Dissociative disorders

Overview

Dissociative disorders are mental health conditions that involve experiencing a loss of connection between thoughts, memories, feelings, surroundings, behavior and identity. These conditions include escape from reality in ways that are not wanted and not healthy. This causes problems in managing everyday life.

Dissociative disorders usually arise as a reaction to shocking, distressing or painful events and help push away difficult memories. Symptoms depend in part on the type of dissociative disorder and can range from memory loss to disconnected identities. Times of stress can worsen symptoms for a while, making them easier to see.

Treatment for dissociative disorders may include talk therapy, also called psychotherapy, and medicine. Treating dissociative disorders can be difficult, but many people learn new ways of coping and their lives get better.

Symptoms

Symptoms depend on the type of dissociative disorder, but may include:

• A sense of being separated from yourself and your emotions.
• Thinking that people and things around you are distorted and not real.
• A blurred sense of your own identity.
• Severe stress or problems in relationships, work or other important areas of life.
• Not being able to cope well with emotional or work-related stress.
• Memory loss, also called amnesia, of certain time periods, events, people and personal information.
• Mental health problems, such as depression, anxiety, and suicidal thoughts and behaviors.

The American Psychiatric Association defines three major dissociative disorders: Depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder.

Depersonalization/derealization disorder

Depersonalization involves a sense of separation from yourself or feeling like you're outside of yourself. You may feel as if you're seeing your actions, feelings, thoughts and self from a distance, like you're watching a movie.

Derealization involves feeling that other people and things are separate from you and seem foggy or dreamlike. Time may seem to slow down or speed up. The world may seem unreal.

You may go through depersonalization, derealization or both. Symptoms, which can be very distressing, may last hours, days, weeks or months. They may come and go over many years. Or they may become ongoing.

Dissociative amnesia

The main symptom of dissociative amnesia is memory loss that's more severe than usual forgetfulness. The memory loss 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 time when you felt shock, distress or pain. A bout of dissociative amnesia usually occurs suddenly. It may last minutes, hours, or rarely, months or years.

Dissociative amnesia can be specific to events in a certain time, such as intense combat. More rarely, it can involve complete loss of memory about yourself. It sometimes may involve travel or confused wandering away from your life. This confused wandering is called dissociative fugue.

Dissociative identity disorder

Formerly known as multiple personality disorder, this disorder involves "switching" to other identities. You may feel as if you have two or more people talking or living inside your head. You may feel like you're possessed by other identities.

Each identity may have a unique name, personal history and features. These identities sometimes include 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. Dissociative identity disorder usually also includes bouts of amnesia and often includes times of confused wandering.

When to see a doctor

Sometimes dissociative disorder symptoms occur in a crisis with severe or impulsive behavior. People with these symptoms need care more urgently and in an emergency department at a hospital when safety becomes a concern.

If you or a loved one has less urgent symptoms that may be a dissociative disorder, contact your doctor or other health care professional for help.

Suicidal thoughts or behavior

If you have thoughts of hurting yourself or someone else, call 911 or your local emergency number right away or go to an emergency department.

Share your concerns with a trusted relative or friend. Or contact a suicide hotline:

• In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, 7 days a week. Or use the Lifeline Chat at 988lifeline.org/chat/. Services are free and confidential.
• If you're a U.S. veteran or service member in crisis, call 988 and then press 1, or text 838255. Or chat using veteranscrisisline.net/get-help-now/chat/.
• The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454.

Causes

Dissociative disorders usually start as a way to cope with shocking, distressing or painful events. The disorders most often form in children who go through long-term physical, sexual or emotional abuse. Less often, the disorders form in children who've lived in a home where they went through frightening times or they never knew what to expect. The stress of war or natural disasters also can bring on dissociative disorders.

When you go through an event that's too much to handle emotionally, you may feel like you're stepping outside of yourself and seeing the event as if it's happening to another person. Mentally escaping in this way may help you get through a shocking, distressing or painful time.

Risk factors

You're at greatest risk of having a dissociative disorder if you've had long-term physical, sexual or emotional abuse during childhood.

Other shocking, distressing or painful events also may cause dissociative disorders to arise. These may include war, natural disasters, kidnapping, torture, extensive early-life medical procedures or other events.

Complications

Having a dissociative disorder increases the risk of complications and having other mental health conditions. These may include:

• Depression and anxiety.
• Post-traumatic stress disorder.
• Sleep disorders, including nightmares, insomnia and sleepwalking.
• Physical symptoms such as lightheadedness or seizures that are not due to epilepsy.
• Eating disorders.
• Problems with sexual function.
• Problems with alcohol and drug use.
• Personality disorders.
• Major problems in personal relationships, at school and at work.
• Self-injury or high-risk behavior.
• Suicidal thoughts and behavior.

