Dissociative Disorders

Dissociative disorders are characterized by various symptoms that may be grouped into three major categories: cognitive, emotional, and behavioral. The specific symptoms can vary widely among individuals and may differ depending on the type of dissociative disorder. 

Cognitive symptoms

Mental or cognitive symptoms of dissociative disorders may include the following, depending on the diagnosis: 

• Memory loss (amnesia) of specific periods, events, people, or personal details, also known as dissociative amnesia
• A sense of being detached from oneself, also known as depersonalization
• A lack of sense of self or self-identity
• A perception of the people and things around oneself as distorted and unreal, also known as derealization
• Difficulty coping with or avoiding stress

Emotional symptoms

Below are some emotional symptoms of dissociative disorders: 

• Sudden and unexpected mood shifts, including becoming suddenly depressed or anxious for no apparent reason
• Having a sense that the world is distorted or “unreal” (derealization) 
• Significant periods of being disconnected or detached from the personal physical state, surroundings, or reality (depersonalization)
• Emotional numbness
• Suicidal thoughts and feelings

Behavioral symptoms

Dissociation can change behavior.³ Below are a few behavioral symptoms of some dissociative disorders: 

• The presence of two or more distinct identities or personality states, each with a unique pattern of perceiving and interacting with the environment—most commonly associated with dissociative identity disorder (previously called multiple personality disorder)
• Finding oneself in places without remembering how one got there
• Demonstrating different personalities (also known as alters), which may have different names, voices, personal histories, and characteristics
• Out-of-body experiences, including when an individual believes they are watching a movie of their life or observing themselves from a distance

Experiencing any of these symptoms can be distressing, and the severity or frequency of symptoms can vary between individuals. Some people with dissociative disorders may experience symptoms only occasionally, while others may experience them daily. If you or someone you know is experiencing any of these symptoms, reaching out to a healthcare professional for evaluation can be crucial. Dissociative mental health disorders are real, and help is available. 

Dissociative disorders, mental health conditions that involve experiencing a loss of connection between thoughts, behavior, and identity, are most often associated with overwhelming stress or trauma.⁴ They frequently occur as the mind’s way of coping with experiences that are too traumatic or distressing to process. Common risk causes and risk factors associated with the development of dissociative disorders may include:

• Severe psychological trauma: Post-traumatic stress disorder is often related to traumatic experiences, like natural disasters or war, but also commonly involves early childhood abuse (physical, sexual, or emotional).
• Personality factors: Certain personality traits, such as fantasy proneness or being easily hypnotized, may be associated with a higher risk of developing dissociative disorders.
• Dissociative parent: Having a parent or caregiver with a dissociative disorder may increase the risk, though this phenomenon is not fully understood because the disorders are not passed down genetically. 

Trauma triggers in dissociative disorders 

Dissociative disorder symptoms may also be triggered by reminders of the traumatic events that led to the original development of the disorder. These triggers can vary between individuals but may include the following:

• Sensory triggers: Certain sights, smells, sounds, or physical sensations can trigger a dissociative state. For example, a particular smell or sound of a voice may trigger a flashback to the traumatic event. 
• Emotional triggers: Strong emotions like fear or anger can act as triggers. Emotional stress can also bring on symptoms, such as the surfacing of alters in dissociative identity disorder.
• Situational triggers: Certain conditions or environments that cause an individual to recall past trauma may trigger a dissociative episode. For example, they might be exposed to specific places, people, or times of the year that remind them of a traumatic event. 
• The causes and triggers of dissociative disorders are complex and unique to each individual. Some may experience depersonalization, while others may perceive situations as unreal, as seen with derealization. Understanding these factors can be a crucial part of treatment and recovery.

Treatments for dissociative disorders often involve therapy, medication, and various forms of self-care to maintain your mental health and well-being. The main goal of treatment may be to help individuals integrate the dissociated parts of their identity and improve their ability to function and cope with daily life. Some treatment options include therapy, medication, self-care, and other options as needed.

Medication

Currently, there are no specific medications to treat dissociative disorders. However, some medicines may be used to manage symptoms or conditions associated with the disorders, such as the following: 

• Antidepressants: These medications can help individuals manage symptoms related to co-occurring conditions like anxiety, depression, or obsessive-compulsive disorder.
• Anti-anxiety medication: These medications may treat severe panic, anxiety, and fear.
• Antipsychotic medications: Some of these medications may benefit those experiencing symptoms like hallucinations or delusions.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The details in this article is not a replacement for medical advice or diagnosis.

