Dissociative disorders are commonly misunderstood conditions that affect a decent portion of the general population. According to the National Alliance on Mental Illness (NAMI), these disorders are characterized by an involuntary escape from reality marked by a disconnection between consciousness, thoughts, identity, and memory. Individuals from all age groups, ethnic, social, and socioeconomic backgrounds can experience some type of dissociative disorder.
Transient symptoms of depersonalization/derealization in the general population are common. There’s a lifetime prevalence rate of between 26 and 74 percent and between 31 and 66 percent at the time of a traumatic event. An estimated 75 percent of people will experience a depersonalization/derealization episode in their life, while only 2 percent will meet the criteria for chronic episodes.
Despite the condition affecting people of all ages and races, women are more likely to be diagnosed with a dissociative disorder than men. Symptoms of a dissociative disorder will first develop in response to a traumatic event, such as military combat or abuse, to suppress the memories and keep them under control.
During a stressful situation, these symptoms can worsen and lead to challenges in a person’s daily activities. However, the type of symptoms someone faces will depend on the dissociative disorder they have. These mental disorders cause a disconnection and lack of continuity between memories, thoughts, surroundings, and identity, and a person will escape reality in an unhealthy and involuntary way that causes significant problems.
Some examples of dissociative symptoms include detachment or feeling as though they’re outside their body, amnesia, and memory loss. The three types of dissociative disorders include the following:
- Dissociative identity disorder
- Dissociative amnesia
- Depersonalization/derealization disorder
Examples of mild dissociation include highway hypnosis and daydreaming, which involves losing touch with a person’s immediate surroundings. During a traumatic experience like a natural disaster or crime victimization, dissociation helps the person tolerate what is often too tough to bear. In these situations, the person will dissociate the memory of the circumstances, place, or feelings about the overwhelming event. It allows them to mentally escape the pain, fear, and horror. However, it may make it harder to remember the details later on, which is common among many accident and disaster survivors.
Treatment for dissociative disorders requires a combination of psychotherapy and medication to be the most effective. However, finding the right treatment plan is often challenging, although once it’s been found, the individual can lead a healthy and productive life.
Below, we’ll look into identity and personality disorders and what to look for if you’re concerned about yourself or a loved one.
Dissociative Identity Disorder
Dissociative identity disorder is caused by traumatic events or abuse that occurred when the person was a child or other overwhelming experiences that caused lasting effects. The condition was once referred to as multiple personality disorder.
The most common symptoms of dissociative identity disorder include the following:
- The existence of two or more distinct identities or personality states. These distinct identities are typically accompanied by changes in memory, thinking, and behavior. The signs and symptoms can be observed by the person or others.
- Continued gaps in memory about personal information, everyday events, or past traumatic events.
- These symptoms will cause significant problems or distress in occupational, social, or other areas of functioning.
- A sense of being detached from yourself and your emotions
- A blurred sense of identity
- Memory loss (amnesia) from specific events, time periods, and people.
- A perception of the things and people around you as unreal or distorted.
- Mental health issues that include anxiety, depression, and suicidal thoughts or behaviors.
- Significant problems and stress at work, in your relationships, or other areas of your life
In addition to what was mentioned above, the disturbance can’t be a normal part of a broadly accepted religious or cultural practice. As mentioned in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), in many cultures globally, experiences of being possessed are a routine part of spiritual practices and are not considered dissociative disorders.
The personal preferences and attitudes about food, clothes, or other activities of a person with dissociative identity disorder might suddenly shift, followed by shifting back. The identities will occur involuntarily, are unwanted, and lead to distress. Those with dissociative identity disorder could feel that they’ve become an observer of their own actions and speech and that their bodies feel different. For example, they could feel like a small child or like they’re the opposite gender.
A person with dissociative identity disorder may feel as though they are within two or more entities, each with its own way of remembering and thinking about themselves or their lives. It’s vital to keep in mind that despite these alternate states appearing to be or feeling different, they’re all manifestations of a single, whole person. Other terms used to describe these alternate states include “alternate personalities, alters, identities, or states of consciousness.