Prevention

Children who are physically, emotionally or sexually abused are at increased risk of developing mental health conditions, 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 health care professional or a leader in your faith community.
• Ask for help finding resources such as parenting support groups and family therapists.
• Look for churches, other faith-based groups and community education programs that offer parenting classes that also may help you learn a healthier parenting style.

If you or your child was abused or went through another shocking, distressing or painful event, see a doctor or other health care professional right away. Your doctor can refer you to a mental health professional who can help you or your child recover and learn healthy coping skills. Or you may be able to contact mental health services directly.

Diagnosis

Diagnosis usually involves talking about your symptoms and ruling out any medical condition that could cause the symptoms. Testing and diagnosis often include a referral to a mental health professional to make a diagnosis.

Diagnosis may include:

• Physical exam. Your health care professional examines you, talks about your symptoms and reviews your personal history. Certain tests may rule out physical conditions that can cause symptoms such as memory loss and feeling separate from reality. Examples include head injury, certain brain diseases, a severe lack of sleep, and drug or alcohol use.
• Mental health exam. Your mental health professional talks with you about your thoughts, feelings and behavior, and your symptoms. With your permission, information from family members or others may be helpful.

Treatment

Dissociative disorders treatment may vary based on the type of disorder you have. Generally, treatment includes talk therapy and medicine.

Talk therapy

Also called psychotherapy, talk therapy is the main treatment for dissociative disorders. This form of therapy involves talking about your disorder and related issues with a mental health professional. Look for a therapist with advanced training or experience in working with people who have had trauma.

Your therapist works with you to help you understand the cause of your condition. Your therapist also can help you develop new ways of coping with stressful situations. Over time, your therapist may help you talk more about the shocking, distressing or painful events you went through. Generally this happens after you have a trusting relationship with your therapist and the coping skills to safely have these conversations.

Medicine

Although there are no medicines that specifically treat dissociative disorders, your doctor may prescribe antidepressants, anti-anxiety medicines or antipsychotic medicines. These may help with mental health symptoms that are part of dissociative disorders.

Preparing for an appointment

As a first step, your doctor or other health care professional may suggest that you have a health exam to rule out possible physical causes of your symptoms. In some cases, you may be referred right away to a mental health professional. You may want to take a family member or friend along, if possible, to help you remember information.

Here's some information to help you get ready for your appointment, and what to expect.

What you can do

Before your appointment, make a list of:

• Any symptoms you have, including any recent behavior that caused confusion or concern for you or your loved ones.
• Key personal information, including any major stresses or recent life changes. Also note events from your past, including your childhood, that caused physical or emotional problems. If you can't recall some periods of your life, note the time frame and anything you can remember about the period leading up to your memory loss.
• Your medical information, including other physical or mental health conditions you have. Include any medicines, vitamins, herbs or other supplements you're taking, and the doses.
• Questions to ask to make the most of your appointment.

Some questions to ask may include:

• What's likely causing my symptoms or condition?
• What are other possible causes?
• How will you decide on my diagnosis?
• Is my condition likely short term or long term?
• What treatments do you recommend for my condition?
• How much can I expect my symptoms to improve with treatment?
• How will you monitor my progress?
• I have these other health conditions. How can I best manage them together?
• Should I see a specialist?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Feel free to ask other questions during your appointment.

What to expect from your doctor

Your health care or mental health professional is likely to ask you several questions. For example:

• What symptoms concern you or your loved ones?
• When did you or your loved ones first notice your symptoms?
• Are there periods of time in your life that you don't remember?
• Have you ever found yourself some distance away from your home or work, and not known how you got there?
• Do you ever feel as if you're outside of your body, seeing yourself?
• Do you feel as though there is more than one person, or maybe many people, living inside your head?
• What other symptoms or behaviors are causing you or your loved ones distress?
• How often do you feel anxious or depressed?
• Have your symptoms caused problems in your work or your personal relationships?
• Have you ever thought about harming yourself or others?
• Do you drink alcohol or use drugs?
• Do you now serve in the military? Have you served in the past?
• Have you ever been touched against your will?
• Were you physically abused or neglected as a child?
• Was anyone in your family abused during your childhood?
• Are you currently being treated for any other medical conditions, including mental health conditions?

Be ready to answer these questions to save time to talk about what's most important to you.