Abstract
Dissociative disorders deal with one’s cognition and perception of self and others. The definition of these disorders outlines the word disruption as the main concept of these conditions. The three types of dissociative disorders are dissociative identity disorder, dissociative amnesia, and depersonalization disorder. The primary cause of these disorders is prolonged trauma, which can occur in childhood as well as the adulthood of a person. All these types have similar symptoms in that they are followed by a person having difficulties in his or her everyday life. Moreover, problems with memory and detachment from reality are also symptoms of these conditions. The treatment of dissociative disorders consists of talking therapy and medications.
Introduction
The issues related to one’s mental health can significantly affect people’s way of living. Many disorders are connected to an individual’s inability to perceive events, emotions, and words of other people rationally and adequately. For example, dissociative disorders deal with a person experiencing problems with memory, the identity of self and others, perception, and awareness. The symptoms of these disorders can affect many aspects of one’s life. This paper aims to research dissociative disorders and describe their history, types, causes, symptoms, and ways of prevention and treatment.
Definition
Multiple types of dissociative disorders can be outlined. However, the definition of this condition, in general, can be determined. Although different types can focus on various aspects of one’s cognition, the range of affected areas remains the same. According to the American Psychiatric Association (2013), dissociative disorders can be characterized by the concept of dissociation or “disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior” (p. 291). The keyword in this definition is disruption as it explains the central problem of these disorders. All types of this condition cause issues with one’s memory and identity in such a way that a person cannot adequately perceive the world and interpret it in a manner that is considered logical. For example, people with dissociative disorders may experience having difficulties with understanding such concepts as their presence, place, and existence of surroundings.
Types
The American Psychiatric Association distinguishes three main types of dissociative disorders. First of all, dissociative identity disorder is characterized by the “fragmentation of identity” (American Psychiatric Association, 2013, p. 292). Individuals with this condition can experience a split in their personality states and behavior and have problems with memory which can be explained by a person behaving differently and not remembering the incidents of alternative behavior.
The second type is called dissociative amnesia and is defined by a person not being able to recall information connected to oneself (American Psychiatric Association, 2013). This condition can be further distinguished into several categories according to the amount of information that the person cannot remember. Thus, some persons with this disorder can notice the lack of information about their past, while others remain unaware of this issue. Moreover, dissociative amnesia includes dissociative fugue, otherwise known as unplanned wandering. People with this type of disorder may find themselves in different places without any recollection of how they got there.
Finally, depersonalization disorder is the third identified type of this condition. It can be characterized by an individual experiencing detachment from various aspects of reality such as one’s mind, body, or surroundings. These feelings are often followed by a person trying to test reality. One can experience the derealization of surrounding areas as well as depersonalization of self at the same time.
The American Psychiatric Association (2013) also outlines other specified and unspecified dissociation disorders for the cases that do not meet the standards for a particular type of disorder. These conditions can have similar symptoms that do not occur as frequently or have some differences in their patterns. Patients with unspecified disorders can be evaluated several times to see the symptoms’ progression.
Criteria for the Diagnosis and the DSM-5
According to the NHS Choices (2017), many people may experience an incident of dissociation during their lifetime. However, to be diagnosed, one has to have consistency in the symptoms. The criteria for diagnosing these disorders are described in the Diagnostic and Statistical Manual of Mental Disorders or the DSM-5. In this book, a part of the criteria is grouped according to the specific disorder. However, some aspects are the same for each type. For instance, specific qualifications include the presence of multiple identities for dissociative identity disorder, failure to recall autobiographical memory for dissociative amnesia, and recurring experiences of derealization and depersonalization for depersonalization disorder. Similar criteria include an individual being significantly affected by the presence of symptoms on a clinical and psychological level and having social and occupational issues. Moreover, it is crucial to exclude outside factors that can potentially cause the same effects. For example, drug or alcohol abuse and other mental health-related issues such as schizophrenia and PTSD should be evaluated before coming to a diagnosis.
Causes
One can outline multiple causes of dissociative disorders. However, most cases include patients developing these disorders after a specific trauma. In these situations, an individual can try to forget the overwhelming experience and develop a mechanism of dissociation to escape the possibility of recalling hurtful events. Many symptoms of these disorders are also induced by feelings of embarrassment and confusion (Dorahy et al., 2015). It is essential to separate the dissociative disorders from trauma-related disorders, although they have many similarities. The causes of these conditions are virtually the same. However, the outcomes are different. According to Cronin, Brand, and Mattanah (2014), dissociative disorders are often caused by the “ongoing, severe childhood traumas” (p. 22676). Therefore, many children and adolescents, as well as adults, may experience the symptoms of the disorder depending on the emotional processing speed of an individual.
