Dissociative Disorders: Types, Symptoms And Causes
A few years ago the series “The United States of Tara” was broadcast, whose protagonist, Tara, an American housewife, shared a house with her husband, her two children and, in her head, her four other personalities. Tara had dissociative identity disorder.
This disorder is part of dissociative disorders psychological conditions in which the person becomes detached from reality, or it may even be that, as with Tara, their personality fragments and emerges in the form of new ones.
Below we will see in more depth what these disorders are, what we understand by the idea of dissociation, as well as the symptoms and possible causes of them.
Dissociative disorders are a set of mental disorders in which the main symptom is disconnection from reality, in addition to a lack of continuity between thoughts, memories and conscious experiences of the person. People who suffer from this type of disorder escape from reality involuntarily, which causes serious problems in their daily lives.
The cause of these disorders is usually traumatic, and their appearance can be interpreted as a consequence of the brain’s difficulties when processing certain content that has a great aversive emotional load. On the other hand, it can also be the result of a brain injury or malformations in the brain.
It must be clarified that dissociation with reality is not usually only perceptual or intellectual in nature; It is also emotional. For example, there are people who suffer from a dissociative symptom known as derealization, in which we have the feeling that part or all of what is around us is not real, it is just a shadow of what really exists; In any case, it is an experience that is difficult to put into words, with emotional and, above all, subjective roots.
What do we mean by dissociation?
In essence, we speak of dissociation as the state in which there is a disconnection, more or less serious, between reality and the person’s perception. Dissociative experiences are not consciously integrated, implying disturbances in the continuum of your thoughts, memory, and sense of identity aspects that are generally processed consciously.
We have all, at some point in our lives, dissociated. For example, it is very common to be reading a book and completely disconnect from what is happening around us. This mechanism is very useful when we want to know what we are reading, but we are in a noisy environment. By disconnecting from distractions we completely immerse ourselves in the story of the book in front of us.
Another example would be when we are walking to class or work and we are thinking about our things, without paying attention to what we find along the way. As this is a route that we already know, we have it very automated, and we do not pay attention to the details along the way. As with the case of the book, these are situations in which dissociating is not pathological. It represents a saving of our cognitive resources, since we do not pay attention to what we do not need.
The real problem comes when this dissociation makes us unable to remember what we are doing, or separates us from our material present, which is beyond our subjectivity. It is as if, for a moment, we had detached ourselves from our body and it acted independently, but without later remembering what it was doing. This automation occurs even in situations where close attention should be paid.
common symptoms
As there are several dissociative disorders, each of them has characteristic symptoms However, they do present common symptoms:
Prevalence
The prevalence of dissociative disorders is estimated between 2 and 3% in the general population, although there are studies that point to 10% Dissociation can occur in acute or chronic forms. The chances of them occurring after experiencing a traumatic event are very high, close to 70% of cases, although it is normal for the associated symptoms to last a few weeks at most.
However, it must be taken into account that the presence of dissociative disorders does not have to be maintained throughout life; They can appear and disappear at a certain time.
Types of dissociative disorders
According to the DSM-5, there are three main dissociative disorders, plus a fourth that includes dissociative symptoms but that do not fully fit with the other three diagnoses:
1. Dissociative amnesia
The main symptom is memory loss, much more serious than simple everyday forgetfulness, which cannot be justified by the existence of a previous neurological disease.
The person is not able to remember important information about themselves, nor about relevant life events and people especially those that have to do with the moment in which the traumatic event occurred.
Sometimes, the person carries out a dissociative fugue, that is, they wander around in a state of confusion without being aware of what is happening around them.
The episode of amnesia occurs suddenly, and its duration can be very variable, ranging from a few minutes to years. Generally, Patients with dissociative amnesia are aware of their memory loss, which is usually reversible
This is the most common specific dissociative disorder of the three, and it is the one that can frequently be seen in places such as hospital emergency rooms, accompanied by other disorders such as anxiety.
2. Dissociative identity disorder
This disorder was previously known as “multiple personality disorder.”, and is characterized by the alternation between different personalities. It is the most severe and chronic form of dissociation. Personality changes are usually motivated by some environmental effect, especially stressful situations. It is the disorder suffered by the protagonist of “The United States of Tara.”
