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Dissociative Disorders

Dissociative DisordersDefinition

Dissociative disorders are a group of mental health conditions characterized by disruptions in a person’s memory, identity, emotion, perception, or consciousness. These disruptions are often experienced as a disconnection from oneself, one’s surroundings, or both. They commonly develop as a coping mechanism in response to trauma, significant stress, or abuse, particularly during childhood.

Key characteristics of dissociative experiences include feeling detached from your body (depersonalization), feeling as though your surroundings aren’t real (derealization), and experiencing gaps in memory or a sense of discontinuity about yourself. While everyone experiences mild dissociation from time to time (like daydreaming), dissociative disorders involve more severe and persistent disruptions that significantly impair daily functioning.

Subtypes of Dissociative Disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes several specific subtypes of dissociative disorders:

  • Dissociative Identity Disorder (DID): Formerly known as Multiple Personality Disorder, DID is characterized by the presence of two or more distinct personality states (or “alters”). These alters have their own patterns of perceiving, relating to, and thinking about the environment and self. Individuals with DID often experience significant gaps in recall of everyday events, personal information, and/or traumatic events.
  • Dissociative Amnesia: This involves the inability to recall important personal information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. There are several types:
    • Localized Amnesia: Inability to recall events during a specific time period (e.g., a car accident).
    • Selective Amnesia: Inability to recall specific events within a broader period (e.g., remembering the accident itself but not the events leading up to it).
    • Generalized Amnesia: Complete loss of personal history, including identity.
    • Continuous Amnesia: Amnesia that begins with a traumatic event and extends forward in time.
  • Persistent Depersonalization/Derealization Disorder: This involves recurring or persistent feelings of detachment from one's body or mental processes (depersonalization) and/or a sense of unreality regarding one's surroundings (derealization). These experiences are distressing and impair social or occupational functioning.
  • Other Specified Dissociative Disorder (OSDD): This category is used when an individual experiences significant dissociative symptoms that don’t fully meet the criteria for any of the specific dissociative disorders, but cause significant distress or impairment. Symptoms can include a less complete form of DID, chronic and severe depersonalization/derealization, or dissociative trance disorder.
  • Unspecified Dissociative Disorder: This category is used when the clinician can determine that dissociative symptoms are present, but lacks sufficient information to make a specific diagnosis.

Example

A woman experienced severe emotional abuse during childhood. As an adult, she sometimes finds herself in situations where she cannot recall important details about her past, particularly surrounding the abusive events. She occasionally feels as though she is watching herself from outside her body and struggles to recognize familiar places as real. On some days, she feels like a completely different person, with distinct thoughts and behaviors that don’t align with her usual personality. This combination of amnesia, depersonalization, and shifts in perceived identity suggests a possible dissociative disorder, and further evaluation would be needed for a specific diagnosis.

Why it Matters

Dissociative disorders can significantly impact a person’s daily life, relationships, and ability to function at work or school. Without proper diagnosis and treatment, individuals may struggle with feelings of confusion, alienation, emotional numbness, and difficulty maintaining a stable sense of self. However, with therapy, people can learn to manage their symptoms, process underlying trauma, and improve their quality of life.

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