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Dissociative disorders

Someone with a dissociative disorder escapes reality in ways that are involuntary and unhealthy. The person with a dissociative disorder experiences a disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity.

The symptoms of dissociative disorders — ranging from amnesia to alternate identities — depend in part on the type you have. Symptoms usually develop as a reaction to trauma and help keep difficult memories at bay. Times of stress can temporarily worsen symptoms, making them more obvious. Dissociative disorders cause problems with functioning in everyday life.

Treatment for dissociative disorders may include talk therapy (psychotherapy) and medication. Although treating dissociative disorders can be difficult, many people learn new ways of coping and lead healthy, productive lives.

Symptoms Causes Risk factors Complications Prevention

Signs and symptoms of dissociative disorders include:

  • Memory loss (amnesia) of certain time periods, events and people
  • Mental health problems, such as depression, anxiety, and suicidal thoughts and attempts
  • A sense of being detached from yourself
  • A perception of the people and things around you as distorted and unreal
  • A blurred sense of identity
  • Significant stress or problems in your relationships, work or other important areas of your life

There are three major dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association:

  • Dissociative amnesia. The main symptom of this disorder is memory loss that's more severe than normal forgetfulness and that can't be explained by a medical condition. You can't recall information about yourself or events and people in your life, especially from a traumatic time. Dissociative amnesia can be specific to events in a certain time, such as intense combat, or more rarely, can involve complete loss of memory about yourself. It may sometimes involve travel or confused wandering away from your life (dissociative fugue).  An episode of amnesia may last minutes, hours, or, rarely, months or years.
  • Dissociative identity disorder. This disorder, formerly known as multiple personality disorder, is characterized by "switching" to alternate identities. You may feel the presence of one or more other people talking or living inside your head, and you may feel as though you're possessed by other identities. Each of these identities may have a unique name, personal history and characteristics, including obvious differences in voice, gender, mannerisms and even such physical qualities as the need for eyeglasses. There also are differences in how familiar each identity is with the others. People with dissociative identity disorder typically also have dissociative amnesia and often have dissociative fugue.
  • Depersonalization-derealization disorder. This disorder involves an ongoing or episodic sense of detachment or being outside yourself — observing your actions, feelings, thoughts and self from a distance as though watching a movie (depersonalization). Other people and things around you may feel detached and foggy or dreamlike, and the world may seem unreal (derealization).  You may experience depersonalization, derealization or both. Symptoms, which can be profoundly distressing, may last only a few moments or come and go over many years.

When to see a doctor

If you or someone you love has any of the signs or symptoms described above, talk to a doctor. Treatment is available.

Dissociative disorders usually develop as a way to cope with trauma.  The disorders most often form in children subjected to long-term physical, sexual or emotional abuse or, less often, a home environment that's frightening or highly unpredictable.  The stress of war or natural disasters also can bring on dissociative disorders.

Personal identity is still forming during childhood. So a child is more able than an adult is to step outside of himself or herself and observe trauma as though it's happening to a different person. A child who learns to dissociate in order to endure an extended period of youth may use this coping mechanism in response to stressful situations throughout life.

People who experience long-term physical, sexual or emotional abuse during childhood are at greatest risk of developing dissociative disorders. Children and adults who experience other traumatic events, such as war, natural disasters, kidnapping, torture or invasive medical procedures, also may develop these conditions.

People with a dissociative disorder are at increased risk of complications and associated disorders, such as:

  • Self-harm
  • Suicidal thoughts and attempts
  • Sexual dysfunction, including sexual compulsions or avoidance
  • Alcoholism and drug use disorders
  • Depression and anxiety disorders
  • Post-traumatic stress disorder
  • Personality disorders
  • Sleep disorders, including nightmares, insomnia and sleepwalking
  • Eating disorders
  • Severe headaches

Dissociative disorders are also associated with major difficulties in personal relationships and at work. People with these conditions often aren't able to cope well with emotional or professional stress, and their dissociative reactions — from tuning out to disappearing — may worry loved ones and cause people at work to view them as unreliable.

Children who are physically, emotionally or sexually abused are at increased risk of developing mental health disorders, such as dissociative disorders. If stress or other personal issues are affecting the way you treat your child, seek help.

Talk to a trusted person such as a friend, your doctor or a leader in your faith community. Ask for help locating resources such as parenting support groups and family therapists. Many churches and community education programs offer parenting classes that also may help you learn a healthier parenting style.

If your child has been abused or has experienced another traumatic event, see a doctor immediately. Your doctor can refer you to mental health providers who can help your child recover and adopt healthy coping skills.

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