressing events arise. Hypnosis will then be achieved through the administration of medications to develop the patients’ skills in handling stressful situations appropriately.

How to Treat Depersonalization Disorder

Treatment for depersonalization disorder usually focuses on the management of factors that led to the disease progression. This may include minimizing the psychological effects of childhood abuse and maltreatment through desensitization.

Various psycho-therapeutic interventions are proven helpful in the management of signs and symptoms of dissociative disorder. These may include the implementation of cognitive techniques to stop recurring thoughts about the unreal state of being, and behavioral techniques to involve the patient in activities that divert him from depersonalization. Grounding techniques are proven to be effective as well in promoting the connection between the patient and his environment.