17 Minutes

By THE BALANCE
Fact checked

Dissociation is a mental state in which an individual loses contact with their ideas, emotions, memory, and sense of self. Dissociative disorders involve forgetfulness, depersonalization, amnesia, and dissociative disorders.

Individuals who have suffered trauma usually have some kind of dissociation during the incident immediately or in the hours, days, or weeks afterward. For instance, the incident may appear ‘implausible,’ or the individual may feel detached from the events unfolding around them as if observing them on TV. In the majority of situations, dissociation improves spontaneously.

Certain individuals, on the other hand, experience a dissociative condition that requires therapy. Dissociative illnesses are complicated and contentious issues that require specialized diagnosis, therapy, and assistance. If you or a loved one is worried that they may have a dissociative disorder, it is critical to get specialist care.

Professionals in mental health recognize four distinct forms of dissociative disorders which include the following: Disorder of dissociative identity, Dissociative amnesia, Disorder of depersonalization, and Dissociative fugue. 

Many individuals daydream regularly, but it is totally normal if this occurs to you. However, if you suffer from a mental health disorder known as “dissociation,” your experience of disconnection from the reality around you is frequently far more complex.

Dissociation refers to a breakdown in the way your mind processes data. You may experience a sense of disconnection from your ideas, emotions, experiences, and environment. It can have an effect on your sense of self and on how you see the time.

Symptoms frequently resolve on their own. This process may take several hours, days, or weeks. However, you may require therapy if your dissociation is the result of a particularly distressing incident or if you have a mental health problem such as schizophrenia.

Numerous factors might contribute to your dissociation. For instance, you may dissociate if you are very stressed or following a terrible event. You may also have signs of dissociation as a side effect of some other mental disease, such as anxiousness.

The below are among the signs of dissociation.

  • You may lose track of certain time frames, activities, and personal information.
  • Disconnection from one’s own body.
  • Suffering from a sense of disconnection from the environment around you.
  • You may be unaware of your identity.
  • You may well have numerous distinct identities.
  • You may have little or no physical discomfort.
  • You may have these symptoms for the duration of the triggering event or for a little period thereafter. This is referred to as an episode.

For other individuals, these symptoms may linger far longer. If you suffer from a dissociative condition, you may experience these symptoms for extended periods of time or even continuously.

Dissociative identity disorder (DID), formerly called multiple psychological disorder (MPD), is a type of psychological disorder in which at least two distinct and fairly stable personality states are maintained. The disease is associated with memory lapses that are not addressed by normal forgetting. The personality states alternatively manifest in a person’s conduct; yet, the disorder presents differently. 

Additionally, personality disorders (particularly avoidant and borderline), depression, illegal substance abuse disorders, conversion disorder, somatization disorder, disordered eating, obsessive-compulsive disorder,  post-traumatic stress disorder, and sleep disorders frequently occur in patients with DID. Self-injury, non-epileptic convulsions, flashbacks with forgetfulness for their content, anxiety symptoms, and suicidal behavior are also prevalent.

DID is related to severe childhood issues or trauma. Around 90% of instances involve a background of parental neglect throughout childhood, while the remaining 10% involve war traumas or medical treatments during early life. Additionally, genetic and biochemical elements are likely to be involved. If the patient’s situation is better explained by illegal substance abuse disorder, epilepsy, other mental conditions, creative play in kids, or religious practices, the diagnosis for DID should be reserved.

To be diagnosed with DID, an individual must meet the following criteria:

  • Two or more separate personalities or states of mind, each with its own mode of relating and thinking.
  • Forgetfulness and lapses in recall of mundane activities, intimate details, or terrible experiences.
  • The individual must be disturbed or experiencing difficulty in significant areas of their life as a result of the disease.
  • The experiences are not associated with conventional religious or cultural practices, or with imaginative play in childhood. For instance, a kid having an invisible friend does not necessarily indicate that the child has a mental health problem.
  • The signs are not due to substance addiction or other health issues such as epilepsy.

Dissociative identity disorder is defined by the coexistence of two or more different or split identities or personality modes that exert persistent control over the individual’s behavior. Additionally, dissociative identity disorder is associated with an inability to recall significant personal information that is too extensive to be explained by simple amnesia. Additionally, there are extremely different memory differences associated with a dissociative identity disorder that may fluctuate.

