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Dissociation and Dissociative Disorders? Definition, Causes, Facts

Dissociation (disconnection from aspects of oneself and/or the environment) is something that people do naturally, so what, then, are dissociative disorders? Like all disorders, dissociative disorders have symptoms so severe as to cause great distress to a person and his or her life, and this is distinctly different from an individual who may experience dissociation occasionally and without harm.

What Is Dissociation?

If you've ever driven to work or the grocery store, gotten there and not remembered how you got there, you have experienced a very normal form of dissociation. Dissociation is a lack of connection between thoughts, memories, surroundings, actions and/or identity. Normal forms of dissociation are minor and not problematic whereas when dissociative disorders are defined, they have severe symptoms that cause problems in a person's life.

Causes of Dissociative Disorders

Dissociative disorders are typically caused by trauma as a way of coping with this stress. According to the Mayo Clinic:


"Dissociative disorders most often form in children subjected to long-term physical, sexual or emotional abuse or, less often, a home environment that's frightening or highly unpredictable. The stress of war or natural disasters also can bring on dissociative disorders."

Dissociative Identity Disorders in the DSM-5

Dissociative identity disorder is associated with overwhelming experiences, traumatic events and/or abuse that occurred in childhood. Dissociative identity disorder was previously referred to as multiple personality disorder.

Symptoms of dissociative identity disorder (criteria for diagnosis) include:

  • The existence of two or more distinct identities (or “personality states”). The distinct identities are accompanied by changes in behaviour, memory and thinking. The signs and symptoms may be observed by others or reported by the individual.

  • Ongoing gaps in memory about everyday events, personal information and/or past traumatic events.

  • The symptoms cause significant distress or problems in social, occupational or other areas of functioning.

In addition, the disturbance must not be a normal part of a broadly accepted cultural or religious practice. As noted in the DSM-5-TR1, in many cultures around the world, experiences of being possessed are a normal part of spiritual practice and are not dissociative disorders.

The attitude and personal preferences (for example, about food, activities, and clothes) of a person with dissociative identity disorder may suddenly shift and then shift back. The shift in identities happens involuntarily, are unwanted and cause distress. People with dissociative identity disorder may feel that they have suddenly become observers of their speech and actions, or their bodies may feel different (e.g., like a small child, like the opposite gender, huge and muscular).

The Sidran Institute notes that a person with dissociative identity disorder “feels as if she has within her two or more entities, each with its way of thinking and remembering about herself and her life. It is important to keep in mind that although these alternate states may feel or appear to be very different, they are all manifestations of a single, whole person.” Other names used to describe these alternate states include “alternate personalities,” “alters,” “states of consciousness” and “identities.”

For people with dissociative identity disorder, the extent of problems functioning can vary widely, from minimal to significant problems. People often try to minimize the impact of their symptoms.


Risk Factors and Suicide Risk

People who have experienced physical and sexual abuse in childhood are at increased risk of dissociative identity disorder. The vast majority of people who develop dissociative disorders have experienced repetitive, overwhelming trauma in childhood. Among people with dissociative identity disorder in the United States, Canada and Europe, about 90 percent had been the victims of childhood abuse and neglect.

Suicide attempts and other self-injurious behaviour are common among people with dissociative identity disorder. More than 70 percent of outpatients with dissociative identity disorder have attempted suicide.1

Treatment

With appropriate treatment, many people are successful in addressing the major symptoms of dissociative identity disorder and improving their ability to function and live a productive, fulfilling life.

Treatment typically involves psychotherapy. Therapy can help people gain control over the dissociative process and symptoms. The goal of therapy is to help integrate the different elements of identity. Therapy may be intense and difficult as it involves remembering and coping with past traumatic experiences. Cognitive behavioral therapy and dialectical behavioral therapy are two commonly used types of therapy. Hypnosis has also been found to be helpful in treatment of dissociative identity disorder.

There are no medications to directly treat the symptoms of dissociative identity disorder.

  • Dissociative amnesia (with a possible sub-diagnosis of dissociative fugue, which involves confused wandering with amnesia) – an inability to recall important information to the extent that it cannot be explained by normal forgetfulness.

  • Dissociative identity disorder – is characterized by two or more identities or personality traits within a single individual.

  • Depersonalization/derealisation disorder – major detachment wherein a person feels that objects around him or she are changing in shape or size or that people are automated and inhuman. A person may also feel detached from his or her own body.

  • Other dissociative identity disorders not specified – a dissociative disorder that doesn't fall specifically into one of the other three diagnoses.

Dissociative Disorder Facts and Statistics

Dissociative disorders have been studied, but not to the extent of many other disorders so dissociative disorder facts are often disputed. That said, some dissociative disorder facts and statistics include:

  • An estimated 2.4% of people meet the diagnostic criteria for depersonalization/derealisation disorder, although this estimate is argued by many and, in reality, it may be lower.

  • Dissociative identity disorder may be observed in 1-3% of the population.

  • Some believe that dissociative disorders should be considered trauma-related disorders.

  • Dissociative identity disorder used to be known as multiple personality disorder. The name was changed in 1994.

  • According to the Sidran Institute (devoted to education around trauma disorders), most people with a dissociative disorder also have a posttraumatic stress disorder.

Related conditions

Both acute stress disorder and posttraumatic stress disorder (PTSD) may involve dissociative symptoms, such as amnesia and depersonalization or derealization.

Related conditions

  • Acute stress disorder

  • Posttraumatic stress disorder (PTSD)

Both acute stress disorder and PTSD may involve dissociative symptoms, such as amnesia and depersonalization or derealization on.


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