Dissociative disorders involve a loss of awareness of your surroundings or self. There are five types of dissociative disorders.
Everyone dissociates at times — if you’ve ever found your mind wandering or got lost in a daydream, you’ve experienced dissociation.
But if you have persistent dissociation, you may have a dissociative disorder. Chronic dissociation can be overwhelming and keep you from living the life you want. It’s scary to feel disconnected from your experiences and identity.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), there are five types of dissociative disorders:
- dissociative identity disorder (DID)
- depersonalization/derealization disorder
- dissociative amnesia
- unspecified dissociative disorder
- other specified dissociative disorder
Dissociative disorders can be diagnosed by a mental health professional. Various therapies and coping methods can help relieve dissociation.
What are dissociative disorders?
Dissociation is an uncontrollable disconnection from your body, people, sense of self, or environment. When you dissociate you may have trouble identifying with your senses, or you may be unaware of your sensory experiences.
Dissociation is often related to trauma. In fact, the American Psychiatric Association reports that about 90% of people with DID have experienced childhood abuse and neglect.
Dissociation sometimes happens during traumatic events. It’s a protective measure where your nervous system creates a disconnect between you and your body or surroundings. This is helpful in the moment, but dissociative states can arise long after the trauma has ended and disrupt your daily life.
Sometimes, people dissociate during a traumatic event and the dissociation resolves without treatment. Other times, people may experience dissociation as a symptom of post-traumatic stress disorder (PTSD) or dissociation that meets the classification of a dissociative disorder.
Dissociative disorders often require treatment from a mental health professional.
Dissociative identity disorder
Dissociative identity disorder (DID) is rare, affecting around 1.5%Trusted Source of people worldwide. DID was previously known as multiple personality disorder.
Individuals with DID experience two or more distinct personality states or identities that often present as uncontrollable to the person experiencing them.
According to a 2019 literature review, symptoms of DID include:
- intense dissociation: people with DID often experience dissociation from their memory, self, thoughts, sense of agency, perception, and motor functioning
- changes in behavior: they may act differently due to intense dissociation
- gaps in memory: It may be hard to recall events, trauma, or personal information
- distress: the person or people affected by this disorder often experience troubles at work, school, or in social settings
Many people with DID experience suicidal thoughts or may have challenges with self-harm behaviors. If you’ve received a diagnosis of DID, consider speaking with a mental health professional about available treatment options.
If you’re considering acting on suicidal thoughts, please seek professional support immediately.
Calling or texting a crisis helpline will connect you with a trained counselor 24/7, any day of the year, completely free of charge:
- Call the National Suicide Prevention Lifeline at 800-273-8255.
- Text HOME to 741741 to reach the Crisis Text Line.
The causes of DID have been widely debated in the literature. Research indicates two models of DID: the trauma model and the fantasy model.
The trauma model suggests that people with DID experienced repeated severe childhood trauma, such as physical abuse, sexual abuse, or neglect.
The fantasy model suggests that people are prone to suggestion, and so when it is proposed that an individual could have DID they relate to it. The fantasy model also suggests that people with DID could create false memories of trauma to support a DID diagnosis.
ResearchTrusted Source provides evidence that supports the trauma model as the root of dissociation and dissociative disorders. There is little evidence that supports the fantasy model.
DID is often misdiagnosed, so if you’re experiencing symptoms, it may take a while to receive the correct diagnosis and receive appropriate treatment.
If you think you have DID, consider setting up an appointment with a mental health professional such as a psychiatrist, psychologist, or licensed therapist. This diagnosis is often based on a person’s self-reported experiences.
Mental health professionals will often ask questions about your history. They may ask you to complete assessments such as the Dissociative Experiences Scale. Talking with a professional trained in treating dissociative disorders is the first step toward diagnosis and treatment.
Research indicates that stabilization and therapy are first-line treatments for those with DID. Your mental health professional may visit your treatment in three steps:
- helping you create a safe environment and stabilize your symptoms
- helping you address and work through trauma
- helping you reintegrate your identity and establish a relationship with yourself and your environment
The authors of this research suggest that some common types of psychotherapy used for the treatment of DID include:
- trauma-focused cognitive behavioral therapy (TF-CBT)
- dialectical behavior therapy (DBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- psychodynamic therapy
They note that EMDR is often only recommended if you have adequate coping skills and feel safe.
A 2013 reviewTrusted Source says that there are no medications for dissociation, but medications are often prescribed to help people deal with co-occurring symptoms, such as depression, anxiety, and PTSD.
Depersonalization/derealization disorder (DPDR) is a dissociative disorder with two distinct elements:
- Depersonalization: The feeling of losing your identity or feeling you aren’t real. It may feel like you’re watching yourself from outside your body.
