Learning Objective
Differentiate between types of dissociative disorders—Depersonalization/Derealization Disorder, Dissociative Amnesia, and Dissociative Identity Disorder—based on core clinical features and underlying mechanisms.
Overview of Dissociative Disorders
| Disorder | Core Feature | Key Clinical Findings | Reality Testing | Associations/Triggers |
|---|---|---|---|---|
| Depersonalization/Derealization Disorder | Persistent detachment from self (depersonalization) or surroundings (derealization) | Feels like “watching self from outside” or “world feels unreal” | Intact | Stress, trauma, anxiety |
| Dissociative Amnesia | Inability to recall important personal information | Memory loss (often of traumatic events), may wander away (fugue state) | Intact | Severe trauma or stress |
| Dissociative Identity Disorder (DID) | ≥2 distinct identities with different memories and behaviors | “Switching” between identities, memory gaps | Intact (except for amnestic episodes) | Childhood abuse, PTSD, depression, BPD, substance use |
Key Points for Step 1
- Reality testing remains intact → differentiates dissociative disorders from psychosis.
- Trauma-related: Most cases are linked to severe or repeated trauma, especially in childhood.
- Functional imaging: Altered limbic system and prefrontal activity in DID.
- Treatment: Psychotherapy is the mainstay; medications are only for comorbid conditions.
Clinical Correlations
| Scenario | Likely Diagnosis |
|---|---|
| A woman reports feeling as though she is observing her body from outside, but knows it’s not real. | Depersonalization/Derealization Disorder |
| A soldier cannot recall personal details after a traumatic battle and is found living in another town. | Dissociative Amnesia with Fugue |
| A patient exhibits alternating “child” and “adult” personas with different voices and handwriting styles. | Dissociative Identity Disorder |
