Dissociative Disorder

Dissociative Disorder

One of the most misunderstood mental health diagnoses is Dissociative Disorder, formally known as Multiple Personality Disorder. Hollywood has portrayed people with this disorder in a variety of films in genres from horror to comedy, including titles such as Sybil, Dr. Jekyll and Mr. Hyde, or Jim Carrey in Me, Myself, and Irene. However, it is important to look to research and facts to better understand the diagnosis and treatment of these disorders.

Dissociative Disorders are identified by a disruption in the typical integration of thoughts, memory, identity, emotions, perception, movement, and behavior. These problems can cause impairment in everyday life for those who experience these symptoms. There are five separate diagnoses in this category which are:

• Dissociative Identity Disorder
• Dissociative Amnesia
• Depersonalization/Derealization Disorder
• Specified Dissociative Disorder
• Unspecified Dissociative Disorder

These diagnoses cover a wide range of symptoms with various severity levels. Many times, these symptoms occur as a result of trauma. Sometimes these symptoms present with a feeling of disconnection from one’s own personality (depersonalization). Other times there may be a feeling of disconnection from one’s environment (derealization). All the diagnoses cause impairment or distress in relationships, jobs, or other areas of life.

This article will review the significant symptoms that describe each disorder in this category.

Dissociative Identity Disorder (DID)

A person with this disorder typically presents with two or more distinct personalities that can be observed by others or reported by the individual. DID is associated with overwhelming experiences of traumatic events or abuse occurring in childhood. As a result, this person may experience a disruption in mood, behavior, thoughts, memory, and activities. A person may also report having an “out of body” experience (depersonalization) where they become observers of themselves saying or doing things they do not have control over. They may also experience emotions or impulsive behaviors that do not agree with their typical values. Individuals may also report their bodies feeling different (e.g., like a child, opposite gender, etc.) Non-epileptic seizures or other physical symptoms that cannot be medically explained may also occur.

There may be a gap in their memory (dissociative amnesia) regarding the passage of time that cannot be accounted for or forgetting details of traumatic events beyond typical forgetfulness. Three distinct types are:

1. Forgetting events from periods of childhood or adolescence.
2. Forgetting information that one has typically, including how to do their job, driving, etc.
3. Finding out things that occurred in their everyday life that they do not remember experiencing, such as items they bought or things they collected that wind up in their house.
4. Experiencing travel (dissociative fugue) they don’t remember and ending up in a place they do not remember going, such as a beach, nightclub, or distant location.

In the past, this disorder was misinterpreted as spiritual possession due to a lack of understanding or training of those who are with these individuals at the time they experience these symptoms. However, more recently, this disorder has been understood as a response to trauma and the person’s inability to cope with or handle those events. When these behaviors are seen as “Possession-form identities” in DID, the person presents as if a spirit or supernatural being has taken control, resulting in a person speaking or acting distinctly differently. Sometimes these practices are part of the cultural experience or spiritual practice and do not qualify as DID.

A person with DID often has other mental health issues simultaneously, such as depression, anxiety, and other related problems. For best outcomes, a person should receive evaluation and treatment to address their current symptoms and early traumatic experiences to alleviate the underlying causes and improve their overall well-being.

Dissociative Amnesia

This condition is the inability to recall important information about one’s life that should typically be remembered. There are two types of dissociative amnesia. First, localized amnesia is when you cannot remember something from a specific period. Some people can recall events from that time, but not other events. An example would be some part of childhood, but not other events from that time.

In contrast, generalized amnesia is when a person cannot remember anything from their life history. As a result, these individuals may lose the ability to recall knowledge, while others may lose their ability to perform some skills. In addition, some people are not aware they forget important details, while others are acutely aware and uncomfortable.

This condition can occur due to various events, including childhood abuse, mild traumatic brain injury, or recent traumatic events. Depression and anxiety typically co-occur in individuals experiencing these problems.

Depersonalization/Derealization Disorder

There are two different ways this disorder can present. First, depersonalization is when one experiences being an observer of their thoughts, feelings, sensations, body or actions, e.g., time, emotions, or physical numbness. Second, when a person experiences derealization, they feel disconnected from their surroundings, similar to a dream-like state. A person will experience impairment in both conditions in social, occupational, or other situations.

People with this disorder may experience symptoms intermittently that last from hours to days and may be brought on by their environment. Childhood trauma, including neglect, abuse, or witnessing domestic violence, is commonly associated with the disorder. In addition, symptoms may be induced by hallucinogens, marijuana, ecstasy, ketamine, etc.

Marijuana may cause new-onset panic attacks and depersonalization/derealization simultaneously.

Other Specified Dissociative Disorders

This category is for those whose symptoms do not meet the criteria for one of the other diagnoses but exhibit some features of the disorder. Some designations include

1. Chronic and recurrent syndromes of mixed dissociative disorder
2. Identity disturbance due to prolonged and intense coercive persuasion
3. Acute dissociative reactions to a stressful event
4. Dissociative trance

Individuals who are pressured to act or think a certain way may exhibit distress that causes them to dissociate or conform to the expected behavior. Examples of this may be thought reform, brainwashing, indoctrination while captive, cult recruitment, grooming children, etc. This may result in a person questioning their true identity or forgetting their prior self.

Unspecified Dissociative Disorder

The individual has some symptoms present in a dissociative disorder, but the clinician prefers to delay an official diagnosis for one reason or another. Situations that may evoke this diagnosis would be an emergency room setting where there is a shorter interaction with the patient.

At Vanguard Psychiatry, we can help you or your loved one navigate these problems. Various issues can be addressed and resolved during treatment through a collaborative approach with our medical networks. Vanguard Psychiatry is a reliable resource for you and your family.