Dissociative Disorders
Dissociative disorders are a group of mental disorders defined as "... a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment." All dissociative disorders cause significant interference with the patient's general functioning, including social relationships and employment.
Dissociation is a mechanism that allows the mind to separate or compartmentalize certain memories or thoughts from normal consciousness. These split-off mental contents are not erased. They may resurface spontaneously or be triggered by objects or events in the person's environment.
The dissociation process occurs along a spectrum of severity. It does not necessarily mean that a person has a dissociative disorder or other mental illness. A mild degree of dissociation can occur with physical stress; people who have gone without sleep for a long period of time, have had "laughing gas" for dental surgery, or have been in a minor accident often have brief dissociative experiences. Another commonplace example of dissociation is a person becoming involved in a book or movie so completely that surroundings or the passage of time go unnoticed. Dissociation is related to hypnosis, which also involves a temporarily altered state of consciousness.
People in other cultures sometimes have dissociative experiences in the course of religious (in certain trance states) or other group activities. These occurrences should not be judged in terms of what is considered "normal" in the United States.
Moderate or severe forms of dissociation are caused by such traumatic experiences as childhood abuse, combat, criminal attacks, brainwashing in hostage situations, or involvement in a natural or transportation disaster. Patients with acute stress disorder, post-traumatic stress disorder, or conversion disorder and somatization disorder may develop dissociative symptoms.
In dissociative amnesia, the patient is unable to remember important personal information, to a degree that cannot be explained by normal forgetfulness. In many cases, it is a reaction to a traumatic accident or witnessing a violent crime. Patients with dissociative amnesia may develop depersonalization or trance states but do not experience a change in identity.
In dissociative fugue, a person temporarily loses sense of personal identity and travels to another location where he/she may assume a new identity. Again, this condition usually follows a major stress or trauma. Apart from inability to recall past or personal information, patients with dissociative fugue do not behave strangely or appear disturbed to others. Cases of dissociative fugue are more common in wartime or in communities disrupted by a natural disaster.
In depersonalization disorder, the primary symptom is a sense of detachment from self. Depersonalization as a symptom (not as a disorder) is quite common in college-age populations. It is often associated with sleep deprivation or "recreational" drug use. It may be accompanied by "derealization" (where objects in an environment appear altered). Patients sometimes describe depersonalization as feeling like a robot or watching themselves from the outside. Depersonalization disorder may also involve feelings of numbness or loss of emotional "aliveness."
Dissociative identity disorder (DID) is the newer name for multiple personality disorder (MPD). DID is considered the most severe dissociative disorder and involves all of the major dissociative symptoms.
DDNOS (dissociative disorder not otherwise specified) is ascribed to patients with dissociative symptoms that do not meet the full criteria for a specific dissociative disorder.
The moderate to severe dissociation that occurs in patients with dissociative disorders is understood to result from a set of causes:
- An innate ability to dissociate easily
- Repeated episodes of severe physical or sexual abuse in childhood
- The lack of a supportive or comforting person to counteract abusive relative(s)
- The influence of other relatives with dissociative symptoms or disorders.
The relationship of dissociative disorders to childhood abuse has led to intense controversy and lawsuits concerning the accuracy of childhood memories. The brain's storage, retrieval, and interpretation of memories are still not fully understood. Controversy also exists regarding how much individuals presenting dissociative disorders have been influenced by books and movies to describe a certain set of symptoms (scripting).
The major dissociative symptoms are:
Amnesia—marked by gaps in a patient's memory for long periods of time or for traumatic events.
Depersonalization—in which the patient feels that his or her body is unreal, is changing, or is dissolving. Some patients experience this as being outside their bodies or watching a movie of themselves.
Derealization — the external environment is perceived as unreal. The patient may see walls, buildings, or other objects as changing in shape, size, or color. In some cases, the patient may feel that other persons are machines or robots, though the patient is able to acknowledge the unreality of this feeling.
Patients with dissociative fugue, DDNOS, or DID often experience confusion about their identities or even assume new identities. After a stressful experience, the patient may act differently, answer to a different name, or appear confused by his or her surroundings.
Treatment of the dissociative disorders can involve psychotherapy, medications, hypnosis, or a combination of these approaches.
In psychotherapy, patients often require treatment by a therapist with some specialized understanding of dissociation. This background is particularly important if the patient's symptoms include identity problems.
Some doctors will prescribe tranquilizers or antidepressants for the anxiety and/or depression that often accompany dissociative disorders. Patients with dissociative disorders are, however, at risk for abusing or becoming dependent on medications.
Hypnosis is frequently recommended as a method of treatment for dissociative disorders, partly because hypnosis is related to the process of dissociation. Hypnosis may help patients recover repressed ideas and memories. Therapists treating patients with DID sometimes use hypnosis in the process of "fusing" the patient's alternate personalities.
The prospects for recovery from dissociative disorders vary. Recovery from dissociative fugue is usually rapid. Dissociative amnesia may resolve quickly, but can become a chronic disorder in some patients. Depersonalization disorder, DDNOS, and DID are usually chronic conditions. DID usually requires five or more years of treatment for recovery.
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