Dissociation: Types, Causes, Symptoms & Treatment

Dissociation is a feeling of disconnection from yourself and the world around you. This can be a disconnection between an individual’s sensory experience, sense of self, thought, or history.

What Dissociation Feels Like

People who dissociate may feel detached from their bodies or feel as though the world around them is not real. Dissociation can happen for many people as a natural response to trauma that they cannot control.

Experiences of dissociation can last for a relatively short amount of time, as short as a few hours, or this feeling can last for much longer, as long as weeks or months.

Many people may experience dissociation during their lifetime, as it can be a way for the mind to cope with too much stress. If an individual dissociates for a long time, this may develop into a dissociative disorder.

Therefore, instead of this being something that might be experienced as a one-off for a short time, this can become a far more common experience for some people and may be the main way they deal with stressful experiences.

Dissociation can be detrimental as it disturbs areas of functioning that usually work together automatically. These areas are consciousness, memory, identity, and awareness of the self and the environment.

People who experience dissociation may experience something called depersonalization. This is a feeling of being disconnected from the body, being outside of oneself, and observing your actions, thoughts, or feelings from a distance.

Also, people who disassociate may experience derealisation. This is where the world around the individual does not feel real as if living in a movie.

The surroundings may appear distorted, two-dimensional, or artificial because of derealisation. Therefore, dissociation can range anywhere from a mild sense of detachment to a more severe disconnection from reality.

Types

Dissociative identity disorder

Dissociative identity disorder (DID), renamed from multiple personality disorder in 1994, is a disorder that is categorized by the presence of two or more identities or personalities that an individual has.

These identities recurrently take control of the individual’s behavior, as well as resulting in them forgetting important personal information.

An individual with DID will ‘switch’ to the alternating identities and may feel the presence of two or more people talking inside their head.

The other personalities may have their own names, personal histories, characteristics, style of voice, and mannerisms.

Depersonalization-derealisation disorder

This type of dissociative disorder is associated with the presence of persistent or recurrent experiences of depersonalization, derealization, or both.

People with this disorder may feel like a stranger to themselves and/or to their surroundings, feeling unreal in themselves and their surroundings feeling unreal.

Individuals with this disorder may also have a distorted sense of time, altered bodily perceptions, and numb emotions and bodily senses.

Dissociative amnesia

Dissociative amnesia is the most common dissociative disorder, with different types of amnesia branching from this condition. The main symptom of this disorder is memory loss which is more severe than normal forgetfulness.

One type of dissociative amnesia is localized amnesia, which is the failure to recall events of a specific period of time. Selective amnesia is when some, but not all, events can be recalled during a period of time.

Generalized amnesia, which is the rarest type, is when an individual’s life history is completely forgotten, and they may forget their identity.

Unspecified dissociative disorder

Unspecified dissociative disorder is applied to people whose symptoms are characteristic of a dissociative disorder but do not meet the full criteria for any of the specific disorders mentioned above.

This unspecified category is often used in situations where a doctor or clinician chooses not to specify which, if any, disorder an individual may have due to there being insufficient information to make an actual diagnosis.

Signs And Symptoms

Symptoms associated with dissociative disorders vary depending on the type of disorder being experienced.

It is understood there are five core components of dissociative disorders. Each dissociative disorder could be described and understood using a combination of one of these five core symptoms:

• Amnesia – memory loss of certain time periods, events, people, and personal information, which are recurrent.

  These gaps in memory can vary from several minutes to years and are inconsistent with ordinary forgetting.

• Depersonalization – a sense of detachment or disconnection from oneself and their emotions. This can include feeling like a stranger to oneself, being on autopilot, or feeling like a part of their body does not belong to them.

  Often, individuals who feel depersonalization may induce injuries to themselves in order to feel ‘real’.

• Derealization – the perception of the familiar people and surroundings around an individual as being distorted and unreal. For instance, close friends or relatives may not seem real to an individual experiencing derealisation.

  The world around them may also appear distorted or blurred or artificial in general. Some episodes of derealisation may happen during flashbacks, whereby an individual may feel much younger than they are and feel as if the present environment is unreal at that time.