- Derealization: Feeling detached from your experiences. It may feel like people and objects around you are distant or unreal.
Research from 2022Trusted Source reports that DPDR is rare, occurring in around 1% of the general population. The rates are higher in people with other mental health conditions, including depression, borderline personality disorder, schizophrenia, and other dissociative disorders.
According to a 2020 reviewTrusted Source, common symptoms of DPDR include:
- disconnection from yourself
- disconnection from your environment
- blunted emotions
- distortions of the environment
- feeling like you’re watching yourself in a movie
- perceptions of leaving your body and coming back into your body through flashes of light
- feeling connected to dream experiences
- feeling like familiar situations are completely new, or unfamiliar situations are familiar
- tactile sensations and imagery when describing something that you can see visually
The causes of DPDR are not well known and more research is needed.
A 2022 systematic review suggests that possible causes of DPDR include:
- severe stress
- childhood abuse
The authors report that DPDR may be linked to depression, anxiety, and substance use.
Diagnosis of DPDR is often made by a mental health professional through a psychiatric assessment. In addition to talking about your symptoms, some assessmentsTrusted Source help in the diagnosis of DPDR, such as:
- The Multiscale Dissociation Inventory
- Dissociative Experiences Scale
- The Multidimensional Inventory of Dissociation
If you have depersonalization or derealization symptoms frequently, you may consider seeking treatment as the symptoms can be very overwhelming.
Treatment for DPDR includes psychotherapy and medication.
Research suggests that psychodynamic therapies may help. The authors also note that psychoeducation and grounding exercises may help treat depersonalization and derealization.
Dissociative amnesia is a condition in which you may have difficulty recalling important information about yourself and your life. It is the most common dissociative disorder, occurring in approximately 1.8%Trusted Source of the population.
The existence of dissociative amnesia is widely debated as some people believe that the symptoms can be better explained by other diagnoses.
According to the DSM-5-TR, symptoms of dissociative amnesia include:
- trouble recalling information from your life
- the information that is difficult to recount is often traumatic
- the information that is forgotten is usually easily remembered
- inability to recall information isn’t due to substance use
- amnesia can be about specific events or life history
Dissociative amnesia can cause problems with relationships or work. Forgetting information can last for a short period or several years and usually happens suddenly.
Some people with dissociative amnesia may experience dissociative fugue, meaning they travel away from home due to forgetting information about where they usually live.
As with all dissociative disorders, research suggests dissociative amnesia is related to severe stress and trauma. Traumatic experiences can cause dissociation in the form of forgetting information relevant to one’s life.
Dissociative amnesia is diagnosed by self-reporting symptoms and assessments that test for dissociative symptoms. However, because individuals aren’t aware of their amnesia when they experience it, diagnosing this condition may be more difficult.
Treatment for dissociative amnesia involves psychotherapy and potential evaluation for medication.
A 2018 study suggests that psychotherapy and medication may be effective treatments for dissociative amnesia. The authors note that many types of psychotherapy focus on ensuring the individual is safe and stabilized, as dissociation can cause much distress.
Unspecified dissociative disorder
Unspecified dissociative disorder refers to individuals with dissociative symptoms — or symptoms consistent with a dissociative disorder — but who do not meet the full criteria for a dissociative disorder.
This diagnosis is most often used in settings such as emergency rooms where there may not be enough information for a clinician to make a complete diagnosis.
Other specified dissociative disorder
Other specified dissociative disorder is listed in the DSM-5-TR as a disorder where the person is experiencing dissociative symptoms but their symptoms do not meet the full criteria for any other dissociative disorder. A mental health professional may diagnose it when there is an identifiable cause that is not necessarily typical of other dissociative disorders.
There are four common presentations of other specified dissociative disorder:
- mixed dissociative symptoms: disturbances of identity without amnesia
- identity disturbances due to chronic and extreme persuasion: disturbances of identity due to brainwashing, being involved with a cult, or being subjected to torture
- dissociative reactions to stress: dissociation as a result of stressful events that last a few hours to less than one month
- dissociative trance: an uncontrollable loss of awareness of their surroundings
Five dissociative disorders are listed in the DSM-5-TR. Each one has a solid link to trauma and extreme stress.
While many people experience dissociation from time to time, persistent dissociation that feels uncontrollable often requires treatment through therapy. Some people may also choose to take medication for conditions related to dissociative disorders, such as anxiety and depression.
If you experience dissociation, help is available.
You can start by searching for mental health support near you to locate a mental health professional. Additionally, you can visit the Dissociative Identity Disorder Research website to access resources and support.
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