What are the other names for this Condition? (Also known as/Synonyms)

• DD (Dissociative Disorder)

What are Dissociative Disorders? (Definition/Background Information)

• Dissociative Disorders are disorders that result in a breakdown of consciousness (mind), and cause confusion in memory, awareness, identity, or perception
• Every individual may feel some amount of dissociation in a passing manner, some time in their life. But, when the disconnected feeling becomes continuous, it is classified as a disorder
• There are 3 types of Dissociative Disorders:
  • Dissociative identity disorder (DID): It was commonly referred to as multiple personality disorder, and is characterized by the presence of two or more distinct and separate personalities within an individual. Although multiple personalities can exist within a single person, only one personality is manifested at a single time
  • Dissociative amnesia: It involves a temporary loss of recall memory caused by disassociation, which may last for a very short period of a few seconds, or sometimes even to several years. The interruption may be voluntary or involuntary and is most often a result of psychological trauma
  • Depersonalization/derealization disorder: It is a mental disorder involving out of body experiences in which one feels as though he/she has disconnected from their body and thoughts, and is observing themselves from the outside. This detached feeling can be similar to being in a dream-like state
• Individuals may develop Dissociative Disorders primarily due to environmental factors, as they commonly manifest as coping mechanisms following long-term psychological stress, such as abuse, trauma, or violence. These disorders may also be a symptom of other health conditions, such as brain diseases or personality disorders
• Dissociative Disorders can be treated using a combination of psychotherapy and medication. Many factors are known to influence the prognosis of these disorders. But, alongside a steady treatment, individuals with a strong support system and a healthy lifestyle can lead a regular life without losing their grip on reality

Who gets Dissociative Disorders? (Age and Sex Distribution)

Dissociative Disorders are prevalent in all racial and ethnic groups. Other distribution factors depend on their subtypes, as shown below:

• Dissociative identity disorder:
  • In clinical populations, the estimated prevalence of dissociative identity disorder ranges from 0.5% to 1%. In general populations the estimated prevalence is somewhat higher ranging from 1%-5%
  • Females are more likely to be affected than males
  • This disorder can manifest at any age
• Dissociative amnesia:
  • The annual prevalence of dissociative amnesia is 1.8% among the general population
  • Females are more likely to be affected than males; up to 1% of the male population and 2.6% of the female population may be affected
  • Dissociative amnesia can appear in any age group past infancy
• Depersonalization/derealization disorder:
  • The disorder has a prevalence of 0.8%-2% among the general population
  • Both males and females can be affected equally
  • Symptom manifestation can occur as early as age 16 years

What are the Risk Factors for Dissociative Disorders? (Predisposing Factors)

The risk factors for Dissociative Disorders are as follows:

• Immense or ongoing psychological stress during childhood, such as abuse, trauma, or violence
• Certain behavioral traits, such as denial or difficulty adapting to situations

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Dissociative Disorders? (Etiology)

• Dissociative disorders primarily develop as a coping mechanism to trauma. Some such circumstances include:
  • Children subjected to long-term physical, sexual, or emotional abuse
  • Overwhelming psychological stress, caused by traumatic events such as war, violence, accidents, or disasters
• Some Dissociative Disorders may also have a genetic basis, and be associated with brain diseases, such as dementia, or personality disorders, such as schizophrenia

What are the Signs and Symptoms of Dissociative Disorders?

The signs and symptoms of Dissociative Disorders may differ between the affected individuals based on the subtype of the disorder, and could include: 

• Memory loss:
  • Certain time periods, events, and people
  • Inability to recall important childhood memories
• Unreality of self and surroundings:
  • Detachment from oneself, one’s thoughts and emotions
  • Blurred sense of identity
  • Distorted perception of people and things 
• Mental health problems:
  • Depression or anxiety
  • Suicidal thoughts and behaviors
  • Mood swings
• Physical health problems:
  • Headaches 
  • Generalized body pain

How are Dissociative Disorders Diagnosed?

Dissociative Disorders may be diagnosed using one the following physical and psychiatric methods:

• Complete physical and psychiatric examination
• Extensive medical history evaluation to factor in any medication or substance use that may be causing the dissociative experience
• Assessment of the signs and symptoms based on the criteria listed in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
• Laboratory tests
• Imaging studies
• Biopsy studies, if necessary
• Differential diagnosis to rule-out any other conditions that may present similar signs and symptoms

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Dissociative Disorders?

The following complications of Dissociative Disorders may be observed:

• Aggressive tendencies
• Poor social skills; difficulty in maintaining personal and social relationships
• Loneliness or social solitude 
• Substance use and abuse (alcohol or drug dependence)
• Mental disorders that include:
  • Depression and anxiety 
  • Post-traumatic stress disorder (PTSD)
  • Personality disorders
  • Sleep disorders including nightmares, insomnia, and sleep walking
  • Eating disorders
• Self-mutilation such as cutting or burning one’s skin
• Suicidal thoughts and behaviors

How are Dissociative Disorders Treated?

The treatment for Dissociative Disorders is dependent on the individual’s signs and symptoms. The focus of treatment is to address the root cause of dissociation and then change the negative thoughts and behaviors associated with it.

The potential treatment options for Dissociative Disorders are as follows:

• Psychotherapy, the primary form of treatment, may be applied in different methods:
  • Cognitive-behavioral therapy (CBT) focuses on changing negative and dysfunctional thought patterns, feelings, and behaviors
  • Eye movement desensitization and reprocessing (EMDR) helps treat individuals suffering from recurring nightmares or flashbacks, such as in the case of post-traumatic stress disorder (PTSD)
  • Dialectical behavior therapy (DBT) treats those with severe personality disturbances that may have resulted from abuse or trauma, and helps to change toxic behavioral patterns such as self-harm, suicidal thinking, and substance abuse
  • Family therapy helps to educate family members about the disorder and recognize the symptoms in the case that the affected individual starts to show signs of recurrence
  • Creative therapies (art/music therapy) explores an individual’s creativity and allows them to express their thoughts, feelings and experiences in a safe and creative environment
• Meditation and relaxing techniques: Clinical hypnosis can be used to reach a new state of relaxation in which individuals can explore their subconscious thoughts, feelings, and memories that they are usually and consciously not aware of
• Medication: There is no medication that can treat the disorder itself. However, medication can be prescribed to treat depression or anxiety that may be associated with Dissociative Disorders

How can Dissociative Disorders be Prevented?

Currently, there are no methods or guidelines available to delay or prevent the onset of Dissociative Disorders. However, the following steps may be taken to slow its progression:

• Early intervention, once dissociative symptoms are displayed
• Seeking professional help following any psychologically traumatic event in one’s life
• Speaking with a trusted friend or family member to help cope with stress
• Avoiding alcohol and drugs, as substance dependencies can aggravate the symptoms of Dissociative Disorders

Effective management of Dissociative Disorders require the early detection, education, and consistent treatment with psychotherapy and medication.

What is the Prognosis of Dissociative Disorders? (Outcomes/Resolutions)

The prognosis of Dissociative Disorders can vary depending on the severity of the signs and symptoms. The prognosis is generally assessed on a case-by-case basis.

• Individuals with symptoms, which are mainly post-traumatic, function well and recover completely with treatment
• Symptomatic individuals with symptoms as well as other coexisting disorders, such as personality or mood disorders, require a longer and a possible slower course of ‘crisis-ridden’ treatment
• Alongside the clinical treatment, close family members and friends play an important role in the recovery process. This can help ensure that the affected individuals are able to lead a happy and healthy life

Additions and Relevant Useful Information for Dissociative Disorders:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/emotional-well-being/