Dissociative Disorders

Dissociative disorders are characterized by a disruption or discontinuity in key areas of personal functioning, namely consciousness, identity, memory, and self-awareness. During dissociative episodes, individuals may exhibit behaviors, emotional expressions, and levels of consciousness that differ significantly from their typical selves.

According to the American Psychological Association (APA), dissociation is “a defense mechanism in which conflicting impulses are kept apart or threatening ideas and feelings are separated from the rest of the psyche.”

While dissociation may serve as a short-term coping mechanism, it becomes problematic when it turns into a long-standing response to stress. In such cases, it can develop into a mental health disorder.

Types of Dissociative Disorders

  1. Dissociative Identity Disorder (DID)

As per DSM-5, Dissociative Identity Disorder is marked by:

  • The presence of two or more distinct personality states or experiences of possession.
  • Recurrent episodes of dissociative amnesia, where individuals cannot recall autobiographical information.

Each identity may possess its own name, personal history, and set of characteristics. These identities may also vary in voice, gender, and mannerisms.

Diagnostic Criteria:

  • Presence of two or more distinct personality states.
  • Recurring memory gaps for everyday events, personal information, or traumatic experiences.
  • Significant distress or impairment in functioning.
  • Symptoms are not culturally sanctioned religious practices.
  • Symptoms are not due to substance use or a medical condition.

Symptoms:

  • Intrusions into consciousness such as voices or intrusive thoughts.
  • Shifts in self-perception, preferences, or attitudes.
  • Sensory distortions, such as feeling detached from the body.
  • Impaired sense of agency.
  • Sudden onset of strong emotions or impulses.
  • Feeling disconnected from surroundings.
  • Difficulty regulating emotions.

  1. Dissociative Amnesia

According to DSM-5, Dissociative Amnesia involves the inability to recall important autobiographical information, typically of a stressful or traumatic nature, that goes beyond ordinary forgetfulness. It can manifest in different forms:

  • Localized: Inability to recall events within a specific time period.
  • Selective: Inability to recall specific aspects of an event.
  • Generalized: Complete loss of identity or life history.

Diagnostic Criteria:

  • Inability to recall distressing or traumatic personal information.
  • Causes significant disruption in social and occupational functioning.
  • Not attributable to substance use.
  • Not better explained by another mental disorder.

Symptoms:

  • Sudden memory loss, particularly of traumatic events.
  • Gaps in life history.
  • Confusion or uncertainty regarding personal identity.
  • Emotional detachment.
  • Dissociative flashbacks.
  • Difficulty maintaining relationships due to memory issues.

  1. Depersonalization/Derealization Disorder

As per DSM-5, this disorder involves persistent or recurring experiences of:

  • Depersonalization: Feeling detached from one’s mind, self, or body.
  • Derealization: Feeling detached from the external environment.

Diagnostic Criteria:

  • Recurrent episodes of depersonalization and/or derealization.
  • Intact reality testing during episodes.
  • Significant distress or impairment in functioning.
  • Symptoms are not caused by substance use.
  • Not explained by another mental health condition.

Symptoms:

  • Feeling as if observing oneself from outside the body.
  • Emotional numbness.
  • Decreased sense of personal agency.
  • Surroundings appear foggy or unreal, with visual distortions.
  • Body parts may feel unfamiliar or altered.
  • Experience of auditory distortions.

  1. Other Specified Dissociative Disorders

This category includes dissociative symptoms that cause significant distress or impairment but do not meet full criteria for any specific dissociative disorder.

Symptoms:

  • Subtle yet disruptive alterations in self-perception or sense of agency.
  • Identity disturbances stemming from prolonged or extreme influence (e.g., indoctrination)
  • Dissociative responses to high stress.
  • Episodes of dissociative trance.

  1. Unspecified Dissociative Disorders

This classification applies to individuals exhibiting dissociative symptoms that cause clinical concern but do not fit the diagnostic criteria for any specific dissociative disorder.

Causes of Dissociative Disorders 

  1. Abuse- Experiences of physical, emotional, or sexual abuse often overwhelm an individual’s coping capacity. As a result, the brain may trigger dissociation to protect the person from unbearable pain or trauma. This detachment helps create psychological distance from the abusive experience.
  2. Accidents- Severe accidents can cause intense fear and shock, overwhelming a person’s ability to process the event. Dissociation may occur as an automatic defense to reduce emotional and physical distress. This coping mechanism helps the mind shield itself from traumatic memories.
  3. Chronic Stress- Prolonged exposure to chronic, high levels of stress can disrupt normal functioning of identity and consciousness. Over time, this persistent stress may contribute to dissociative symptoms as the brain attempts to manage ongoing emotional strain. It can fragment a person’s sense of self and reality.
  4. Attachment Issues- Early emotional neglect or inconsistent caregiving interferes with secure personality development. Without a stable attachment foundation, individuals may develop fragmented identities to manage emotional pain. This disruption can increase vulnerability to dissociative disorders later in life.
  5. Witnessing Trauma- Observing traumatic events, such as the serious injury or death of a loved one, can overwhelm emotional processing. Dissociation serves as a protective response to avoid fully experiencing these intense feelings. It creates a mental barrier that helps reduce psychological distress.
  6. Major Life Events- Extreme events like war, displacement, or natural disasters cause profound psychological upheaval. These experiences can shatter a person’s sense of safety and self-coherence, leading to dissociative symptoms. The mind uses dissociation to protect itself from the severity of the trauma.

Treatment of Dissociative Disorders

  1. Psychotherapy- Often considered the primary treatment for dissociative disorders, psychotherapy helps individuals explore the roots of their dissociation. It addresses traumatic experiences that led to identity fragmentation and memory disruptions. Over time, it promotes integration of the self and emotional healing.
  2. Cognitive Behavioural Therapy (CBT)- CBT helps individuals recognize harmful thought patterns that maintain dissociation and avoidance. It focuses on reducing fear and shame associated with trauma-related memories. Grounding techniques and cognitive restructuring improve day-to-day functioning and reduce dissociative episodes.
  3. Eye Movement Desensitization and Reprocessing (EMDR)- EMDR assists in reprocessing traumatic memories that often trigger dissociative symptoms. The therapy allows the brain to reframe distress without overwhelming the individual. This reduces identity confusion and emotional detachment. 
  4. Dialectical Behaviour Therapy (DBT)- DBT enhances skills like emotional regulation and mindfulness, which are critical for managing dissociation. It helps individuals stay grounded and connected to their current reality. This is particularly useful in preventing dissociative episodes during emotional stress.
  5. Hypnotherapy-Hypnotherapy creates a safe, focused state where individuals can access dissociated memories. It supports the retrieval and integration of suppressed or fragmented experiences. This approach is especially effective in addressing identity disruptions in Dissociative Identity Disorder.

Dissociative disorders, though complex, are treatable with the right therapeutic support. Early recognition and a tailored treatment approach can empower individuals to reconnect with their sense of self and lead fulfilling lives.

Related resources:

If you’re living with dissociative disorders, these supportive tools and resources can aid in grounding, emotional regulation, and building a stronger connection with yourself.

  • Therapy care: Discover Yourself, Dealing with Stress, Emotional intelligence. 
  • Guided meditation: Self compassion, Observing self, Inner Peace
  • Guided visualization: Overcoming Anxiety
  • Well being Journals- Worry-time journal
Back to blog