• Identity confusion – some people with dissociative disorders may have a blurred sense of their own identity. This may involve an inner struggle regarding an individual’s sense of self or identity, with feelings of conflict and uncertainty.

• Identity alteration – this is a sense of acting like a different person some of the time and in different situations.

  Individuals who experienced this may use different names depending on the situation, realize they have items that they do not recognize, or may have learned a new skill that they have no recollection of learning.

Usually, if any of the core components of dissociation are being experienced, that are persistent, cause significant distress, disrupt important areas of functioning, and cannot be explained by other means (e.g., through alcohol or mind-altering drugs), this could be an indication that an individual has one of the dissociative disorders.

Causes

The most prevalent cause of dissociative disorders is when an individual has experienced a traumatic event and/or abuse, particularly during early childhood.

This dissociation can be a possible way of helping a person distance themselves or cope with a traumatic situation.

A common cause may stem from repeated emotional and/or physical abuse in childhood. Similarly, disrupted attachment between the child and their parent/primary caregiver, such as being neglected or failing to respond to the child, can cause dissociation.

Other factors include a child witnessing domestic abuse or witnessing the death or suicide of a relative or close friend. Also, if a parent/caregiver of the child has severe mental health conditions, this could also result in the dissociation of the child.

Particularly, if trauma has been experienced before the age of 5, this makes it more likely that the child will dissociate. The average age of onset of dissociative disorders is 16, and 95% of people typically experience symptoms before the age of 25.

Early childhood trauma can prevent a child from forming a unified sense of self or personality during their earliest years. Instead, the trauma may cause different ‘behavioral states’ to become more dissociated, resulting in multiple identities being developed.

Another known cause for dissociative disorders may be substance use. The use of some recreational drugs, such as ecstasy and Ketamine, can cause some feelings of dissociation whilst taking them.

This dissociation would only be considered a disorder if these feelings continued after stopping using the drugs.

Dissociation may also occur as a symptom of other conditions rather than being a part of a dissociative disorder.

Also, because of dissociative disorders, individuals are at an increased risk of developing the following conditions as well:

• Post-traumatic stress disorder (PTSD)

• Depression

• Obsessive-compulsive disorder ( OCD )

• Substance use disorders

• Borderline personality disorder (BPD)

• Schizophrenia

• Phobias

• Acute stress disorder

Diagnosis

For a diagnosis of dissociative disorder, an individual will be assessed for their symptoms in order to rule out the presence of other conditions.

A physical examination may be required by a doctor who will ask in-depth questions about the symptoms being experienced and personal history.

Physical conditions such as head injury, brain diseases, and sleep deprivation should be ruled out as possible causes of the symptoms.

Psychiatric examinations are also required in which a mental health professional will ask questions about the individual’s thoughts, feelings, and behaviors.

Some assessments may be used to help determine if someone is experiencing dissociation:

Dissociative experiences scale (DES)

This assessment is a self-report questionnaire that measures dissociative experiences. These experiences can include those such as derealisation, depersonalization, and amnesia.

The DES is primarily used as a screening tool for people suffering from psychotic disorders or schizophrenia.

Structured clinical interview for dissociation

A structured clinical interview for dissociation will utilize the Diagnostic Statistical Manual of Mental Disorders (DSM-IV), a manual for assessing and diagnosing mental health conditions.

This will be used to investigate the five core components of dissociative symptoms: amnesia, depersonalization, derealisation, identity confusion, and identity alteration.

This will systematically rate both the severity of individual symptoms and the evaluation of the overall diagnosis of a dissociative disorder.

Clinician-Administered PTSD Scale (CAPS)

Although primarily used for the diagnosis of PTSD against the DSM-IV using severity scores for the symptoms of PTSD, a symptom cluster score can also be calculated specifically for dissociation.

CAPS tests for depersonalization by asking whether the individual has even felt disconnected from their body.

CAPS also tests for derealisation by asking questions surrounding whether there had been times when the individual was in a situation when things seemed unreal and unfamiliar.

Neuroimaging studies have identified areas of the brain that differ in those with dissociative identity disorder (DID) compared to those who do not have this condition.

Through the use of magnetic resonance imaging (MRI), it was found that the hippocampus and the amygdala of DID individuals were significantly smaller (Vermetten et al., 2006). The hippocampus has a role in forming long-term memories, whilst the amygdala regulates emotions.