Symptoms Of Conversion Disorder

While not everyone experiences DID in the same manner, some people report “alters” or alternate personalities with their own gender, age, or ethnicity. Each will have its own unique attitudes, mannerisms, and speaking style. Occasionally, the alters are imagined persons; occasionally, they are animals. It is referred to as “switching” since each personality displays itself and exerts influence over the persons’ conduct and thinking. Switching between platforms might take seconds, minutes, or even days. Certain individuals seek treatment using hypnosis, in which the individual’s various “alternative selves” or identities may be extremely sensitive to the therapist’s wishes.

Additionally, headaches, forgetfulness, time loss, trances, and “out of body experiences” may be signs of dissociative identity disorder. Certain individuals suffering from dissociative disorders exhibit a proclivity for self-persecution, self-sabotage, and even aggression (both self-inflicted and outwardly directed). For instance, someone suffering from dissociative identity disorder may find themselves engaging in behaviors they would not ordinarily engage in, such as speeding, dangerous driving, or stealing money from an employer or acquaintance but feel it necessary to do so. According to some, this sensation is similar to being a passenger in one’s own body instead of the driver. In other words, they genuinely believe they are helpless.

There are various major aspects in which dissociative identity disorder’s mental mechanisms alter how a person experiences life, including the following:

Depersonalization. This sensation of detachment from one’s body is commonly known as an “out-of-body” experience.

De-realization. This is the sensation that the surroundings are not real, or that it appears cloudy or distant.

Amnesia. This is an inability to recollect vital personal details that is so vast that it could be attributed to normal forgetfulness. Micro-amnesias can also occur, in which the topic of conversation is forgotten or the information of a relevant dialogue is lost from one instant to the next.

Confusion over one’s identification or modification of one’s identity. Both of these entail a sensation of befuddlement about one’s identity. When a person struggles to define their life interests, their political, religious, or social beliefs, their sexual preference, or their career objectives, this is an example of identity uncertainty. Along with these visible changes, the individual may suffer aberrations in time, place, and circumstances.

It is now recognized that these disconnected states do not represent fully developed personalities, but rather a fractured sense of identity. Different identity states remember different pieces of autobiographical information when they suffer from the amnesia associated with a dissociative identity disorder. Typically, an individual has a “host” personality who identifies with the person’s given name. Ironically, the host personality is frequently ignorant of the other personas’ presence.

Additionally, individuals with DID frequently exhibit symptoms of PTSD and other mental health concerns, such as:

  • Depression
  • Suicidal ideas
  • Sleep deprivation
  • Anxiety
  • Signs of obsessive-compulsive disorder
  • Psychotic symptoms

DID manifests differently in each individual, and individuals may experience a variety of symptoms at various periods. Some individuals have a few changes, while others may have dozens or even hundreds. Flipping among the different alters is not a decision for several people, while others have some influence over the process.

A trauma model, which is backed by research on the correlation between a history of serious childhood abuse and psychotic symptoms, and a socio-cognitive model are two conceptual frameworks for the genesis of DID.

Trauma model — This conception of DID is built on the stress-diathesis model, which states that some diseases emerge in people who have a genetic susceptibility to the disease (the diathesis) and are exposed to considerable “stress,” which can be an ecological condition or a life event. Among the predisposing elements hypothesized in DID is a person’s inherent proclivity to detach, referred to as “dissociativity.” The key stresses considered to contribute to DID in individuals with a high degree of dissociation include sexual assault, physical violence, or other serious childhood trauma. These variables are described in further detail below.

Dissociation — Dissociation is a regular occurrence in persons who are not suffering from a mental disorder. Normal dissociation is considered as the capability for a mix of intense attention (absorption) and dissociation from distraction. Individuals’ propensity for dissociation varies significantly between populations.

The notion of detachment as a defense mechanism against life-threatening stress, such as a predator assault, is taken in part from an animal model of protective reaction to life-threatening stress. Animals have demonstrated being frozen, postural immobility, apathy, hypo-arousal, and analgesia in these conditions, all of which are analogous to human dissociative symptoms.

Childhood trauma — The most frequently identified “stress” in this framework is a background of severe sexual or physical abuse as a child, or other severe trauma, including psychological abuse, especially when supported by a lack of attachment security to caretakers, an absence of soothing following astounding life experiences, and potentially genetic factors. These variables may contribute to an inability of the self to be integrated throughout situations and emotions.

DID is believed to be a possible consequence of sexual or physical trauma in childhood. People who have been subjected to such maltreatment may have acute or posttraumatic stress disorder but have not been reported to experience DID.

Countless studies have confirmed the presence of a medium to a substantial link between traumatic experience, particularly childhood maltreatment, and dissociative signs and/or a dissociative disorder diagnosis, with essentially no contradictory evidence.

