Dissociative disorders explained.

Jason Brien.

Dissociative disorders involve problems with memory, identity, emotion, perception, behavior and sense of self. Dissociative disorders frequently occur AFTER trauma. This is why trauma conditions such as acute stress disorder and post-traumatic disorder contain dissociative features. When a person experiences trauma, they are forced to recognise certain aspects of themselves that they were previously unaware of. These sudden realizations can cause embarrassment, confusion or even lead one to hide these newfound realizations from others. Other mental health conditions can also manifest dissociative symptoms.

Examples of dissociative symptoms include detachment or feeling as if one is outside oneself. This particular symptom can be both hard to understand and difficult to explain and so a person experiencing this symptom may stay quiet fearing that others may think that they are crazy or on drugs. Likewise, dissociative symptoms can lead to memory loss and/or amnesia and again, one may try and hide or deny these sudden deficits. If you are elderly for example, you may be embarrassed about sudden memory loss or amnesia as others may think it is a sign of old age and impending dementia or Alzheimer’s disease.

Other symptoms include a blurred sense of identity, a perception that the people and things around you are distorted or somehow unreal. Your intimate, familial, social and occupational roles and relationships may be suffering and you may well be experiencing bouts of depression, anxiety and other mental health challenges. All of these factors and symptoms combined makes a person much more susceptible to stress and their daily living is likely to be significantly affected. The Diagnostic and Statistical Manual 5th Edition (DSM-5) describes three major dissociative disorders; Dissociative amnesia, dissociative identity disorder and depersonalization-derealization disorder.

Dissociative amnesia; 

The main symptom of associative amnesia is memory loss that's more severe than normal forgetfulness. The amnesia also cannot be explained by a medical condition or substance use/misuse. If you are experiencing dissociative amnesia, you will find it hard to recall certain information about yourself, other people or events which have occurred in your life (especially those memories associated with a traumatic experience or time). Dissociative amnesia can be specific to events within a certain time frame or a particular traumatic experience (war, abduction, serious sexual assault, etc.

Alternatively, and more rarely, dissociative amnesia can involve the complete loss of memory about yourself. Dissociative fugue for example involves travel or sudden, unexpected and confused wandering away from your life. People suffering from dissociative fugue may not ‘come to their senses’ for years after and so they will be confused as to why they are living another life in another town, city, state or country. Any episode of amnesia often occurs suddenly and unexpectedly and may last from minutes, to hours, months or years (rarely months or years though).

Dissociative identity disorder (DID);

This condition used to be known as multiple personality disorder. DID is characterized by "switching" to alternate identities. A person experiencing DID may feel the presence of two or more people/entities talking or living inside their head simultaneously (hence the ‘multiple’ personalities). Each identity or entity may have a unique name, personal history and unique personal characteristics such as voice, accent, gender, mannerisms, preferences (likes and dislikes), religion and physical qualities (needing to wear glasses, walking with a limp, etc).

The different and separate identities and entities may or may not be familiar with one another and they may or may not like one another. Some identities may never cross paths and others may be quite familiar with each other. The identity which is ‘prominent’ can vary depending on factors such as psychological motivation, current level of stress, culture, internal conflicts/dynamics, and emotional resilience. So, some identities or entities may ‘appear’ regularly and others may only ‘appear’ once, rarely or never. To ‘appear’ essentially means to take control over the body. To become the prominent identity. There is some debate/controversy about whether DID is a product of therapy rather than being a genuine mental health condition.

Depersonalization-derealization disorder; 

The sense of detachment which characterises this condition either occurs regularly and persistently or it occurs episodically (every now and then, separate and distinct periods of time). If you are experiencing depersonalization and derealization, people and things around you may feel detached and foggy or dreamlike. You may also feel like time is either slowed down or sped up and everything around you (yourself included) may seem unreal (derealization). A person diagnosed with depersonalization/derealization disorder will find it hard to articulate their symptoms which may lead them to think that they are going crazy and may lead them to hide the symptoms out of fear that others will label them as ‘crazy’.

A person experiencing this particular disorder can also experience extreme rumination and obsessional preoccupation particularly around concerns about whether they truly exist or not. This may lead a person to continually look at themselves in the mirror or compel them to ask others to verify their existence (some aspects of NPD may be the result of depersonalization/derealization symptoms). Anxiety and depression are also quite common in varying degrees. Overall, the symptoms of depersonalization and derealization are quite distressing and they can last from a few moments to regular occurrences over many years.