- Seattle Anxiety Specialists, PLLC does not currently provide treatment for Dissociative Identity Disorder (DID) but we do provide treatment for trauma-related dissociation. (For DID treatment, please refer to this list of DBT providers.)
Dissociation
Overview
While it’s normal to take the occasional break from one’s thoughts, when this departure from reality becomes pervasive and a person becomes disconnected from their memory, identity, emotion, perception, behavior and/or sense of self, then they may have a dissociative disorder.[1] Those who experience trauma can consequently experience some form of dissociation in the subsequent days, weeks, or months after the event.[2] In many of these cases a “detached” period occurs (i.e., the person has slight amnesia, only partially remembers recent events, and withdraws from their usual activities or behaviors), after which people often recover without the need for treatment.[3] However, in cases typically following a severely traumatic event people may develop a full dissociative disorder in order to cope with their stress. In these cases, a person’s mind protects them from a disturbing memory with prolonged symptoms that can have damaging effects on memory, identity, and the ability to build relationships.[4]
Causes
Dissociation can be described as the way the mind protects itself from overloading from stress.[5] This can occur from a one-time incident of intense stress or from prolonged exhaustion.
Trauma survivors are often described as having a “fight-flight-or-freeze response”, but many also dissociate in response to a trigger or sensory stimuli related to their traumatic event. Even years removed from the traumatic event, a person with a dissociative disorder can be triggered by specific senses (e.g., sights, sounds, smells, touches, tastes) that they associate with a traumatic event.[6] These triggers exacerbate dissociative symptoms, but dissociation can also become a part of a person’s behavior without a specific stimulus. Those of any age group, race, ethnicity and socioeconomic background can experience a dissociative disorder.[7] Of notable cause, among people with dissociative identity disorder in the United States, Canada and Europe, 90 percent have experienced childhood abuse and neglect.[8]
To identify appropriate treatment, it is also important to rule out physical conditions such as head-injury, brain lesions/tumors or drug use - all of which can present with symptoms of amnesia and depersonalization.[9]
The range of dissociative disorders
There are three types of dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), each presenting with specific symptoms:[10]
Dissociative Amnesia:
Dissociative amnesia is the most common of dissociative disorders and has one primary symptom: difficulty remembering important information about one’s life.[11] These memory gaps appear retrospectively, and are a reaction to a traumatic or stressful event. Dissociative amnesia also has a high chance of comorbidity with other psychiatric disorders, such as personality disorders.[12]
Depersonalization Disorder:
Also referred to as depersonalization-derealization disorder, depersonalization disorder is a condition where the individual feels like an outside observer to their own experiences.[13] Individuals experiencing this disorder may have a persistent feeling that all their surroundings are unreal, foreign, or far-removed. The world around them may feel dream-like and as though it is separated from them.[14]
Symptoms include:
Depersonalization: feeling disconnected from one’s thoughts, feelings, and/or body
Derealization: disconnection from surroundings or environment (including other individuals)
Sensory distortions, such as auditory sharpness, or changes in smell, color, and perception
Distorted sense of time and place
While 75% of all adults will experience at least one instance of depersonalization and/or derealization over the course of their lives, in just over two percent of the population symptoms become chronic and can persist for years.[15] Women are 1.5 times more likely to develop depersonalization disorder than men.[16]
Dissociative Identity Disorder (DID):
Someone with DID has multiple personalities that control their behavior at different times.[17] The other behaviors/states may have different body language, voice tone, outlook on life and memories. At least two of the additional personalities repeatedly appear and control the affected person's consciousness, causing long lapses in memory that far exceed typical episodes of forgetfulness.[18] Other symptoms include:[19]
Marked discontinuity in sense of self and/or agency
Changes in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning
Dissociative amnesia (DA)
Disruption in autobiographical memory that includes gaps or difficulties in recall of everyday events, important personal information, and/or traumatic events
Previously referred to as multiple personality disorder until 1994, DID occurs in an estimated 1-5% of the global population.[20] DID is also typically associated with severe childhood trauma and abuse, but can also occur because of a genetic predisposition to dissociate.[21]
Similar Conditions
The following conditions can present with symptoms similar to dissociative disorders:
A traumatic event can also cue the onset of acute stress disorder and post-traumatic stress disorder (PTSD), both of which share similar symptoms and treatments to dissociative disorders.
It is also important to note that dissociation differs from psychosis, although the two are commonly used interchangeably. With dissociation, a person begins to mentally disconnect from reality, whereas psychosis involves an addition of some kind: hearing or seeing things others cannot or having grandiose beliefs (e.g., believing one has superpowers or severely exaggerating personal achievements).[22]
While people with schizophrenia are likely to experience both dissociation and psychosis, dissociation tends to occur on its own in any of the aforementioned dissociative disorders, depression, and borderline personality disorder (BPD).
