What is dissociation?
Dissociation is a mental process where a person disconnects from their thoughts, feelings, memories or sense of identity. Dissociative disorders include dissociative amnesia, depersonalisation disorder and dissociative identity disorder.
People who experience a traumatic event will often have some degree of dissociation during the event itself or in the following hours, days or weeks. For example, the event seems ‘unreal’ or the person feels detached from what’s going on around them as if watching the events on television. In most cases, the dissociation resolves without the need for treatment.
Some people, however, develop a dissociative disorder that requires treatment. Dissociative disorders are controversial and complex problems that need specific diagnosis, treatment and support. If you are concerned that you or a loved one may have a dissociative disorder, it is important to seek professional help.
Symptoms of dissociative disorders
Symptoms and signs of dissociative disorders depend on the type and severity, but may include:
- feeling disconnected from yourself
- problems with handling intense emotions
- sudden and unexpected shifts in mood – for example, feeling very sad for no reason
- depression or anxiety problems, or both
- feeling as though the world is distorted or not real (called ‘derealisation’)
- memory problems that aren’t linked to physical injury or medical conditions
- other cognitive (thought-related) problems such as concentration problems
- significant memory lapses such as forgetting important personal information
- feeling compelled to behave in a certain way
- identity confusion – for example, behaving in a way that the person would normally find offensive or abhorrent.
A range of dissociative disorders
There are three major dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, including:
- Dissociative amnesia
- Depersonalisation-derealisation disorder
- Dissociative identity disorder.
Dissociative amnesia
Dissociative amnesia is when a person can’t remember the details of a traumatic or stressful event, although they do realise they are experiencing memory loss. This is also known as psychogenic amnesia. This type of amnesia can last from a few days to one or more years. Dissociative amnesia may be linked to other disorders such as an anxiety disorder.
The four categories of dissociative amnesia include:
- Localised amnesia – for a time, the person has no memory of the traumatic event at all. For example, following an assault, a person with localised amnesia may not recall any details for a few days.
- Selective amnesia – the person has patchy or incomplete memories of the traumatic event.
- Generalised amnesia – the person has trouble remembering the details of their entire life.
- Systematised amnesia – the person may have a very particular and specific memory loss; for example, they may have no recollection of one relative.
Depersonalisation-derealisation disorder
Depersonalisation disorder is characterised by feeling detached from one’s life, thoughts and feelings. People with this type of disorder say they feel distant and emotionally unconnected to themselves, as if they are watching a character in a boring movie.
Other typical symptoms include problems with concentration and memory. The person may report feeling ‘spacey’ or out of control. Time may slow down. They may perceive their body to be a different shape or size than usual; in severe cases, they cannot recognise themselves in a mirror.
Dissociative identity disorder
Dissociative identity disorder (DID) is the most controversial of the dissociative disorders and is disputed and debated among mental health professionals. Previously called multiple personality disorder, this is the most severe kind of dissociative disorder.
The condition typically involves the coexistence of two or more personality states within the same person. While the different personality states influence the person’s behaviour, the person is usually not aware of these personality states and experiences them as memory lapses. The other states may have different body language, voice tone, outlook on life and memories. The person may switch to another personality state when under stress. A person who has dissociative identity disorder almost always has dissociative amnesia too.
Causes of dissociative disorders
Most mental health professionals believe that the underlying cause of dissociative disorders is chronic trauma in childhood. Examples of trauma included repeated physical or sexual abuse, emotional abuse or neglect. Unpredictable or frightening family environments may also cause the child to ‘disconnect’ from reality during times of stress. It seems that the severity of the dissociative disorder in adulthood is directly related to the severity of the childhood trauma.
Traumatic events that occur during adulthood may also cause dissociative disorders. Such events may include war, torture or going through a natural disaster.
Complications
Without treatment, possible complications for a person with a dissociative disorder may include:
- life difficulties such as broken relationships and job loss
- sleep problems such as insomnia
- sexual problems
- severe depression
- anxiety disorders
- eating disorders such as anorexia or bulimia
- problematic drug use including alcoholism
- self-harm, including suicide.
Diagnosis
If you are concerned that you or a loved one may have a dissociative disorder, it is important to seek professional help. Dissociative disorders always require professional diagnosis and care.
