Dissociation and dissociative disorders

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 and signs of dissociative disorders depend on the type and severity, but may include:

• identity confusion – for example
• behaving in a way that the person would normally find offensive or abhorrent

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 identity disorder. 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 The four categories of dissociative amnesia include:

• 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

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 (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. Most mental health professionals believe that the underlying cause of dissociative disorders is chronic , 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. Without treatment, possible complications for a person with a dissociative disorder may include:

• 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: and other cognitive problems.

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 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. – Although there are no medications that specifically treat dissociative disorders, your doctor may prescribe antidepressants, anti-anxiety medications or to help control the mental health symptoms associated with dissociative disorders. Symptoms of dissociative disorders 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 A range of dissociative disorders Dissociative amnesia Depersonalisation-derealisation disorder Dissociative amnesia anxiety disorder Localised amnesia Selective amnesia Generalised amnesia Systematised amnesia Depersonalisation-derealisation disorder Dissociative identity disorder Causes of dissociative disorders trauma in childhood.

Examples of trauma included repeated physical or sexual abuse Complications 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 Physical causes (such as head trauma or brain tumours) can cause amnesia Mental illnesses such as obsessive-compulsive disorder , panic disorder and post-traumatic stress disorder Treatment Psychotherapy – also known as ‘talk therapy’ or counselling , which is usually needed for the long term.

Examples include cognitive therapy and psychoanalysis Medication antipsychotic medications Where to get help Your GP (doctor) – for referral to a specialist service Psychologist Psychiatrist.

Key Points

• 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
• Other typical symptoms include problems with concentration and memory
• Traumatic events that occur during adulthood may also cause dissociative disorders