Dissociative Disorders

Dissociation is an involuntary disconnection with reality, and is one way that the mind copes with high stress, such as in traumatic experiences.

It’s helpful to think of dissociation as occurring along a continuum. Most of us are familiar with mild every-day forms of dissociating or losing touch with the present, such as having a daydream. This is quite normal, and nothing to be concerned about.

More serious dissociation occurs at the other end of the continuum and is often associated with trauma experiences, particularly during childhood. Here, the disconnection from reality develops as a defense mechanism or coping strategy - to help protect us from painful current experiences.

However, if it continues beyond the traumatic event, dissociation has serious consequences for everyday functioning. In such cases, dissociation may be a diagnosed mental health condition. Below are the different types and symptoms of dissociative disorders, and how to access treatment.

What are dissociative disorders?

Dissociative disorders are a group of trauma-related conditions, where people experience a disconnection, or problems with:

  • Memory
  • Thoughts
  • Awareness
  • Perception
  • Identity
  • Consciousness

Types of dissociative disorders

There are three main types of dissociative disorders in the DSM 5, the manual therapists use to diagnose mental health conditions:

  • Dissociative identity disorder: This is a complex and chronic type of dissociative disorder. The condition was previously called ‘multiple personality disorder’, as people with this condition can have more than one identity. Each identity can have completely different characteristics, ways of thinking, and behaving. People may feel that they have little control over which identity is dominant at any given time, which can lead to confusion about who they really are.
  • Dissociative amnesia: This condition affects memory, but is more severe than day-to-day forgetfulness. People may experience blank episodes of memory, lasting from minutes to years. During these periods, people may be unable to remember information about themselves, be unable to recall periods of their lives, or may be confused about their surroundings. It is often connected to a traumatic or highly stressful event.
  • Depersonalization/derealization disorder: This condition involves feelings of unreality, such as being detached from your body or surroundings. For example, you might feel that you are watching what’s happening to you from outside of your body, or feel that the world around you is unreal. People are often aware that something unusual is happening to them and find it distressing. Conditions like acute stress disorder and post-traumatic stress disorder can also include symptoms of depersonalization or derealization.

Prevalence of dissociative disorders

Many people have the experience of dissociation at some point in their lives. Research suggests that around 26-74% of people may experience a passing symptom of depersonalization or derealization at some point, making it a relatively common experience (1). It’s important to note that these kind of more common experiences are not necessarily indicative of an underlying mental health condition.

In terms of the prevalence of diagnosable conditions, a 12-month U.S. study found that (2):

  • 1.5% of people experienced dissociative identity disorder
  • 1.8% of people experienced dissociative amnesia
  • 0.8% of people experienced depersonalization/derealization disorder
  • 4.4% of people experienced dissociative symptoms of clinical severity that did not meet criteria for one of the other diagnoses; known as dissociative disorder not otherwise specified.

Symptoms of dissociative disorders

Symptoms differ according to the specific disorder, but common examples include:

  • A feeling of detachment from the world around you
  • Feeling as if you are outside your own body
  • Uncertain sense of identity
  • Memory loss or amnesia
  • It’s also quite common to experience other mental health conditions, like anxiety, depression, or have difficulty sleeping

In some cases, symptoms are short-lived, following a traumatic event. In other cases, symptoms persist and have a serious impact on day-to-day functioning. It’s important to seek treatment if dissociation is impacting your daily life; options for this are discussed below.

Treatment options for dissociative disorders

If you’re experiencing dissociative symptoms, see a mental health professional about one or more of the following options:

  • Therapy: Therapy for dissociative disorders should be undertaken with a therapist specializing in trauma treatment. Initially, the focus is on developing strategies for coping, grounding, and getting control over dissociation. Later on, trauma experiences or the underlying cause of the symptoms is discussed. See more tips below on types of therapy and selecting a therapist.
  • Check-ups: It’s important to have a check-up with your doctor to ensure that there is no underlying medical cause for dissociative symptoms.
  • Talk to others: Talking to family and friends about your past experiences and dissociative symptoms can be a helpful part of the healing process. It also means that these important support people are better placed to help you, once they understand how you feel.
  • Hotlines: If you’re having thoughts of suicide or need immediate support, call the National Suicide Prevention Hotline at 1-800-273-8255. For information (not hotline services), you can also call the Sidran Institute for Traumatic Stress Education and Advocacy at 410-825-8888.
  • Online resources: The Sidran Institute has helpful information and resources related to dissociation. Reading about the similar experiences of others can also be helpful. For example, check out the American Psychiatric Association website, which publishes stories about experiences with dissociative disorders.

Therapy for dissociative disorders

Psychological therapy is an important part of treatment for dissociative disorders. Common evidence-based therapeutic approaches include:

  • Cognitive Behavioral Therapy (CBT): CBT helps us to become aware of and change unhelpful thinking patterns, behaviors, and beliefs. In particular, Trauma-Focused CBT can help people heal from traumatic experiences, which are often associated with dissociative disorders.
  • Dialectical Behavior Therapy (DBT): DBT is a skills-based approach to treating dissociative disorders. DBT teaches distress tolerance, emotion regulation, mindfulness, and communication skills.
  • Eye Movement Desensitization and Reprocessing Therapy (EMDR): EMDR can be a helpful technique for healing from trauma, without necessarily discussing the experience in-depth.
  • Mindfulness Practices: Mindfulness helps us to connect with the present and develop moment-to-moment awareness.

It’s important to consider different therapy types and how they resonate with you before choosing. If you’re unsure, your prospective therapist is a great person to seek advice from.

What to look for in a therapist for dissociative disorders

There are several factors to keep in mind when selecting a mental health professional, including:

  • Specialization: Look for a therapist who has experience and specialized training in trauma or dissociative disorders. Therapists often include this kind of information in their biographies so that it’s easy for you to find.
  • Qualifications: With so many different provider types available, it can be difficult to decide which type of mental health professional to see. The most important thing is to look for a currently licensed therapist. While dissociative disorders are not usually treated with medication, some other commonly co-occurring disorders may benefit from medication. If you think this might be needed, make sure you see a psychiatrist. This particular type of mental health professional is able to prescribe.
  • Personal fit: The trusting relationship between you and your therapist, known as the “therapeutic alliance,” can have a huge impact on the efficacy of therapy. This is especially true of treatment for dissociative disorders, given much of the work relies on you feeling comfortable sharing traumatic memories with your therapist. The best way to judge how you might feel about a therapist is to ask for a preliminary phone call. This also enables you to ask about their experience and what therapy with them will be like. Try to speak to a few different therapists before deciding on a provider.
  • Therapy type: Alongside this, you’ll also want to prioritize the therapy type that appeals to you, as discussed in the section above.

Sources and references

  • (1) Hunter EC., et al., 2004, “The epidemiology of depersonalisation and derealisation. A systematic review”, Soc Psychiatry Psychiatr Epidemiol, 39(1)
  • (2) Johnson JG., et al., 2006, “Dissociative disorders among adults in the community, impaired functioning, and axis I and II comorbidity”, J Psychiatr Res, 40(2)
  • Şar, V., 2017, “Dissociative disorders: Epidemiology”, The SAGE Encyclopaedia of Abnormal and Clinical Psychology
  • American Psychiatric Association website, “What are dissociative disorders?”, https://www.psychiatry.org/
  • NHS website (United Kingdom), “Dissociative disorders”, https://www.nhs.uk/
  • Sidran Institute website, https://www.sidran.org/