Memory, identity, emotion, perception, behavior, and sense of self are all affected by dissociative disorders. Dissociative symptoms have the potential to disrupt all aspects of mental functioning.
Dissociative symptoms include feelings of detachment or being outside one’s body, as well as loss of memory or amnesia. Dissociative disorders are frequently linked to a history of trauma.
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Dissociative disorders are classified into three types:
Disorder of dissociative identity
Amnesia due to dissociation
Disorder of depersonalization and derealization
The Sidran Institute, which works to help people understand and cope with traumatic stress and dissociative disorders, describes dissociation and its potential applications as follows:
Dissociation is defined as a disconnect between a person’s thoughts, memories, feelings, actions, or sense of self. This is a natural process that everyone has gone through. Daydreaming, highway hypnosis, or “getting lost” in a book or movie are all examples of mild, common dissociation, all of which involve “losing touch” with awareness of one’s immediate surroundings.
Dissociation can help a person tolerate what would otherwise be too difficult to bear during a traumatic experience such as an accident, disaster, or crime victimization. In such cases, a person may dissociate the memory of the location, circumstances, or feelings about the traumatic event, mentally escaping the fear, pain, and horror. As many disaster and accident survivors have reported, this can make it difficult to remember the details of the experience later on.
Dissociative Identity Disorder is a type of dissociative identity disorder.
Childhood abuse, traumatic events, and/or overwhelming experiences are all linked to dissociative identity disorder. Previously, multiple personality disorder was used to describe dissociative identity disorder.
Dissociative identity disorder symptoms (diagnostic criteria) include:
Two or more distinct identities (or “personality states”) exist. Changes in behavior, memory, and thinking accompany the distinct identities. Others may notice the signs and symptoms, or the individual may report them.
Gaps in memory about everyday events, personal information, and/or past traumatic events that persist.
Significant distress or problems in social, occupational, or other areas of functioning are caused by the symptoms.
Furthermore, the disruption must not be a normal part of a widely accepted cultural or religious practice. As stated in the DSM-5-TR1, experiences of being possessed are a normal part of spiritual practice in many cultures around the world and are not dissociative disorders.
A person with dissociative identity disorder’s attitude and personal preferences (for example, about food, activities, and clothing) may abruptly shift and then shift back. Identity shifts occur involuntarily, are unwelcome, and cause distress. People suffering from dissociative identity disorder may experience the sensation of suddenly becoming observers of their own speech and actions, or their bodies may feel different (e.g., like a small child, like the opposite gender, huge and muscular).
A person with dissociative identity disorder “feels as if she has two or more entities within her, each with its own way of thinking and remembering about herself and her life,” according to the Sidran Institute. It is critical to remember that, while these alternate states may feel and appear very different, they are all manifestations of a single, whole person.” These alternate states are also known as “alternate personalities,” “alters,” “states of consciousness,” and “identities.”
The extent of functioning problems for people with dissociative identity disorder can range from minor to severe. People frequently try to minimize the severity of their symptoms.
Suicide and Risk Factors
People who have experienced physical and sexual abuse as children are more likely to develop dissociative identity disorder. The vast majority of people who develop dissociative disorders have been subjected to repeated, overwhelming trauma as children. In the United States, Canada, and Europe, approximately 90% of people with dissociative identity disorder had been the victims of childhood abuse and neglect.
Suicide attempts and other self-harming behavior are common in people suffering from dissociative identity disorder. More than 70% of dissociative identity disorder outpatients have attempted suicide. 1
Many people are successful in addressing the major symptoms of dissociative identity disorder and improving their ability to function and live a productive, fulfilling life with appropriate treatment.
Psychotherapy is commonly used in treatment. Therapy can help people gain control of their dissociative symptoms and process. The goal of therapy is to assist in the integration of various aspects of identity. Therapy can be intense and difficult because it involves remembering and coping with traumatic experiences from the past. Cognitive behavioral therapy and dialectical behavioral therapy are two types of therapy that are commonly used. Dissociative identity disorder has also been found to benefit from hypnosis treatment.
There are currently no medications available to treat the symptoms of dissociative identity disorder. Medication, on the other hand, may be useful in treating related conditions or symptoms, such as using antidepressants to treat depression symptoms.
Disorder of Depersonalization/Derealization
Depersonalization/derealization disorder is characterized by a significant ongoing or recurring experience with one or both of the following conditions:
Depersonalization refers to feelings of disconnection from one’s mind, self, or body. People may feel as if they are outside of their bodies, watching events unfold around them.
Derealization refers to feelings of disconnection from one’s surroundings. People may have the impression that the things and people around them are not real.
The person is aware of reality and that their experience is unusual during these altered states. Even if the person appears to be unresponsive or emotionless, the experience is extremely distressing.
Symptoms can appear as early as childhood, with the average person experiencing the disorder at the age of 16. Only about 20% of people with depersonalization/derealization disorder experience symptoms after the age of 20.
Amnesia with Dissociative Identity Disorder
Dissociative amnesia is the inability to recall information about oneself (not normal forgetting). This amnesia is usually caused by a traumatic or stressful event and can manifest as:
localized – unable to recall a specific event or period of time (most common type)
selective – unable to recall a specific aspect of an event or a series of events over a period of time
generalized – loss of identity and life history (rare)
Dissociative amnesia is associated with a history of childhood trauma, particularly emotional abuse and neglect. People may be unaware of or have a limited awareness of their memory loss. People may also downplay the significance of memory loss related to a specific event or time period.
Review this week’s Learning Resources on dissociative disorders.
Use the Library to investigate the controversy regarding dissociative disorders. Locate at least three scholarly articles that you can use to support your Assignment.
The Assignment (2–3 pages)
Explain the controversy that surrounds dissociative disorders.
Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.
Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.
Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.