On this page we are going to take at look at dissociative disorders, their symptoms, treatment, causes and the different types there are.
What is dissociation?
A good place to start to understand dissociative disorders, is by considering just what dissociation is. As people, our thoughts, sensations, feelings, memories and perceptions make us who we are. During dissociation these things ‘disconnect’ from each other. There is a change in our sense of identity, our memories and even the way in which we see the things around us.
Being able to disconnect can be a natural part of everyday life. For example we may pop upstairs to get an item and arrive back downstairs with it and not remember actually going to fetch it – it was done so automatically that we forget the process involved. Frequently, people may learn to disassociate from pain, we see this particularly in childbirth, where after the severe pain a woman vowing never to go through that agian, but in time convinces herself 'it can't have been that bad' (this is useful for the continuation of the species).
Dissociation can also occur as a side effect of some drugs or medication. Excessive consumption of alcohol can also cause feelings of dissociation. Dissociation can also occur as we try to cope with traumatic events and experiences and move on.
It has been described by a survivor of a plane crash as 'like being in a film where he was watching the situation unfurl as though he was not a part of it He felt as though the experience was unreal but it struck him afterwards that he was not at all afraid.' This kind of experience is quite common when faced with trauma, it allowed the individual to focus on survival without the panic and fear.
Types of dissociation
Let’s take a look at the different forms of dissociation. There are five different categories:
- Identity confusion
- Identity alteration
Dissociation becomes a dissociative disorder when the dissociation persists with repeated episodes, when dissociation is involuntary. This can result in difficulty with everyday life such as interfering with work, home life, social life or school. It is not uncommon for sufferers of dissociative disorders to hide the distress they are experiencing and they appear to be functioning well.
Types of Dissociative disorder
Dissociative disorders are split into five specific disorders as listed in the DSM IV:
- Depersonalisation disorder
- Dissociative fugue
- Dissociative amnesia
- Dissociative identity disorder (DID)
- Dissociative disorder not otherwise specified (DDNOS)
Each of these different forms of the disorder are covered more deeply on their own page on the site please see guides below.
There are many different symptoms which may be experienced by an individual with dissociative disorder with each of the five disorders listed above showing varying symptoms (please see the individual guides for more details).
Symptoms may include some of the following:
- Detachment from yourself and/or the world around you
- Having no recall of personal information
- Memory gaps
- Arriving in a place and not recalling how you got there
- Distorted view of your body,
- Feelings of being personally unreal or that what is happening is unreal - as if being part of a film, or an outsider looking on.
- Internal voices
- Out-of body experiences
- Being unable to recognise yourself in a mirror
- Feeling unfamiliar in usual surroundings
- Forgetting previously learned skills
- Feeling that people you know are strangers
- Seeing objects as a different shape, colour or size
- Not knowing who you are
- Confusion over your sexuality or gender
- A feeling that there are different people within you
- Behaving like different people or in a child-like way
- Calling yourself ‘we’ instead of ‘I’
- Having different handwriting styles
These disorders have been much misunderstood, this misunderstanding may be rooted in the fact that other mental health conditions have certain features of dissociation.
The causes of dissociative disorders are complicated. Many studies have been conducted into the causes for it. Study shows that people who have this condition in a moderate to severe form have almost always experienced a history of trauma or abuse during childhood.
As dissociative disorders do not affect all survivors of childhood trauma or abuse more research is required to determine the ‘cause and effect’ relationship.
Other theories are that the causes can include abuse prior to the age of five, or over an extended period, also that the abuse is severe and repeated and occurs to a child who has a natural ability to dissociate.
Treatment will often include talking therapies to help the sufferer come to terms with any past trauma. Speaking to your GP about any symptoms you are experiencing will help you come to an accurate diagnosis and rule out other conditions.
Once a disorder is diagnosed you may be referred to NHS treatment in your local area (if this is available), you may be offered therapy through voluntary organisations, or you may wish to seek private help.
Reconnecting experience with emotion and identity is very important and therapy can help, it may take time and a good relationship with your therapist is essential.
Medication may be offered if you are experiencing depression, anxiety or psychotic symptoms, however there is no medication specifically for dissociation and the most effective treatment is psychological.
Art therapy and other creative therapies can really be of benefit to dissociative disorder sufferers as they can help them come to terms with and 'reconnect' with emotions and feelings.
For more information on specific disorders please see guides below.