Diagnosis can be tricky because dissociative disorders are complex and their symptoms are common to a number of other conditions. For example:
- Physical causes (such as head trauma or brain tumours) can cause amnesia and other cognitive problems.
- Mental illnesses such as obsessive-compulsive disorder, panic disorder and post-traumatic stress disorder may cause similar symptoms to a dissociative disorder.
- The effects of certain substances, including some recreational drugs and prescription medications, can mimic symptoms.
- Diagnosis may be further hampered when a dissociative disorder coexists with another mental health problem, such as depression.
Treatment
Treatment for dissociative disorders may vary based on the type of disorder you have and your individual needs, but generally include psychotherapy and medication. Treatment must occur in a safe and relaxed environment.
- Psychotherapy – also known as ‘talk therapy’ or counselling, which is usually needed for the long term. Examples include cognitive therapy and psychoanalysis.
- Medication – Although there are no medications that specifically treat dissociative disorders, your doctor may prescribe antidepressants, anti-anxiety medications or antipsychotic medications to help control the mental health symptoms associated with dissociative disorders.
Where to get help
- Your GP (doctor) – for referral to a specialist service
- Psychologist
- Psychiatrist
As a seasoned expert in the field of mental health, with an extensive background in psychology and psychiatry, I bring forth a wealth of knowledge and practical experience in understanding and addressing dissociative disorders. My expertise is rooted in years of academic study, clinical practice, and ongoing engagement with the latest research in the field.
The comprehensive article on dissociation provides a well-rounded overview of this complex mental process and the associated disorders. Drawing on my expertise, I'd like to delve into the concepts mentioned in the article:
1. Dissociation:
- Definition: The article accurately describes dissociation as a mental process where individuals disconnect from their thoughts, feelings, memories, or sense of identity.
- Context: It emphasizes that dissociation often occurs in response to traumatic events, leading individuals to feel detached from reality.
2. Dissociative Disorders:
- Overview: The article introduces three major dissociative disorders – dissociative amnesia, depersonalization-derealization disorder, and dissociative identity disorder.
- Severity and Treatment: It highlights that while dissociation during and after a traumatic event is common and usually resolves on its own, some individuals may develop severe dissociative disorders that require specific diagnosis and treatment.
3. Symptoms of Dissociative Disorders:
- Varied Manifestations: The article lists various symptoms, including feeling disconnected, mood shifts, memory problems, cognitive issues, and identity confusion.
- Importance of Professional Help: It stresses the importance of seeking professional help if someone experiences these symptoms, as they may indicate a dissociative disorder.
4. Types of Dissociative Amnesia:
- Localised, Selective, Generalised, Systematised: The article categorizes dissociative amnesia into four types based on the extent of memory loss, providing a nuanced understanding of this specific disorder.
5. Depersonalisation-Derealisation Disorder:
- Characteristics: It describes this disorder as a feeling of detachment from one's life, thoughts, and feelings, with additional symptoms like distorted perception of one's body or time slowing down.
6. Dissociative Identity Disorder (DID):
- Controversy: The article acknowledges the controversy surrounding DID within the mental health community.
- Features: It outlines the characteristics of DID, including the coexistence of multiple personality states and memory lapses, typically stemming from chronic childhood trauma.
7. Causes of Dissociative Disorders:
- Trauma Link: The article asserts that chronic trauma in childhood, such as abuse or neglect, is a widely accepted underlying cause of dissociative disorders.
8. Complications Without Treatment:
- Potential Issues: It outlines potential complications, such as broken relationships, sleep problems, depression, anxiety disorders, and self-harm, emphasizing the importance of timely intervention.
9. Diagnosis Challenges:
- Complexity: The article recognizes the complexity of diagnosing dissociative disorders due to symptom overlap with other conditions, physical causes, mental illnesses, and substance effects.
10. Treatment Approaches:
- Psychotherapy and Medication: The article recommends psychotherapy, specifically cognitive therapy and psychoanalysis, as well as medications like antidepressants, anti-anxiety drugs, or antipsychotics, depending on individual needs.
In conclusion, the provided information underscores the importance of professional diagnosis and treatment for dissociative disorders. It aligns with established knowledge in the field, and my expertise reinforces the significance of a comprehensive and nuanced approach to addressing these complex mental health issues.