Poor newborn attachment – In predisposed individuals, a poor mother-infant connection has been proposed as a further risk factor for DID. Two longitudinal studies documented cohorts of 168 and 56 low-income, high-risk kids who were identified for social services after infancy and tracked until age 19. Both studies discovered that the strength of infant-mother connection in the first 2 years of life was a more powerful predictor of self-reported dissociation episodes in late teenage years than childhood trauma.

Socio-cognitive model — An alternate model of DID, the “socio-cognitive model,” postulates that an individual’s DID symptoms reflect role rehearsal in accordance with societal and relational expectations. Patients are suggested to develop an ability to perceive themselves as owning numerous selves and to believe in fantasies about sexual and physical abuse. Patients are reported to internalize DID characteristics through depictions of DID in films, novels, and other forms of media.

A coinciding concept, the “fantasy model” of dissociation, emphasizes a putative link between the patient’s fantasy proclivity and dissociation, implying that dissociation is related to a proclivity to daydream about a traumatic past.

An iatrogenic contribution to the patient’s development of DID is hypothesized, implying that certain practitioners who manage DID may unintentionally promote the disorder’s manifestations via provocative psychotherapeutic procedures.

The American Psychiatric Association’s DSM-5 lists the following dissociative disorders:

Dissociative identity disorder (formerly known as multiple personality disorder) is characterized by the fluctuation of two or more different personality states with poor memory between them. The hosting personality may be unconscious of the other, alternate personalities in extreme circumstances; nevertheless, the alternative personalities may be conscious of all the current personalities.

Dissociative amnesia (formerly psychogenic amnesia) is the short-term loss of recollection memory, more precisely episodic memory, as a result of a stressful or traumatic incident. It is the most often reported dissociative disorder. This illness may manifest suddenly or progressively and can persist anywhere from seconds to decades, based on the intensity of the shock and the sufferer. 

Previously a distinct category, the dissociative fugue is now considered a subtype of dissociative amnesia.

Depersonalization-derealization disorder: moments of disconnection from one’s self or surroundings that may be seen as “unreal” (loss of control over or “outside” self) while maintaining knowledge that this is only a sensation and not a reality.

The former group of unspecified dissociative disorders has been divided into twofold subcategories: other specified dissociative disorders and nonspecific dissociative disorders. These classes are used to describe types of pathological dissociation that do not completely fit the requirements for the other stated dissociative disorders; or when the appropriate group cannot be established; or when the disease is temporary.

Dissociative disorders are classified as follows in the ICD11:

  • Disorder of dissociative neurological problems
  • Dissociative amnesia
  • Disorder of trance
  • Amnesia with dissociative fugue
  • Disorder of possession trance
  • Disorder of dissociative identity
  • Dissociative identity disorder with partial dissociation
  • Disorder of depersonalization-derealization

There is not a singular assessment that can identify DID. A medical practitioner will assess your concerns and your personalized health background. They may do tests to clear out underlying medical explanations for your complaints, such as head traumas or neurological disorders.

Signs of DID generally show up in juvenile stages, between the ages of five and ten. But caretakers, schools, or medical practitioners might overlook the indications. DID could be mistaken with other social or educational issues prevalent in children, such as attention deficit hyperactivity disorder (ADHD). For this reason, DID typically is not confirmed until maturity.

Dissociative identity disorder is quite variable from person to person. Even highly trained mental health specialists sometimes struggle to diagnose DID. Nonetheless, there are twelve questions a user may ask themselves or a loved one if they believe they or they have a loved one has DID or similar dissociative condition. Utilize this test to aid in the comprehension of symptoms and feelings.

  • Do you experience noticeable intervals in your ideas, behaviors, or knowledge of your activities?
  • Have you ever glanced into a mirror and felt as if you were staring at someone you didn’t recognize?
  • Have you ever entirely forgotten about a significant occasion?
  • Have you ever had a discussion with someone and immediately lost track of what was said?
  • Had you ever been told of an incident or action that you either have no recollection of or believe was a dream?
  • Have you ever found yourself wearing clothing you have no recollection of wearing or possessing anything new that you have no recollection of purchasing?
  • Have you ever been told by someone close to you that you forgot who they were or didn’t recognize them?
  • Are there moments when sensations seem to be fake or too real?
  • Has somebody ever informed you that you’ve been looking out into space for an extended amount of time, completely unresponsive?
  • Do you ever find yourself abruptly and mysteriously speaking loudly to yourself while you’re alone?
  • Is there ever a period when you are unable to avoid discomfort or seem to be impervious to it?
  • Is it true that you can accomplish some activities with ease at times and find them tough at others?
  • Do you ever have moments when you sense as if you are two distinct persons?