Other treatment options

Below are other treatment options that might be used in the treatment of dissociative disorders: 

• Clinical hypnosis: Treatment techniques that involve deep relaxation may be beneficial in exploring thoughts, feelings, and experiences hidden from the conscious state.
• Art or music therapy: Creative therapies can offer an opportunity for non-verbal expression and examination, which may be helpful for those dissociating due to trauma.

Self-care

Prioritizing one’s physical and mental health can provide benefits for those managing dissociative disorders. Below are ways to practice self-care in your daily life: 

• Exercise: Physical activity can boost mood, reduce anxiety, and promote a healthier sleep cycle.
• Healthy diet: A balanced diet may stabilize energy levels and support overall health.
• Sleep hygiene: Getting proper rest can be crucial because a lack of sleep can exacerbate dissociative symptoms.
• Mindfulness: Meditation, yoga, and deep breathing may increase awareness of the present moment and provide a sense of calm. 

Treatment can be tailored to the individual based on their specific symptoms and needs. Work closely with a healthcare professional to create the most effective treatment plan.

There are several resources available for individuals experiencing symptoms of dissociative disorders. Therapy is widely recognized as an effective way to cope with these disorders, and online platforms like BetterHelp can provide licensed therapists from home. Since you can match with a therapist through these platforms, you can get connected with someone with experience treating various mental health conditions, including dissociative disorders. 

Other resources include:

• The Traumatic Stress Institute: Formerly the Sidran Institute, this non-profit organization is dedicated to the understanding, treatment, and management of traumatic stress, including dissociative disorders.
• The National Alliance on Mental Health (NAMI): NAMI is a mental health organization dedicated to helping Americans with mental illness through advocacy, education programs, and awareness campaigns.
• International Society for the Study of Trauma and Dissociation (ISSTD): ISSTD is an international non-profit professional association organized to develop comprehensive and clinically effective resources and responses to trauma and dissociation.
• US Department of Health and Human Services: This government resource aims to provide details about mental health conditions. It can also be used to find local resources, including treatment or support groups. 

Finding the right support groups can be a step toward understanding and managing a condition. These groups can provide a space to discuss experiences with others who are going through similar challenges. Open communication with loved ones can also be a valuable resource and create an environment of understanding, empathy, and support.

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. 

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. 

Please see our Get Help Now page for more immediate resources.

Research to understand the neurobiological systems and genetic components of dissociative disorders is ongoing. These studies aim to explore innovative, targeted therapeutic interventions to enhance the effectiveness and timeliness of treatment outcomes:

A comprehensive review published in the Clinical Psychology Review examines the two main models for understanding dissociative experiences: the Trauma Model, which attributes dissociation to traumatic experiences, and the Sociocognitive Model, which emphasizes sociocultural and cognitive factors. The research proposes an approach that includes variables like sleep disruptions, consciousness deficits, and impaired self-control as critical elements of dissociative disorders. This approach could offer common ground for both approaches and future collaboration on researching biological correlations in dissociation.

Cambridge University research acknowledges that dissociative symptoms appear across various disorders and have a high personal and societal cost. However, there is little research and a lack of evidence-based treatment. Existing therapies are time-consuming and do not provide immediate relief, so the series was conducted to explore the neurobiology of dissociation, how it correlates to the current understanding of biological dissociation, and how to create faster, more targeted interventions for dissociative disorders.

90% of individuals with DID have a history of trauma

In the US and Canada, 90% of individuals with dissociative identity disorder had experienced severe trauma in their infancy or childhood. ¹

¹American Psychiatric Association

Below are more statistics on dissociative disorders:

• According to the National Alliance on Mental Illness, “Up to 75% of people experience at least one depersonalization or derealization episode in their lives, with only 2% meeting the full criteria for chronic episodes.”
• Research from McLean Hospital, the largest psychiatric affiliate of Harvard Medical School, states, “Dissociation and its trauma-related antecedents disproportionately impact women.”
• The Delaware Journal of Public Health says, “Detection and treatment of trauma-related dissociation and DDs leads to a myriad of positive outcomes including improved quality of life, treatment outcomes, reduction in health and social risks, decreased healthcare utilization and costs.“