Written by: Daniella Marchese
Edited by: Taina Stuart
Dissociative disorders are commonly misconstrued and misunderstood in media and everyday conversation. It is important to understand what this category of disorders entails and understand key terms. Dissociation is described as a disconnect from your own thoughts, consciousness, or feelings (Lyssenko et al., 2018). An example of dissociation is daydreaming or someone driving down a familiar route and not remembering how they got to their destination. Depersonalization is a detached feeling from oneself and derealization is a detached feeling from the world (Sierra & David, 2011). An example of depersonalization is when someone feels like they are observing their own life from an outside perspective, like watching a movie. An example of derealization is feeling emotionally numb or disengaged from loved ones or having distorted perceptions of space and time. Dissociating is common among many people. However, what differentiates common dissociation from the disorders is when the symptoms cause significant personal distress and impairment with themselves, others or in their social roles (American Psychiatric Association, 2022).
Dissociative disorders are a category of mental disorders which includes dissociative identity disorder (DID), dissociative amnesia, dissociative trance disorder, and depersonalization/derealization disorder (American Psychiatric Association, 2022). Dissociative identity disorder is characterized by a dissociation of personality and consists of a host (the true identity of the individual) and the alters (the different personalities of the host). Common causes of this disorder are trauma, specifically childhood trauma, where different alters will be created in order to protect the host. Dissociative amnesia is when a person experiences memory loss and can’t remember who they are or where they are for a period of time (American Psychiatric Association, 2022). Dissociative fugue is this memory loss associated with the person wandering and ending up in an unknown place. Depersonalization/derealization disorder is when a person feels detached from their body and the world around them (Sierra & David, 2011). Dissociative, depersonalization, and derealization symptoms are present in several mental illnesses, including depression, anxiety, OCD, PTSD, borderline personality disorder, and substance use disorder as well (American Psychiatric Association, 2022).
All of these dissociative disorders are very underresearched and treatment options are limited. Subramanyan et al. (2020) highlights several therapeutic options for dissociative disorders. These include cognitive behavioral therapy (CBT) (focuses on changing thought and action processes), interpersonal psychotherapy (IPT) (focuses on relationships with others), dialectical behavior therapy (DBT) (focuses on mindfulness, emotion regulation and tolerance to distress). Other forms of therapy include psycho-education (informing the person on their mental illness), and eye-movement desensitization reprocessing (EMDR) (helps work through and heal traumatic past). CBT tends to be most effective for treating dissociative disorders and processing the trauma. Yet, more research still needs to be done to further understand and treat these disorders.
Although research still needs to be done to further develop successful interventions for dissociative disorders, they are treatable. They are most effectively treated when the psychological professional has extensive knowledge in trauma and dissociation, as the most frequent cause is trauma, specifically childhood trauma. A potential risk of treating people with dissociative disorders is the possibility of creating a false memory or false account of trauma (Loewenstein, 2018). However, with adequate knowledge of dissociative disorders, trained professionals can avoid this. A common misconception about dissociative disorders is that people with dissociative disorders are dangerous due to the different alters someone may have (Loewenstein, 2018). However, this is not true as many people, as previously stated, create these identities subconsciously as protection or companionship during their traumatic experiences. For example, a person may create an older sibling alter identity to help them through the trauma.
Psychoeducation is key to battling the stigma around any mental illness. Dissociative disorders are more common than people may think and it is important to understand this category of mental disorders, despite the limited research.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787
Loewenstein, R. J. (2018). Dissociation debates: Everything you know is wrong. Dialogues in Clinical Neuroscience, 20(3), 229–242. https://doi.org/10.31887/DCNS.2018.20.3/rloewenstein
Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018). Dissociation in Psychiatric Disorders: A Meta-Analysis of Studies Using the Dissociative Experiences Scale. American Journal of Psychiatry, 175(1), 37–46. https://doi.org/10.1176/appi.ajp.2017.17010025
Sierra, M., & David, A. S. (2011). Depersonalization: A selective impairment of self-awareness. Consciousness and Cognition, 20(1), 99–108. https://doi.org/10.1016/j.concog.2010.10.018
Subramanyam, A., Somaiya, M., Shankar, S., Nasirabadi, M., Shah, H., Paul, I., & Ghildiyal, R. (2020). Psychological Interventions for Dissociative disorders. Indian Journal of Psychiatry, 62(8), 280. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_777_19
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