A dissociative disorder is a mental illness that refers to a group of mental conditions involving disruptions (breakdown) of memory, awareness, sense of identity and perception: dissociative identity disorder, dissociative amnesia and depersonalisation-derealisation disorder. They represent mental illnesses sharing the key feature of dissociation, a coping mechanism used to disconnect emotionally and physically from the pain of a traumatic experience. Dissociation is the extreme disconnection between the self and the outside world, and it functions on the premise of distancing oneself from the painful memories of a stressful or traumatic past experience, by actively avoiding bringing those memories into everyday thought processes to such an extent, as if they had never actually happened in the first place.

 

 

Causes

Dissociative identity disorder: it is generally accepted that the onset of this particular manifestation of dissociative disorders it is mostly due to extreme and repeated trauma (emotional, physical or sexual abuse) that occurs during crucial periods in one’s development

Other potential causes: extremely stressful situations (loss of a parent, war, natural disaster)

 

Dissociative amnesia and depersonalisation-derealisation disorder have similar causes, namely extremely stressful/traumatic events

Common to all three also seems to be an imbalance of certain neurotransmitters, making the person in question, thus more susceptible to developing a dissociative disorder

Symptoms and signs

Dissociative identity disorder:

DID or multiple-personality disorder (as it used to be known) refers to engaging in the habitual coping mechanism of dissociation, a process likened to a form of autohypnosis in the context of early childhood trauma

When dissociation becomes the go-to mechanism when dealing with stressful or painful situations, and especially due to longer periods of abuse, the disassociated mental states take on a separate identity – ‘alternate personality states’ or ‘alters’ – each taking turn in ‘controlling’ the person manifesting them

Each alter can exhibit distinctive personality traits, personal history, ways of behaving and relating to the outside world – each alter can even be of a different gender, have his/her name, and distinct mannerisms

The person suffering from a dissociative disorder may or may not be aware of the other ‘alters’ and might not be aware of the behavior exhibited while another personality state is dominant

Stress or a reminder of the trauma can act as catalysts for ‘switching’ between alters, which usually causes various disturbances in one’s life

 

Dissociative amnesia:

Formerly known as psychogenic amnesia, dissociative amnesia refers to the process of blocking out pieces of important personal information, usually associated with a stressful or traumatic event

Memory loss is quite serious, far surpassing normal forgetfulness and can include gaps in memory for long periods of time or of the traumatic experience itself

The memories still exist, but deep inside one’s mind and cannot be recalled, though they might resurface in cases where something in the person’s surroundings triggers these ‘lost’ memories

 

Depersonalisation-derealisation disorder:

This disorder occurs when one repeatedly experiences the feeling of constantly being observed from the outside of one’s own body, or the persistent feeling that the things comprising one’s environment are not real (or a combination of both)

Many people do experience states similar to these, but in cases where this lasts for extended periods of time, or signs do not completely fade away, the issue becomes serious enough to be considered a disorder

 

Dissociative identity disorder, dissociative amnesia and derealisation-depersonalisation disorder share the following:

Severe decrease in one’s levels of normal functioning

Depression or mood swings

Anxiety, nervousness, panic attacks

Severe headaches or other unaccountable pains in the body

Abnormal eating and sleeping patterns

Depersonalization (feeling detached from one’s body and/or thoughts)

Derealisation (perceiving the external environment as unreal)

Amnesia or a sense of ‘lost time’

Hallucinations

Suicidal ideation

 

Specific depersonalization symptoms: the feeling of being unable to control one’s speech or movements, the sense of a distorted body (shrunken or enlarged head and arms or legs), emotional or physical numbness of one’s senses, the feeling of numbness of emotions and of not belonging

 

Specific derealisation symptoms: the feeling of being alienated from one’s surroundings (as if playing in a movie), feeling emotionally disconnected from the people one cares about, surroundings appearing distorted, artificial, two-dimensional, distortions in perception of time, distortions of distance and the size and shape of objects

Advice

Psychotherapy for improving communication during conflicts and for improving one’s ability to better understand and manage various issues

Cognitive therapy for improving dysfunctional thinking patterns

Family therapy for educating family members for better coping with the situation and offering support in a healthy manner for both the person in question and for themselves

Creative therapies (art and music therapy) for allowing the sufferer to express his/her emotions/thoughts in a safe way

Medication under the form of antidepressants or antianxiety drugs may ameliorate certain symptoms

Clinical hypnosis that focuses on achieving an altered state of consciousness that would allow repressed memories, thoughts and emotions to finally come to surface in a way that is not perceived as threatening to one’s overall well-being, but it is mostly used to help sufferers better manage some of their symptoms (and not necessarily for remembering certain ‘lost’ parts of one’s past)

MISCONCEPTIONS
  • There are different people (“distinct personalities”) ‘inside’ the mind of DID patients

    Therapy might bring to surface memories of events that did not actually happen

    DID is rare and fairly obvious to outside observers

    Therapy aims at dispelling the ‘alters’, when in fact its aim is to allow a fusion between these extreme personality states to take place, in a healthy manner, to open up the ‘communication lines’ between them

    Dissociating is specific only to DID sufferers, when in truth, it is a fairly common coping mechanism (depression, anxiety, post-traumatic stress syndrome)

Statistics

Dissociation seems to be more common in American children

Since females tend to experience a higher ratio of being abused in childhood (10:1), there is a higher incidence of cases of female DID having been reported

DID is usually the result of abuse earlier than 9 years of age

The earlier the abuse, the higher the chances of a greater degree of dissociation

The average number of alternate personalities that a person with DID experiences is between 8 and 13, but there have been cases of a number of alters reaching up to 100

Did you know?

Alters cannot be integrated spontaneously, but gradually

A classic approach to dealing with DID and described by the International Society for the Study of Trauma and Dissociation Treatment Guidelines consists of three steps: stabilization, trauma-work and integration

According to an article entitled The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry published in the Clinical psychopharmacology and neuroscience: the official scientific journal of the Korean College of Neuropsychopharmacology a positive outcome states that “Dissociation and dissociative disorders can be treated successfully because they originate from a mechanism which is not pathological per se. Hence, dissociation and dissociative disorders are reversible subject to appropriate treatment.”

National Multiple Personality Day, March 5, aims to bring awareness to this issue, especially since women are facing an increased risk