Dissociative Disorder
Overview
Dissociative disorders are a group of mental health conditions characterized by disruptions or disturbances in an individual's normal integration of consciousness, memory, identity, emotion, perception, body representation, and motor control. These disruptions can cause a person to experience a sense of detachment from their thoughts, feelings, actions, or surroundings.
There are several types of dissociative disorders, including:
Dissociative Identity Disorder (DID): DID involves the presence of two or more distinct personality states or identities within one person. Each identity may have its own memories, behaviors, and characteristics, and the person may experience gaps in memory for periods when another identity is dominant.
Dissociative Amnesia: This involves significant memory loss that goes beyond normal forgetfulness and is often related to a traumatic or stressful event. The person may be unable to recall important personal information or significant periods of their life.
Depersonalisation-Derealisation Disorder: Individuals with this disorder experience persistent feelings of detachment or disconnection from themselves (depersonalisation) and their surroundings (derealisation). They may feel like they are observing themselves from outside their body or that the world around them is unreal or dreamlike.
Key Features
Dissociative disorders are characterised by the presence of dissociation, which involves disruptions in an individual's normal integration of consciousness, memory, identity, emotion, perception, body representation, and motor control. The key features of dissociative disorders include:
Dissociation: The primary feature of dissociative disorders is the experience of dissociation, where the person feels detached from their thoughts, feelings, actions, or surroundings. This detachment can manifest in various ways, such as feeling like one is watching themselves from outside their body (depersonalisation) or that the world around them is unreal or dreamlike (derealisation).
Memory Disturbances: Individuals with dissociative disorders may experience gaps in memory for significant periods of time, personal information, or traumatic events. Dissociative amnesia is a specific type of dissociative disorder characterised by memory loss that is not due to normal forgetfulness.
Dissociative Identity Disorder: In Dissociative Identity Disorder (DID), formerly known as multiple personality disorder, a person has two or more distinct identities or personality states that may take control of their behavior at different times. Each identity may have its own memories, behaviors, and characteristics.
Trauma or Stress: Dissociative disorders often develop as a coping mechanism in response to traumatic experiences or severe stress. The dissociative symptoms serve as a way for the individual to psychologically protect themselves from overwhelming emotions or memories related to the trauma.
Impairment and Distress: Dissociative symptoms can significantly impair an individual's ability to function in daily life and can cause considerable distress. These symptoms may interfere with work, relationships, and overall well-being.
Co-Occurrence with Other Disorders: Individuals with dissociative disorders may also experience other mental health conditions, such as depression, anxiety, or post-traumatic stress disorder (PTSD), which are often linked to their traumatic experiences.
Onset and Course: Dissociative disorders typically have an onset in childhood or adolescence, with the symptoms persisting over time. However, the specific presentation and course of the disorder can vary widely among individuals.
How We Can Help
Psychoeducation: Psychologists provide individuals with dissociative disorders and their loved ones with information about the nature of dissociation, common symptoms, and the impact of trauma on the development of dissociative symptoms. Psychoeducation helps individuals better understand their experiences and reduces feelings of confusion, shame, and isolation.
Trauma-Informed Therapy: Many dissociative disorders, such as dissociative identity disorder (DID), are often linked to traumatic experiences in childhood. Trauma-informed therapy approaches are used to address underlying trauma and help individuals process and integrate difficult memories and emotions in a safe and supportive environment.
Dissociation-Focused Therapy: Psychologists may utilise specialised therapeutic techniques tailored to address dissociative symptoms and experiences directly. This may include grounding techniques, reality testing exercises, and interventions to increase awareness of dissociative states and triggers.
Cognitive-Behavioral Therapy (CBT): CBT techniques can be adapted to help individuals with dissociative disorders identify and challenge negative thought patterns, beliefs, and cognitive distortions associated with their symptoms. CBT can also help individuals develop coping skills to manage distressing symptoms and improve daily functioning.
Trauma Processing: Psychologists help individuals process traumatic memories and experiences using evidence-based trauma processing techniques, such as eye movement desensitisation and reprocessing (EMDR), narrative therapy, or trauma-focused CBT. These approaches aim to reduce the emotional intensity of traumatic memories and promote integration of fragmented aspects of self.
Internal Communication and Integration: In cases of DID or other dissociative disorders involving distinct identity states, psychologists facilitate internal communication and collaboration among different identity states. Through techniques such as internal dialogue, journaling, and art therapy, individuals work towards greater cooperation, communication, and integration of identity states.
Emotion Regulation Skills: Psychologists teach individuals with dissociative disorders emotion regulation skills to help them manage intense emotions and distress more effectively. This may include mindfulness-based techniques, distress tolerance skills, and emotion-focused coping strategies.
Safety Planning: Psychologists collaborate with individuals to develop safety plans to manage crises, suicidal ideation, self-harming behaviors, or other high-risk situations. Safety plans include strategies for coping with distress, identifying support networks, and accessing emergency resources as needed.
Collaborative Treatment Planning: Psychologists work collaboratively with individuals, their families, and other members of their treatment team to develop comprehensive treatment plans tailored to the individual's unique needs, preferences, and goals. Treatment plans may include a combination of therapy, medication, psychiatric consultation, and support services.
It's important to note that dissociative disorders are relatively rare and can be challenging to diagnose due to the complexity of their symptoms. A comprehensive assessment by mental health professionals, including psychologists and psychiatrists, is necessary to make an accurate diagnosis and develop an appropriate treatment plan. Therapeutic approaches, such as psychotherapy, can help individuals with dissociative disorders address trauma, manage symptoms, and work toward healing and integration.