The person feels the presence of two or more people in their mind, with personalities different from their own and that, in stressful situations or in the presence of certain activators, one of those personalities possesses them and becomes them. In any case, the main personality, which usually corresponds to the patient’s legal name, is usually not aware of the existence of other personalities.
The curious thing about this disorder is that each personality can have its own name, personal history, gender, age differences in voice, accent or even the use of accessories that the original personality does not normally need, such as glasses.
Actually, these are not fully formed personalities, but rather represent something of a fragmented identity. The amnesia associated with this disorder is asymmetric, that is, different personalities remember different aspects of the patient’s life (something similar to the Rashomon effect).
Although at the beginning of therapy patients usually present between 2 and 4 different personalities, as the treatment evolves, more than 15 can be revealed.
3. Depersonalization-derealization disorder
In this disorder, one or two different situations can occur.
Person she suffers a disconnection from herself, giving her the sensation of observing her actions, feelings and thoughts from a certain distance, like someone playing a video game from a third-person perspective. This symptom is depersonalization.
In other cases you may feel that the things around you are distant, unclear, as if you were dreaming. This symptom is derealization, or the feeling that reality is not real.
4. Dissociative disorder not otherwise specified
This label is, in clinical practice, the most common diagnosis These are cases in which dissociative symptoms occur but do not completely correspond to one of the three previous disorders. Therefore, cases that present very varied and heterogeneous characteristics are included here, making their treatment complicated due to the lack of references.
Possible causes
Dissociative disorders are usually considered a defense mechanism to face traumatic events, with the intention of protecting the psychological integrity of those who have been victims of them.
One of the most common causes is having witnessed or suffered physical, emotional, verbal and sexual abuse during childhood, common acts in situations of family abuse. The child experiences these domestic situations as something truly terrifying, especially due to the fact that the abuser’s behavior is very unpredictable. The little one lives in a constant situation of helplessness and stress. Other traumatic situations are having experienced a war, a terrorist attack or a natural disaster.
Given that personal identity is something that is very moldable in childhood, the experience of stressful situations can affect the child for life, with psychopathology emerging once adulthood is reached. Also, and because the personality and identity are not yet formed, it is easier for a child to detach themselves from themselves than for an adult when observing or being the victim of a traumatic event.
Although, once you are an adult, it is most likely that what caused the traumatic event no longer exists or can be dealt with thanks to having greater freedom compared to when you were a child (e.g., the abusive father is old or has died), its use in adulthood is pathological. If the danger no longer exists, there is no objective reason to continue using it, since the psychological integrity of the individual would no longer be at risk.
Risk factor’s
The main risk factor for suffering from a dissociative disorder in adulthood is having been a victim of physical, sexual or other abuse as a child, having witnessed traumatic events or having suffered from negligent parenting Among traumatic events, in addition to terrorism, environmental catastrophes and abuse, is being kidnapped and tortured, as well as long hospitalizations.
Having a dissociative disorder is also a risk factor for suffering other disorders and health problems:
Treatment
The treatment of dissociative disorders is complicated, given that during the amnestic episode, depersonalization, derealization or the manifestation of another personality, the individual’s level of consciousness can be significantly decreased. This makes it difficult to carry out therapy during the time when these symptoms occur. However, yes Certain techniques have been developed to try to deal with those same symptoms
In the case of depersonalization, the patient is made to try to establish physical contact with someone in their immediate context, or to concentrate on an activity such as reading, exercising or talking. Also, to counteract the memory of a traumatic event, the patient is made to try to remember a pleasant experience or visualize a place that he considers safe.
Another technique used, very common in anxiety disorders, is deep breathing training, in addition to different forms of exposure Guided imagination is also used to re-experience traumatic events. These techniques may seem counterproductive, since they seem to increase the strength of the symptoms. However, the main goal of this type of exposure and reimagining is to cause the patient to change the valence associated with the memory of the traumatic events.
Cognitive restructuring is another procedure that cannot be missed when working with traumatic-based problems The objective is to modify thoughts about the experience of the traumatic event, work on the feelings of guilt and self-criticism that the patient may express, and reinterpret the symptoms.