The use of certain drugs can also cause depersonalization disorder to emerge. Usually, cannabis-induced depersonalization falls within the time period of drug-exposure but among a subgroup of cannabis users, symptoms of depersonalization, amnesia, and derealization persist for weeks, months, and years post-drug use.[23]
Dementia is another condition presenting similar to dissociative disorders. While those with dementia may remember personal information but not recall general topics, dissociative disorders typically present as amnesia regarding one’s personal identity and traumatic details, but remain intact memory for general information.[24]
With all mental health disorders, a professional assessment is essential to getting a proper diagnosis and effective treatment plan.
Severity
Episodes of dissociation can interfere with an individual’s work, social life, ability to learn, and their overall mental health.[25] Yang et al., (2022) conducted a multi-study analysis of 23 papers and found that the prevalence rate of those with Depersonalization-Derealization disorder (DDD) comprised only 0% to 1.9% among the general population but 17.5-41.9% of inpatients.[26] The Cleveland Clinic notes that, of the three types, DID presents with the most severe symptoms and impact on an individual's quality of life; more than 70% of whom attempt suicide.[27]
Treatment
The most common form of treatment for all dissociative disorders is psychotherapy, specifically cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT).[28] In CBT, an individual learns how to better manage their thoughts and emotions through self-analysis, while DBT allows a licensed professional to walk an individual through emotional regulation. Additionally, hypnosis/hypnotherapy utilizes acute levels of relaxation and focus, allowing an individual to unpack otherwise repressed memories.[29]
Although there is no medication specific to treating dissociative disorders, diagnosed individuals are often prescribed antidepressants to manage comorbid disorders or related symptoms.[30]
If you suspect you may have a dissociative disorder, please reach out to a licensed mental health professional experienced in treating clients with dissociative disorders or a psychiatrist or clinical psychologist who can help with an evaluation and propose next steps in a treatment plan.
Contributed by: Kate Campbell
Editor: Jennifer (Ghahari) Smith, Ph.D.
References
1 American Psychiatric Association. (2022, October). What are Dissociative Disorders? Psychiatry.org. Retrieved 20 February, 2023, from https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders
2 Victoria State Government Department of Health. (2023). Dissociation and dissociative disorders. Retrieved 21 February, 2023, from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dissociation-and-dissociative-disorders
3 Ibid.
4 Mind UK Organization. (January 2023). Dissociation and Dissociative Disorders. Retrieved February 23, 2023, from https://www.mind.org.uk/information-support/types-of-mental-health-problems/dissociation-and-dissociative-disorders/causes/
5 Ibid.
6 Ibid.
7 National Alliance on Mental Illness. (2020). Dissociative Disorders. Retrieved 20 February 2023, from https://namica.org/illnesses/dissociative-disorders/
8 Ibid.
9 Ibid.
10 Ibid.
11 Ibid.
12 The Dissociative Initiative. (2022). Psychosis and dissociation. Retrieved 22 February, 2023, from https://di.org.au/dissociation-psychosis/
13 National Alliance on Mental Illness (2020)
14 Ibid.
15 Ibid.
16 Ibid.
17 Dissociative Identity Disorder (Multiple Personality Disorder). (2021, May 25). The Cleveland Clinic. Retrieved 20 February 2023, from, https://my.clevelandclinic.org/health/diseases/9792-dissociative-identity-disorder-multiple-personality-disorder
18 Dissociative Identity Disorder. (2022). American Association for Marriage and Family Therapy. Retrieved 20 February, 2023, from https://aamft.org/Consumer_Updates/Dissociative_Identity_Disorder
19 Ibid.
20 Ibid.
21 Mitra, P., Jain, A. (2022, May 17). Dissociative Identity Disorder. National Library of Medicine. Retrieved on 20 February, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK568768/
22 Ibid.
23 The Dissociative Initiative (2022)
24 Madden, S.P., Einhorn P.M., (2018). Cannabis-Induced Depersonalization-Derealization Disorder. The American Journal of Psychiatry. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2018.130202
25 Brand, B.L., Lowenstein, R.J., Lanius. (2014). Dissociative Identity Disorder. In G. O. Gabbard (Ed.), Gabbard's treatments of psychiatric disorders (pp. 439–458). American Psychiatric Publishing, Inc. https://psycnet.apa.org/record/2014-23557-024
26 Complex Dissociation Disorders. (2018). The First Plural: Dissociative Identity Disorder Association. Retrieved 22 February, 2023, from, https://www.firstpersonplural.org.uk/dissociation/complex-dissociative-disorders/
27 Yang, J., Merritt Millman L.S., David A.S., Hunter E.C.M., (2023). The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review, Journal of Trauma & Dissociation, 24:1, 8-41, DOI: 10.1080/15299732.2022.2079796
28 Dissociative Identity Disorder (Multiple Personality Disorder). (2021, May 25). The Cleveland Clinic. Retrieved 20 February 2023, from, https://my.clevelandclinic.org/health/diseases/9792-dissociative-identity-disorder-multiple-personality-disorder
29 Hypnosis. (2022). The Cleveland Clinic. Retrieved 22 February, 2023, from, https://my.clevelandclinic.org/health/treatments/22676-hypnosis
30 Ibid.