Thus, differences in these brain areas could account for the symptoms associated with memory loss and emotions among the different identities in DID.

Another study of individuals with DID observed their cerebral blood flow compared to those without DID, finding that there was lower cerebral blood flow in the orbitofrontal cortex, a region believed to be involved in decision-making.

This resulted in the researchers hypothesizing that this decrease in functioning may result in impulsivity and switching to other identities may represent a drastic expression of impulsive behavior caused by cognitive and emotional conflicts (Sar et al.,)

Treatments

Currently, there are no medications that are specifically targeted to treat dissociative disorders themselves. However, people with these conditions may take medication for some symptoms or other conditions they may have alongside dissociation.

For instance, if someone is experiencing dissociation, they may also have depression or anxiety as a result. Some medications, such as antidepressants, can be used for depressive and anxious symptoms. Similarly, benzodiazepines, a type of sedative medication, can also be used for anxiety.

The primary method for the treatment of dissociative disorders is psychotherapy. These are a collection of talking therapies that usually involve discussing the symptoms, techniques to help cope, working with the other identities (for DID), and helping the individual to understand their condition, including what may be the underlying cause.

Cognitive behavioral therapy ( CBT ) is a type of psychotherapy that helps people to identify and change thought patterns that may be disturbing and have a negative influence on behavior and emotions. CBT focuses on changing the automatic negative thoughts that result in emotional difficulties, depression, and anxiety.

Through the use of CBT, these negative thoughts are identified, challenged, and changed with more realistic thoughts. CBT involves working together with the therapist to practice new thinking skills, set goals, and problem-solve. It also involves completing CBT tasks between therapy sessions, so these skills are thoroughly practiced, becoming a habit.

Dialectical behavior therapy (DBT) is another type of CBT. Its main goal is to help individuals develop healthy ways to cope with stress, regulate their emotions, and improve relationships with others. DBT has a big focus on mindfulness skills.

Mindfulness helps individuals to focus on the present moment, paying attention to what is happening inside them. This can help people with dissociative disorders to pay attention to their thoughts, feelings, and sensations, as well as focus on what is happening around them (such as what they can see, hear, smell, and touch).

CBT has proven to be an effective treatment for many people, with a study reporting that those who completed CBT had significant reductions in their levels of dissociation and depersonalization, with 29% no longer meeting the criteria for dissociative disorders after treatment (Hunter et al., 2005).

Psychotherapies may be needed for a long period of time, with at least one session per week. This will depend on the type of dissociative disorder and how severely the condition is affecting their functioning in everyday life.

References

Dissociative Identity Disorder. (Jul 05, 2021). Traumadissociation.com, Retrieved Jul 5, 2021, from http://traumadissociation.com/dissociativeidentitydisorder.html.
Traumadissociation.com. Retrieved Jul 5

Dissociative Amnesia & Fugue. (Jul 05, 2021). Traumadissociation.com, Retrieved Jul 5, 2021, from http://traumadissociation.com/dissociativeamnesia.html.

Depersonalization/Derealization Disorder. (Jul 05, 2021). Traumadissociation.com. Retrieved Jul 5, 2021 from http://traumadissociation.com/depersonalization.html.

Vermetten, E., Schmahl, C., Lindner, S., Loewenstein, R. J., & Bremner, J. D. (2006). Hippocampal and amygdalar volumes in dissociative identity disorder. American Journal of Psychiatry, 163(4), 630-636.

Hunter, E. C., Baker, D., Phillips, M. L., Sierra, M., & David, A. S. (2005). Cognitive-behaviour therapy for depersonalisation disorder: an open study. Behaviour research and therapy, 43(9), 1121-1130.

Sar, V., Unal, S. N., & Ozturk, E. (2007). Frontal and occipital perfusion changes in dissociative identity disorder. Psychiatry Research: Neuroimaging, 156(3), 217-223.

Steinberg, M., Rounsaville, B., & Cicchetti, D. V. (1990). The Structured Clinical Interview for DSM-III—R dissociative disorders: Preliminary report on a new diagnostic instrument. The American Journal of Psychiatry.