Dissociative Disorders

When working with people who struggle with dissociation, it is important to have a full medical history as well as a trauma history. Dissociative experiences can have other causes including dementia, brain tumor, traumatic brain injury, diabetes, cardio vascular issues, and many others. Therefore a resent physical might be suggested prior to engaging in mental health treatment. The following information is specific to dissociative disorders that are present due to traumatic experiences.

What is Dissociation?

Merriam-Webster Dictionary defines dissociate as “to separate from association or union with another” In mental health, dissociation is discussed in terms of the symptoms a person experiences that prevent them from being fully present in their body, know their mind, and know what is happening is happening to them, and it is happening now. Dissociation is considered a normal event that everyone experiences. It is when a person starts to dissociate in ways and during times that impact their ability to function in life that treatment is recommended. The following is a list of symptoms from the Multidimensional Inventory of Dissociation (MID 6.0) created by Paul Dell PhD. Having any one of these symptoms does not mean a person needs help, it is only when these symptoms begin to impact the persons quality of life should therapy be considered:

Memory Problems, Depersonalization (not happening to me), Derealization (not happening at all), Flashbacks, Somatoform (Body) symptoms, Trance, Hearing Child voices, Hearing voices talking to each other inside, Persecutory voices, speech insertion, thought insertion, made/intrusive emotions, made/intrusive impulses, made/intrusive actions, temporary loss of knowledge, experiences of self-alteration, time loss, “coming to”, fugues (travel without awareness), being told of disremembered actions, finding strange or foreign objects among possessions, and finding evidence of one’s recent actions but no memory of doing them.

Dissociative Disorders

The following dissociative disorders can be experienced as their own disorder, but if they are found in combination then assessing for Dissociative Identity Disorder is warranted.

Dissociative Amnesia is “an inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting (DSM-5- TR page 337).”

Depersonalization/Derealization Disorder can be diagnosed with either depersonalization or derealization or both. Depersonalization is “experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions….” Derealization is “experiences of unreality or detachment with respect to surroundings…(DSM-5-TR page 343).”

Functional Neurological Symptom Disorder formerly Conversion Disorder is recognized as “symptoms of altered voluntary motor or sensory function” and “clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions (DSM-5-TR page 360).”

Other Specified Dissociative Disorder formerly known in part as DDNOS in the DSM-IV-TR is a category designed when a persons dissociative presentation does not meet full criteria for any of the recognized dissociative disorders.

Dissociative Identity Disorder

Dissociative Identity Disorder formerly called Multiple Personality Disorder. This is a real and valid diagnosis that has been shown to be caused by chronic and extreme trauma starting in early childhood. There is also research showing that individuals who have DID are also more highly hypnotizable. It may be the combination of high hypnotizability with chronic trauma that can be the reason why some people have a dissociative identity response while others under similar traumatic conditions do not. More information on the controversy and misinformation regarding this diagnosis can be found in the DID Myths vs Facts page. When working with clients who have complex trauma histories it is not uncommon to find high levels of dissociation. In fact many people with DID can go years without knowing they have DID because it is a disorder designed to hide in plain sight.

Symptoms of DID include a “disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.” …”recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting (DSM-5-TR page 330).”