Risk Factors and Suicide Risk
Individuals who have experienced physical abuse or sexual abuse as children are at increased risk of developing dissociative identity disorder. The majority of those who develop the illness have experienced overwhelming and repetitive trauma in their childhood. Among those with the condition in the United States, Europe, and Canada, 90 percent had been victims of neglect and childhood abuse.
Suicide attempts and other self-harming behavior is common among those with dissociative identity disorder. An estimated 70 percent of outpatients with the condition have attempted suicide.
Depersonalization/derealization disorder typically involves recurring or ongoing experiences of one or both conditions.
- Depersonalization: Experiences of detachment or unreality from a person’s mind, self, or body. They might feel as though they’re outside their bodies or watching the events that are happening to them.
- Derealization: Experiences of detachment or unreality from a person’s surroundings. The person might feel as though the people and things around them are fake.
During these altered experiences, the individual is aware of their reality and that what they’re experiencing is unusual. It can be highly distressful, although the person will appear to lack emotion or be unreactive.
Symptoms might appear as early as childhood. The average age a person will experience the condition is 16, although less than 20 percent of those with depersonalization/derealization disorder will first experience symptoms after the age of 20.
Dissociative amnesia is when a person can’t recall information about themselves, which is typically related to a stressful or traumatic event. It can be one of the following:
- Localized: When the person can’t remember a period of time or event, which is the most common type
- Selective: When the person can’t remember a specific aspect of the event or some events within a specific period
- Generalized: A complete loss of life history and identity, which is considered rare
Dissociative amnesia is associated with childhood trauma, most often when the person experiences emotional neglect and emotional abuse. The person may not be aware of their memory loss unless called upon. They may not even realize they have limited awareness, and they’ll try to minimize the significance of memory loss about a particular time or event.
Both post-traumatic stress disorder (PTSD) and acute stress disorder can involve dissociative symptoms, including depersonalization or derealization and amnesia.
What are Triggers and Flashbacks?
A trigger is a reminder of a traumatic event from the past, which may cause the person to experience dissociation or other types of reactions. It may be a sound, taste, sight, smell, or touch. It could be a situation or how the person moves their body. Unfortunately, many different things can turn into triggers.
A flashback is when the person abruptly experiences traumatic feelings or sensations from the past. It could be prompted by encountering a trigger, which the person could experience the flashback as reliving a traumatic event in the present moment. Flashbacks may cause the person to switch to another part of their identity.
If the individual has dissociated memories because they experience different identity states with other memories or because of amnesia, they might find that they resurface during flashbacks.
What are Dissociative Seizures?
Dissociative seizures are challenging to get diagnosed, and they’re commonly diagnosed as epilepsy. Dissociative disorders might also be known as non-epileptic attack disorder (NEAD). Men, women, and children of all ages have the ability to develop functional seizures. While they might appear to be epileptic seizures, they are not caused by electric activity in the brain.
Associated symptoms might include cognitive difficulties, fatigue, memory loss, confusion on coming round from the seizure, and temporary paralysis of parts of the body. Functional seizures might also co-exist with epilepsy and other neurological symptoms.
What Causes NEAD?
Functional seizures are believed to be triggered by our brain’s response to overwhelming stress, stemming from physical and emotional triggers. However, there might be other causes. For some, symptoms may be caused by a specific traumatic incident, and for others, it’s an accumulation of stress over time. Many people might be confused by the diagnosis if they aren’t stressed.
How NEAD is Diagnosed
Because of the similarities it shares with epilepsy, functional seizures can only be diagnosed by an epilepsy consultant or specialist neurologist. A detailed description of seizures, seeing them in person or on a video, is the primary means of diagnosing the condition. Some people might be sent to the hospital for several days in an attempt to capture a seizure on video and EEG.