M05.09.41 Dissociative Disorders

Dissociative disorders are a group of mental health conditions characterized by a disruption or disconnection between thoughts, memories, emotions, identity, perception, and consciousness. This disruption can cause significant distress and impairment in daily life. Dissociation is a common defense mechanism used to cope with overwhelming experiences, particularly trauma.

Points to Remember:

• Dissociative disorders are more common in individuals with a history of trauma, such as abuse or neglect.
• Dissociative symptoms can be very distressing and can interfere with daily functioning.
• Early diagnosis and treatment can improve outcomes.

Types of Dissociative Disorders:

The following are the main types of dissociative disorders that may be encountered in children and adolescents:

• Dissociative Amnesia:
  • Description: Inability to recall important autobiographical information, usually of a traumatic or stressful nature.
  • Clinical Features:
    • Can involve localized amnesia (forgetting a specific event) or generalized amnesia (forgetting large periods of time or one’s identity).
    • Memories may return spontaneously or with treatment.
  • Example: A teenager forgets being in a car accident but remembers events before and after.
• Dissociative Identity Disorder (DID), Previously Known as Multiple Personality Disorder:
  • Description: Presence of two or more distinct identities or personality states, each with its own pattern of perceiving and relating to the environment.
  • Clinical Features:
    • Individuals may report feeling like they are being watched or controlled by another “person” inside them.
    • Transitions between identities can be sudden or gradual.
    • Amnesia is often present for events that occurred during the time another identity was in control.
  • Important Note: DID is a complex and controversial diagnosis. It is important to consult with a qualified mental health professional for accurate diagnosis and treatment.
• Depersonalization Disorder:
  • Description: Recurrent or persistent experiences of feeling detached from or outside of one’s body (depersonalization).
  • Clinical Features:
    • Feelings of unreality or being in a dream.
    • Feeling like one’s body is distorted or numb.
    • Reality testing remains intact (individuals know these are not real experiences).
  • Example: A child may feel like they are watching themselves from above during a stressful event.
• Dissociative Fugue:
  • Description: Sudden, unexpected travel away from home with an inability to recall one’s past or confusion about one’s identity.
  • Clinical Features:
    • Individuals may wander for hours or days and may even assume a new identity.
    • Episodes can last from hours to months.
    • After the episode, there is usually amnesia for the period of the fugue.

Table 1: Summary of Dissociative Disorders

Diagnosis and Treatment

Diagnosis of dissociative disorders is based on a clinical evaluation that includes a mental health history and a physical examination. There are no specific laboratory tests for dissociative disorders. Treatment typically involves psychotherapy, such as cognitive-behavioral therapy (CBT) or trauma-focused therapy. Medication may also be helpful for managing co-occurring symptoms such as anxiety or depression.

Bibliography:

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
• National Institute of Mental Health. (2020, July 22). Dissociative disorders. https://www.ncbi.nlm.nih.gov/books/NBK568768/