Dissociative Disorders

Dissociative disorders

are mental health conditions characterized by an impaired awareness of one’s own actions, thoughts, sensations, or identity, often as a response to trauma.

• A psychological adaptation to overwhelming emotions or stress.

Types of Dissociative Disorders

• Depersonalization/Derealization Disorder (least severe)

• Dissociative Amnesia (moderate)

• Dissociative Identity Disorder (most severe)

Depersonalization/Derealization Disorder

A dissociative disorder where individuals feel detached from their body or surroundings, often experiencing a sense of unreality.

Depersonalization

Feeling detached from oneself (as if observing from outside the body)

Derealization

Feeling that the external world is unreal or dreamlike often accompanied by visual distortions or a sense of detachment.

Depersonalization/Derealization Disorder Clinical Features

• Sense of watching oneself in a movie

• Emotional or physical numbness

• Altered sense of time (too fast/too slow)

• Brain fog, dizziness

• Anxiety and excessive rumination

• Flat affect; may speak in monotone

• Difficulty forming relationships

  • Severe cases: difficulty recognizing familiar people, places, or objects

Dissociative Amnesia

A condition characterized by the inability to recall important autobiographical information, usually related to a traumatic or stressful event, that is inconsistent with ordinary forgetting.

Types of Dissociative Amnesia

• Localized amnesia

• Generalized amnesia

  • Dissociative fugue

• Systemized amnesia

• Continuous amnesia

Localized Amnesia

The inability to recall events from a specific period, often directly following a traumatic event, while retaining memories from other time periods.

Generalized Amnesia

A form of dissociative amnesia where an individual cannot recall their entire life history or personal information, often including identity.

Dissociative fugue

A subtype of dissociative amnesia where individuals unexpectedly travel away from home, unable to recall their past identity or important personal information.

Systemized amnesia

The inability to recall specific categories of information, such as memories related to a particular person or event, while other memories remain intact.

Continuous amnesia

A type of dissociative amnesia where an individual cannot remember events from a specific point in time onward, while memories from earlier periods remain intact.

Dissociative Identity Disorder (DID)

A complex psychological condition characterized by the presence of two or more distinct personality states or identities, along with recurrent gaps in memory.

• Formerly known as multiple personality disorder, DID often arises as a result of severe trauma during early childhood.

• May engage in risky or self-destructive behavior.

• Suicide risk is very high (75%)

Covert DID (Dissociative Identity Disorder)

in which the presence of alters is not easily observable, often leading to difficulties in diagnosis. Individuals may experience amnesia and identity issues without overtly displaying distinct identities to others.

• Person experiences sudden shifts in thinking, mood, or perception.

• May hear internal voices or feel as if another personality is influencing them.

• Usually aware their experience is unusual.

Overt DID (Dissociative Identity Disorder)

a form where distinct identities are clearly observable, often leading to more apparent symptoms and identifiable alters. Individuals may display noticeable shifts in behavior and memory.

• Identities completely take control of body and mind.

• Person is unaware of the switch; reports memory gaps or “lost time”.

• May find unfamiliar items (e.g. groceries, injuries).

• Fugue states are common (waking up in another city with no memory).

Dissociative Disorders Diagnosis

• Difficult to diagnose due to:

  • Substance intoxication

  • Neurological issues (seizures, brain trauma, dementia)

  • Anxiety disorders

  • Bipolar disorder or schizophrenia

  • Key difference - dissociative symptoms last much longer (months to years) than the temporary episodes seen in other conditions.

Dissociative disorders treatment

Typically involves psychotherapy, medications for co-occurring conditions, and support groups. Treatment focuses on integrating identities and coping with trauma.