We all get lost in a good book or movie. But someone with dissociative disorder escapes reality in ways that are involuntary and unhealthy. The symptoms of dissociative disorders — ranging from amnesia to alternate identities — usually develop as a reaction to trauma and help keep difficult memories at bay.
Treatment for dissociative disorders may include psychotherapy, hypnosis and medication. Although treating dissociative disorders can be difficult, many people with dissociative disorders are able to learn new ways of coping and lead healthy, productive lives.
There are four major dissociative disorders defined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DMS), published by the American Psychiatric Association:
Signs and symptoms common to all types of dissociative disorders include:
Dissociative disorder symptoms (depending on the type of disorder) may include:
When to see a doctor
If you or your child experiences abuse or another traumatic situation, talk to a doctor as soon as possible. Early intervention and counseling may help prevent the formation of dissociative disorders.
Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to chronic physical, sexual or emotional abuse or, less frequently, a home environment that is otherwise frightening or highly unpredictable.
Personal identity is still forming during childhood, so a child is more able than is an adult to step outside of himself or herself and observe trauma as though it's happening to a different person. A child who learns to dissociate in order to endure an extended period of his or her youth may use this coping mechanism in response to stressful situations throughout life.
Though it's rare, adults may develop dissociative disorders in response to severe trauma.
People who experience chronic physical, sexual or emotional abuse during childhood are at greatest risk of developing dissociative disorders. Children and adults who experience other traumatic events, including war, natural disasters, kidnapping, torture and invasive medical procedures, also may develop these conditions.
People with a dissociative disorder are at increased risk of complications that include:
Dissociative disorders are also associated with significant difficulties in relationships and at work. People with these conditions often aren't able to cope well with emotional or professional stress, and their dissociative reactions — from tuning out to disappearing — may worry loved ones and cause colleagues to view them as unreliable.
Preparing for your appointment
Many people with a dissociative disorder first receive medical attention for their condition in an emergency room. Symptoms of a psychiatric crisis requiring urgent medical care include traumatic flashbacks that are overwhelming or are associated with unsafe behavior, such as a suicide attempt. Hallucinations or amnesia also require emergency care.
If you or a loved one has less urgent symptoms of a dissociative disorder, call your family doctor or a general practitioner. As a first step, your doctor may ask you to come in for a thorough examination to rule out possible physical causes of your symptoms. However, in some cases you may be referred immediately to a psychiatrist.
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
For dissociative disorders, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
What you can do in the meantime
Tests and diagnosis
Doctors diagnose dissociative disorders based on a review of your symptoms and your personal history. As part of your evaluation, your doctor may perform tests to rule out physical conditions — including head injuries, certain brain diseases, sleep deprivation and intoxication — that can cause symptoms such as memory loss and a sense of unreality. If your doctor rules out physical causes, he or she will likely refer you to a mental health specialist for an in-depth interview.
To help diagnose dissociative identity disorder, some doctors use medication or hypnosis. These may help your doctor identify alternate personalities or may help you describe repressed memories that played a role in the development of dissociative patterns.
To be diagnosed with a dissociative identity disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DMS), published by the American Psychiatric Association.
Criteria for dissociative amnesia to be diagnosed include:
Criteria for dissociative identity disorder to be diagnosed include:
Criteria for dissociative fugue to be diagnosed include:
Criteria for depersonalization disorder to be diagnosed include:
Treatments and drugs
Psychotherapy is the primary treatment for dissociative disorders. This form of therapy, also known as talk therapy, counseling or psychosocial therapy, involves talking about your disorder and related issues with a mental health provider. Your therapist will work to help you understand the cause of your condition and to form new ways of coping with stressful circumstances.
Psychotherapy for dissociative disorders often involves techniques, such as hypnosis, that help you remember and work through the trauma that triggered your dissociative symptoms. The course of your psychotherapy may be long and painful, but this treatment approach often is very effective in treating dissociative disorders.
Other dissociative disorder treatment may include:
Your therapist may recommend using hypnosis, which is sometimes referred to as hypnotherapy or hypnotic suggestion, as part of your treatment for a dissociative disorder.
Hypnosis creates a state of deep relaxation and quiets the mind. When you're hypnotized, you can concentrate intensely on a specific thought, memory, feeling or sensation while blocking out distractions. Because you're more open than usual to suggestions while under hypnosis, there is some controversy that therapists may unintentionally "implant" false memories by suggestion. However, when conducted under the care of a trained therapist, hypnosis is generally safe as a complementary treatment method.
Children who are physically, emotionally or sexually abused are at increased risk of developing mental health disorders, including dissociative disorders. If stress or other personal issues are affecting the way you treat your child, seek help. Talk to a trusted person such as a friend, your doctor or a leader in your faith community. Ask for his or her help locating resources such as parenting support groups and family therapists. Many churches and community education programs offer parenting classes that also may help you learn a healthier parenting style.
If your child has been abused or has experienced another traumatic event, see a doctor immediately. Your doctor can refer you to mental health providers who can help your child recover and adopt healthy coping skills.
Last Updated: 2011-03-03
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