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.

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.

Many people with a dissociative disorder first receive medical attention for their condition in an emergency room. Symptoms of a psychiatric crisis requiring urgent medical care include traumatic flashbacks that are overwhelming or associated with unsafe behavior, such as a suicide attempt.

If you or a loved one has less urgent symptoms that may indicate a dissociative disorder, call your primary care doctor. As a first step, your doctor may ask you to come in for a thorough exam to rule out possible physical causes of your symptoms. However, in some cases you may be referred immediately to a psychiatrist.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

Before your appointment, make a list of:

  • Any symptoms you're experiencing, 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 trauma. 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 amnesia.
  • Your medical information, including other physical or mental health conditions you have. Make a note of the names of any medications or supplements you're taking and the dosages.

Take a trusted family member or friend along, if possible, to help you remember the information the doctor tells you. Someone who has known you for a long time may be able to talk with the doctor about periods or events that you don't remember.

Make a list of questions to ask your doctor so you can make the most of your appointment. For dissociative disorders, some basic questions to ask include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes?
  • How will you determine my diagnosis?
  • Is my condition likely temporary or long term (chronic)?
  • What treatments do you recommend for this disorder?
  • 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?
  • Are there any restrictions that I need to follow?
  • Should I see a specialist? If so, will my insurance cover seeing a specialist?
  • Are there any brochures or other printed material that I can take? What websites do you recommend?

Don't hesitate to ask questions during your appointment anytime that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

  • What are your symptoms?
  • 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 like you're outside of your body, observing 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 illegal drugs? How often?
  • Do you now or have you ever served in the military?
  • 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 illness?

In an emergency

If you have thoughts of hurting yourself or someone else, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor.

Doctors diagnose dissociative disorders based on a review of symptoms and your personal history. Your doctor may perform tests to rule out physical conditions — for example, head injury, certain brain diseases, sleep deprivation or intoxication — that can cause symptoms such as memory loss and a sense of unreality. If your doctor rules out physical causes, he or she will likely refer you to a mental health specialist to determine your diagnosis.

To be diagnosed with a dissociative identity disorder, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Dissociative amnesia

For a diagnosis of dissociative amnesia, the DSM includes these criteria:

  • You've had one or more episodes — usually something traumatic or stressful — in which you couldn't remember important personal information, or you can't remember your identity or life history. This memory loss is too extensive to be explained by ordinary forgetfulness.
  • Your episodes of memory loss don't occur only during the course of another mental health disorder, such as post-traumatic stress disorder. Also your symptoms are not due to alcohol or other drugs, and they're not caused by a neurological or other medical condition, such as amnesia related to head trauma.
  • You also may experience dissociative fugue, where you purposefully travel or experience confused wandering that involves amnesia — inability to remember your identity or other important personal information.
  • Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life.

Dissociative identity disorder

For a diagnosis of dissociative identity disorder, the DSM includes these criteria:

  • You display, or others observe, two or more distinct identities or personalities, which may be described in some cultures as possession that is unwanted and involuntary. Each identity has its own pattern of perceiving, relating to and thinking about yourself and the world.
  • You have recurrent gaps in memory for everyday events, skills, important personal information and traumatic events that are too extensive to be explained by ordinary forgetfulness.
  • Your symptoms are not a part of broadly accepted cultural or religious practice.
  • Your symptoms are not due to alcohol or other drugs, or a medical condition. In children, symptoms are not due to imaginary playmates or other fantasy play.
  • Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life.

Depersonalization-derealization disorder

For a diagnosis of depersonalization-derealization disorder, the DSM includes these criteria:

  • You have persistent or recurrent experiences of feeling detached from yourself, as if you're an outside observer of your thoughts, sensations, actions or your body (depersonalization). Or you feel detached or experience a lack of reality for your surroundings as if you're in a dream or the world is distorted (derealization).
  • While you're experiencing an episode of depersonalization or derealization, you're aware the experience is not reality.
  • Your symptoms do not occur only during the course of another mental disorder, such as schizophrenia or panic disorder, or during another dissociative disorder. Your symptoms are also not explained by the direct effects of alcohol or other drugs, or a medical condition, such as temporal lobe epilepsy.
  • Your symptoms cause you significant stress or problems in your relationships, work or other important areas of your life.

Psychotherapy is the primary treatment for dissociative disorders. This form of therapy, also known as talk therapy, counseling or psychosocial therapy, involves talking about your disorder and related issues with a mental health provider.

Your therapist will work to help you understand the cause of your condition and to form new ways of coping with stressful circumstances.  Over time, your therapist may help you talk more about the trauma you experienced, but generally only when you have the coping skills and relationship with your therapist to safely have these conversations.

Although there are no medications that specifically treat dissociative disorders, your doctor may prescribe antidepressants, anti-anxiety medications or antipsychotic medications to help control the mental health symptoms associated with dissociative disorders.

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.

Mar. 26, 2014