Symptoms
The symptoms of dissociative disorders range from type to type. First of all, dissociative identity disorder is characterized by the presence of multiple personality types in one person. An individual can feel this presence in the form of multiple voices and be aware of several influences being existent. In other situations, persons do not realize the existence of multiple personalities and shift between different identities with the possibility of not remembering one’s behavior. However, it is not very easy to detect changes in one’s personality as many persons do not have very apparent alterations in their behavior. One’s shift in attitude may be followed by a change in tastes, preferences, or outlooks. It is crucial to note that such alterations can be perceived by a person and his or her close relatives, friends, and medical professionals as well. Other symptoms can also include recurrent gaps in memory and failure to recall personal information.
The central symptom of dissociative amnesia is the inability to remember autobiographical information. This type of dissociative disorder is often characterized by a person having selective or localized amnesia that is triggered by some traumatic events. Thus, by trying to ignore bad incidents, a person can forget other valuable information. The symptoms of this disorder can be present in other types. Therefore, this particular condition is hard to identify. The presence of recurring dissociative flashbacks is also a symptom of this disorder.
Depersonalization and derealization disorder can include a person having experiences with depersonalization, derealization, or both. Individuals with this disorder may feel detached from reality and describe their perception as being foggy and distorted. Moreover, the loss of sensation and seeing surrounding entities and persons as lifeless are often present as well. The aspect of depersonalization is focused on separating the parts of oneself in the cognition. Thus, such individuals may feel like observers of their bodies, minds, and actions.
Prevention and Treatment
Dissociative disorders are somewhat stable regarding the development of their symptoms. However, approximately one-third of all diagnosed individuals have many discrete episodes before they identify a disorder, while another third often has a single incident before they develop a consistent pattern (American Psychiatric Association, 2013). Moreover, these disorders often start appearing in children and adolescents which can complicate the possibility of prevention. However, some approaches can be suggested. First of all, because the causes are often linked to traumatic events, removing a person from a dangerous and stress-inducing environment may mitigate the outcomes of some cases. The abuse of various substances such as alcohol and illicit drugs can also exacerbate the development of a disorder.
Treatment of dissociative disorders combines psychotherapy and the use of medications. Such medications mostly include various antidepressants that treat conditions associated with the issue. Furthermore, several approaches to therapy can be considered. However, the basis of every treatment lies in interaction and conversation with an affected individual. Thus, talking therapies are often suggested as a way of treatment for dissociative disorders (Myrick et al., 2017). Cronin et al. (2014) describe a method of treatment that includes efforts to decrease the dissociation and reduce self-destructive behaviors. Moreover, the development of awareness about self-identity is also an essential part of treatment. Brand, Loewenstein, and Spiegel (2014) argue that trauma-focused treatment can improve patients’ mental health. Therefore, talking therapies centered on one’s traumatic events can help individuals to become more aware of their situation.
Conclusion
Dissociative disorders affect people’s cognition and influence one’s ability to perceive self and others. These conditions can be caused by a single or reoccurring trauma and are often correlated to one’s attempts to forget or interpret such events. Dissociative disorders can develop in one’s childhood and adolescence. However, some people start experiencing symptoms later in their lives. The DSM-5 points out that the process of disruption is essential to understand in diagnosing these disorders, namely the disruption between reality and one’s cognition.
There are three types of dissociative disorders. The first is dissociative identity disorder that can be characterized by an individual having multiple personality sides or identities. The second is dissociative amnesia that is mostly described by a person having trouble recalling personal information and events that are somehow connected to one’s traumatic experiences. Moreover, these persons can forget their wandering and travel from one place to another, which is called dissociative fugue. Finally, the last identified type is called depersonalization and derealization disorder. This type describes individuals that experience detachment from either their bodies and minds or surrounding objects and persons.
These disorders are usually treated with psychotherapy, which includes talking and trauma-based methods. These approaches are directed at giving a person an ability to reflect on his or her painful experiences and develop a level of awareness to deal with reoccurring incidents of disruption.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) (5th ed.). Arlington, VA: American Psychiatric Pub.
Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2014). Dispelling myths about dissociative identity disorder treatment: An empirically based approach. Psychiatry: Interpersonal and Biological Processes, 77(2), 169-189.
Cronin, E., Brand, B. L., & Mattanah, J. F. (2014). The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders. European Journal of Psychotraumatology, 5(1), 22676.
Dorahy, M. J., Middleton, W., Seager, L., McGurrin, P., Williams, M., & Chambers, R. (2015). Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups. Journal of Affective Disorders, 172, 195-203.
Myrick, A. C., Webermann, A. R., Loewenstein, R. J., Lanius, R., Putnam, F. W., & Brand, B. L. (2017). Six-year follow-up of the treatment of patients with dissociative disorders study. European Journal of Psychotraumatology, 8(1), 1344080.
NHS Choices. (2017). Dissociative disorders.