Dissociative disorders are characterized by a sense of disconnection from oneself or from certain memories or experiences. Such disorders are believed to be the result of traumatic experience. The sense of being walled off from the trauma is considered to be a coping mechanism to keep extremely painful memories at bay.
Causes of Dissociative Disorders
Dissociative disorders most frequently have their onset in childhood, when personal identity is still developing, although the disorder may also materialize in adulthood after a traumatic event. Dissociative disorders may be caused by any of the following:
- Sexual abuse or rape
- Physical or emotional abuse
- Trauma as a result of war
- Trauma after a natural disaster
- Chaotic family life
- Traumatic injury
- Traumatic invasive medical procedure
Types of Dissociative Disorders
While all dissociative disorders are characterized by an abnormal detachment from the sense of self or from one’s own memories or experiences, four distinct types of dissociation have been differentiated.
This type of dissociative disorder involves sudden extensive memory loss after a traumatic event and is most frequently diagnosed in children. The patient with dissociative amnesia blocks out terror or extreme pain with an involuntary loss of memory. The memory loss involved may be all-encompassing general amnesia, localized amnesia surrounding a period of hours or days, selective amnesia where only certain parts of an event are remembered, or systematized amnesia where certain aspects of the past are blotted out, such as anything pertaining to a particular person.
A rare type of dissociative disorder, dissociative fugue involves physical escape from highly distressing events. Though temporary, this disorder causes patients to become confused about their own identities and to perhaps assume new ones. In this fugue state, during which they are unsure of who they are, they leave work, home or school and travel for days, weeks or months.
Dissociative Identity Disorder
Dissociative identity disorder was formerly known as multiple personality disorder. This disturbance involves assuming different identities to cope with unbearable stress. People with this disorder experience splits in their identity, feeling themselves to be inhabited by more than one self. They often report feeling the presence of others, or hearing the voices of others, inside their own minds.
Patients with depersonalization disorder feel outside of themselves, observing their own behavior from a distance. The sense of detachment may come and go over a period of years, interrupting daily life, interfering with work or relationships, and leading to delusional thinking.
Symptoms of Dissociative Disorders
Many individuals with dissociative disorders may be disquieted by their symptoms without really understanding their cause. They may be aware that they are having serious psychiatric difficulties, but have trouble expressing precisely what their symptoms are. Symptoms may include:
- Blurred sense of identity
- Memory loss surrounding certain periods, events or individuals
- Depression, anxiety, dread
- Detachment or depersonalization
- Sense that reality is distorted or unreal
- Inexplicable loss of periods of time
These symptoms are serious and require treatment since untreated they are life-threatening and may eventually result in suicide.
Diagnosis of Dissociative Disorders
Dissociative disorders are diagnosed and differentiated according to criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DMS), published by the American Psychiatric Association. In order for a positive diagnosis, the symptoms must be found not to be explicable as the result of prescription medication, substance abuse, or an underlying medical condition, such as temporal lobe epilepsy.
Treatment of Dissociative Disorders
In my practice, I treat dissociative disorders through either psychodynamic psychotherapy or psychoanalysis. This approach views dissociation as a defense mechanism used to manage overwhelming emotions and traumatic experiences. During therapy sessions, I work with the patient to explore their unconscious mind and the unconscious processes that contribute to their symptoms. These sessions can occur one or more times per week over a period of months to years and are designed to help the patient process and integrate traumatic experiences, leading to a resolution of symptoms and improved overall functioning. I have utilized these techniques over the last twenty plus years with lasting results and have seen significant improvement in my patients’ well-being.
Prevention of Dissociative Disorders
Breaking the cycle of dissociative states involves fostering resilience and emotional regulation in individuals who have experienced traumatic events. In my practice, this is done through teaching coping skills, providing a supportive environment, and promoting healthy relationships. When an individual is ready, it is important to talk about painful and traumatic feelings and experiences as this can be a crucial step in the healing process. By using words to process these experiences, individuals can integrate them into their conscious awareness, reducing the likelihood of future dissociative states. My goal in treatment is to help individuals learn to regulate their emotions, form secure attachment relationships, and gain insight into unconscious processes that may contribute to dissociation.