The treatment objective is to improve integrative performance. The International Society for the Study of Trauma and Dissociation has produced phase-oriented therapy recommendations for adults, adolescents, and children that are extensively utilized in the domain of DID treatment. According to the standards, a desirable therapeutic result is a feasible method of integrating or harmonizing different identities.  Certain professionals in the field of DID therapy use the procedures specified in the 2011 treatment recommendations. The longitudinal TOP DD (Treatment of Patients with Dissociative Disorders ) trial found that patients had “statistically significant reductions in dissociation, PTSD, distress, depression, hospitalization, suicide attempts, self-harm, dangerous behaviors, drug use, and physical pain,” as well as increased overall functioning. The effects of treatment have been researched for over 30 years, with some studies including a 10-year follow-up. Guidelines for children and elderly therapy exist that recommend a three-phased strategy based on professional agreement. Highly skilled therapists have a small number of patients who acquire a cohesive identity.

Psychotherapy approaches such as hypnosis, insight-oriented therapy, dialectical behavioral therapy (DBT), cognitive-behavioral therapy (CBT), and eye movement desensitization and reprocessing are often used in treatment (EMDR).

Medications may be used to manage co-occurring illnesses or to alleviate specific symptoms, for example, antidepressants or sleep aids. Certain behavior therapists begin with behavioral therapies such as responding exclusively to a particular identity and then shifting to more conventional therapy after a regular response is achieved. Brief therapy may be problematic owing to managed care since persons diagnosed with DID may have some trouble trusting a psychotherapist and may need considerable time to build a relaxed therapeutic relationship. It is advised to maintain regular contact (at least weekly), and therapy often lasts years, not weeks or months. Although sleep hygiene has been recommended as a possible therapy, it has not been tested. There are relatively few clinical studies examining the therapy of DID in general, and none of them are randomized controlled trials.

The treatment of DID is often phased. Different modifications may manifest as a result of their increased capacity to cope with certain situational pressures or hazards. While some individuals primarily exhibit a great number of alters, this may decrease after treatment—though it is critical for the psychotherapist to get acquainted with at least the more prevalent personality states, since the “host” personality may not represent the patient’s “real” identity. Certain alters may respond poorly to treatment, fearful that the therapist’s ultimate purpose is to eradicate them (mainly those related to unlawful or ferocious activities). A more accurate and useful objective of therapy would be to incorporate adaptive reactions to abuse, injuries, or other dangers into the general personality structure. There is discussion over the appropriateness of exposure therapy (reliving painful experiences, also called abreaction), encounter with alters, and human touch during therapy, and there are medical viewpoints both for and against each choice, with slight high-quality indication to support either position.

Brandt et al. performed a poll of 36 doctors with expertise in treating dissociative disorder (DD) who advised a 3-stage therapy. They established that the initial stage should focus on skill development so that the individual may be taught how to manage high-risk, possibly harmful conduct, as well as control of emotions, relational effectiveness, and other practical actions. Additionally, they advocated “trauma-based cognitive therapy” to alleviate trauma-related cognitive alterations; they also recommended that the therapist address dissociated personas early in treatment. The proposed graduated exposure strategies, as well as suitable treatments, throughout the intermediate period. The last level of therapy was more customized; few people with DD developed a single identity.

The initial stage of treatment emphasizes signs and alleviating stressful elements of the disease, while also guaranteeing the individual’s safety, enhancing the patient’s ability to create and sustain good connections, and enhancing general daily life functioning. This phase of therapy addresses co-occurring illnesses such as illegal drug abuse disorder and disordered eating. The next phase emphasizes gradual re-exposure to painful recollections and re-dissociation avoidance. The last stage concentrates on reuniting different alters’ identities into a single functional alter with all of its memories and experiences intact.

The purpose of the research was to build an “expertise-based prognosis model for the treatment of complicated post-traumatic stress disorder (PTSD) and dissociative identity disorder (DID).” The scientists developed a two-stage investigation, and factor analysis of the survey parts revealed 51 variables that are shared by complicated PTSD and DID. The authors found as a result of their research: “The model is supportive of the existing phase-oriented therapy paradigm, stressing the first stabilization phase’s building of the therapeutic connection and the patient’s resources. Additional study is required to determine the statistical and clinical validity of the model.”

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