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What are dissociative disorders?
Mental illness is a general term for a group of brain disorders that affect
the way a person thinks, feels, acts and/or relates to others and his or her
surroundings. Dissociative disorders are mental illnesses that involve
disruptions or breakdowns of memory, awareness, identity and/or perception—mental
functions that normally operate smoothly. When one or more of these functions is
disrupted, symptoms can result. These symptoms can interfere with a person’s
general functioning, including social and work activities, and relationships.
Dissociative disorders have been linked to overwhelming stress, which may be
the result of traumatic events—such as abuse, accidents or disasters—that
the person has experienced or witnessed. Dissociation is a way of coping that
disconnects, or separates, traumatic memories from the person’s normal
awareness, or consciousness, thus shielding him or her from the pain or fear
associated with the trauma. The traumatic memories, however, still exist but are
deeply buried within the person’s mind. The memories may resurface on their
own or after being triggered by something in the person’s surroundings, or
they may remain buried in the mind and emerge instead as physical symptoms.
Dissociation itself does not always suggest a disorder. There are many
examples of dissociation in everyday experience; for example, daydreaming or
getting lost in music, a book or movie. In a person with a dissociative
disorder, dissociation interferes with everyday functioning. Symptoms result
from the ongoing dissociation of traumatic memories.
Types of dissociative disorders
There are different types of dissociative disorders, which vary in severity
and in symptoms. The recognized dissociative disorders include the following:
- Dissociative amnesia — This disorder occurs when a person
blocks out certain information, usually associated with a stressful or traumatic
event, leaving him or her unable to remember important personal information.
With this disorder, the degree of memory loss goes beyond normal forgetfulness
and includes gaps in memory for long periods of time or of memories involving
the traumatic event.
- Dissociative fugue — With this disorder, the person
temporarily loses his or her sense of personal identity and impulsively wanders
or travels away from home. People with dissociative fugue often become confused
about who they are and may even create new identities. Outwardly, people with
this disorder show no signs of illness, such as a strange appearance or
behavior.
- Depersonalization disorder — This disorder involves a
person’s sense of being disconnected or detached from his or her body. The
disorder is sometimes described as being numb or in a dream, or feeling like you
are watching yourself from outside your body.
- Dissociative identity disorder (DID) — DID, the most
severe type of dissociative disorder, was formerly called multiple personality
disorder. As a coping mechanism, a person with this disorder splits off
feelings, personality traits and characteristics or memories. As a result,
severe stress or other triggers can cause the person to act and speak as though
he or she is a different person. Each identity can have its own name and
personal history, or the identities can be less well-defined and simple feel
like people talking inside the person’s head.
What are the symptoms of dissociative disorders?
The symptoms vary depending on the type of dissociative disorder. The major
dissociative symptoms include the following:
- Amnesia (loss of memory) for certain experiences
- Depersonalization
- Derealization (This involves perceiving the external surroundings
as unreal, such as seeing objects change in size, shape or color.)
- Identity disturbances, either feeling like the person has no
identity or feeling like there are several identities
- Depression and/or anxiety
What causes dissociative disorders?
Exactly why some people develop dissociative disorders is not entirely
understood, but most experts believe these disorders develop as a protection
against remembering painful and/or traumatic life experiences, such as abuse,
rape, war and natural disasters. There also may be a genetic link to the
development of dissociative disorders, since people with these disorders
sometimes have close relatives who have had similar disorders.
How common are dissociative disorders?
As a whole, dissociative disorders are uncommon, affecting an estimated 1
percent to 2 percent of the population. These disorders affect females more
often than males and most often begin whenever the abuse or traumatic event
occurred.
How are dissociative disorders diagnosed?
If symptoms are present, the doctor or therapist will begin an evaluation by
performing a complete history and physical examination. Although there are no
laboratory tests to specifically diagnose dissociative disorders, the doctor may
use various diagnostic tests—such as X-rays and blood tests—to rule out
physical illness or medication side effects as the cause of the symptoms.
Certain conditions—including brain diseases, head injuries, drug and alcohol
intoxication, and sleep deprivation—can lead to symptoms similar to those of
dissociative disorders, including amnesia, depersonalization and derealization.
If no physical illness is found, the person may be referred to a
psychiatrist, psychologist or licensed, independent social worker—mental
health professionals who are specially trained to diagnose and treat mental
illnesses. These professionals use specially designed interview and assessment
tools to evaluate a person for a dissociative disorder. The therapist bases his
or her diagnosis on the patient’s report of the intensity and duration of
symptoms—including any problems with daily functioning caused by the symptoms—and
the therapist’s observation of the patient’s attitude and behavior. The
therapist then determines if the patient’s symptoms and degree of dysfunction
indicate a specific disorder, based on the Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition (DSM-IV), which is the standard
guidebook for the diagnosis of recognized mental illnesses in the United States.
How are dissociative disorders treated?
The first goal of treatment is to relieve symptoms and control the disturbing
behavior. Treatment then aims to help the person safely express and process
painful memories, develop new coping and life skills, restore functioning, and
improve relationships. The best treatment approach depends on the type and
severity of the dissociative disorder, but most likely will include a
combination of treatment methods including the following:
- Psychotherapy — Psychotherapy (a type of counseling) is
the main treatment for dissociative disorders.
- Cognitive therapy — This type of therapy focuses on
changing dysfunctional thinking patterns.
- Medication — There is no medication to treat the
dissociative disorders themselves. However, a person with a dissociative
disorder who also suffers from depression or anxiety may benefit from treatment
with a medication such as an antidepressant or tranquilizer.
- Family therapy — This helps to educate the family about
the disorder and its causes, as well as to help family members recognize
symptoms of a recurrence.
- Creative therapies (art therapy, music therapy) — These
therapies allow the patient to explore and express his or her thoughts and
feelings in a safe and creative way.
Is hypnosis a recognized treatment for dissociative disorders?
Clinical hypnosis is a treatment method that uses intense relaxation,
concentration and focused attention to achieve an altered state of consciousness
(awareness), allowing people to explore thoughts, feelings and memories they may
have hidden from their conscious minds. Hypnosis may be used to help people
better understand any underlying reasons for their thinking patterns and/or
behavior—in order to change them—or to find out if past events are linked to
current problems or disorders.
The very relaxed state achieved during hypnosis makes the person better able
to respond to suggestion and imagery. In this way, hypnosis can help some people
change certain behaviors, such as stopping smoking.
Some therapists recommend hypnosis as a treatment for dissociative disorders
because it can help recover any repressed memories linked to the disorder. It
also may be helpful for people whose symptoms are severe or who need crisis
management. However, hypnosis also poses a risk of creating false memories—usually
as a result of unintended suggestions by the therapist. For this reason, the use
of hypnosis for dissociative disorders remains controversial.
What is the prognosis (outlook) for people with dissociative disorders?
The outlook for people with dissociative disorders varies. Dissociative
amnesia and dissociative fugue often respond quickly to treatment.
Depersonalization disorder and dissociative identity disorder tend to be chronic
(ongoing) conditions that require many years of treatment. In most cases,
however, treatment for dissociative disorders is generally effective.
Can dissociative disorders be prevented?
Although it may not be possible to prevent all cases of dissociative
disorders, it may be helpful to begin treatment in people as soon as they begin
to have symptoms. Further, prevention or elimination of child abuse and quick
intervention following a traumatic event or emotionally distressing experience
may help reduce the risk of developing dissociative disorders.
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