Dissociative disorders: types, symptoms and causes

A few years ago, the series “Tara’s United States” aired, the protagonist, Tara, an American housewife, shared a house with her husband, her two children and, if applicable, her four personalities. Tara had dissociative identity disorder.

This disorder is part of dissociative disorders, Psychological conditions in which the person detaches himself from reality, or it may even be that, as with Tara, his personality fragments and emerges in the form of news.

Below, we’ll take a closer look at what these disorders are, what we mean by the idea of ​​dissociation, and their symptoms and possible causes.

    What are dissociative disorders?

    Dissociative disorders are a set of mental disorders whose main symptom is disconnection from reality, In addition to a lack of continuity between the conscious thoughts, memories and experiences of the person. People who suffer from this type of disorder inadvertently escape reality, which causes them serious problems in their daily life.

    The cause of these disorders is often traumatic and their appearance can be interpreted as a consequence of the brain’s difficulties in processing certain content with a strong aversive emotional charge. On the other hand, it can also be the result of brain damage or brain deformities.

    It should be noted that the dissociation from reality is generally not only of a perceptual or intellectual nature; it is also emotional. For example, there are people who suffer from a dissociative symptom called unrealization, in which we feel that part or all of what is around us is not real, it is just a shadow of what exists. Actually; in any case, it is a difficult experience to put into words, emotionally rooted and above all subjective.

    What do we mean by dissociation?

    In essence, we speak of dissociation in the state in which there is a disconnection, more or less serious, between reality and the perception of the person. Dissociative experiences are not consciously integrated, involving disturbances in the continuum of their thoughts, memory and sense of identity, Aspects generally dealt with consciously.

    We have all, at some point in our lives, dissociated. For example, it is very common to read a book and completely disconnect from what is going on 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 are completely immersed in the story of the book in front of us.

    Another example would be when we walk to class or to work and think about our things, not paying attention to what we find along the way. Since this is a route we are already familiar with, we have it very automated and we don’t pay attention to details along the way. As in the case of the book, these are situations in which the dissociation is not pathological. It saves our cognitive resources because we don’t pay attention to what we don’t need.

    The real problem arises when this dissociation makes us unable to remember what we are doing., Or separates us from our current material, which is beyond our subjectivity. It is as if for a while we have lifted ourselves up from our body and it acts independently, but without remembering what it is doing. This automatism occurs even in situations where great attention must be paid.

    common symptoms

    Since there are several dissociative disorders, each of them has characteristic symptoms. However, they have common symptoms:

    • Loss of memory of certain periods, events, people or personal information.
    • Feeling of being out of yourself, physically and emotionally.
    • The perception that the surroundings are unreal and distorted.
    • Stress and inability to cope.
    • Relationship, personal, professional and other important life issues.
    • Depression.
    • Anxiety.
    • Suicidal thoughts and attempts.

    prevalence

    The prevalence of dissociative disorders is estimated between 2 and 3% in the general population, although there are studies that indicate 10%. Dissociation can occur in acute or chronic forms. The odds that arise 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 should be borne in mind that the presence of dissociative disorders should not be maintained throughout life; they can appear and disappear at times.

    Types of dissociative disorders

    According to the DSM-5, there are three main dissociative disorders, plus a quarter that correctly collect dissociative symptoms but do not fully align with the other three diagnoses:

    1. Dissociative amnesia

    The main symptom is memory loss, much more severe than a simple daily forgetfulness, which cannot be justified by the existence of a previous neurological disease.

    The person is not able to remember important information about himself or about vital events and people involved., Especially those that have to do with when the traumatic event occurred.

    Sometimes the person performs a dissociative escape, that is, they walk in a state of confusion without being aware of what is going on around them.

    The episode of amnesia occurs suddenly, and its duration can vary widely, ranging from a few minutes to a few years. usually patients with dissociative amnesia are aware of their memory loss, which is usually reversible.

    It is the most common specific dissociative disorder of the three, and it is one that can be seen frequently in places like hospital emergency rooms, along with other disorders such as anxiety.

      2. Dissociative identity disorder

      This disorder was formerly 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 certain environmental effects, 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 these personalities has it and becomes her. However, the main personality, which is usually the patient’s legal name, is usually unaware of the existence of other personalities.

      The funny thing about this disorder is that each personality can have their own name, personal history, gender, ageDifferences in voice, accent, or even use of accessories that normally don’t need the original personality, like glasses.

      In reality, they are not fully formed personalities, but rather represent a kind of fragmented identity. The amnesia associated with this disorder is asymmetric, which means that different personalities are reminiscent of different aspects of the patient’s life (something similar to the Rashomon effect).

      Although at the start of therapy patients usually have between 2 and 4 different personalities, as treatment progresses more than 15 may be revealed.

      3. Depersonalization-unrealization disorder

      In this disorder, one or two different situations may arise.

      the person she suffers from a disconnection from herself, which gives her the feeling of observing her actions, feelings and thoughts from a distance., Like someone who plays a video game in a third person perspective. This symptom is depersonalization.

      In other cases, you may feel like things around you are distant, unclear, as if you are dreaming. This symptom is the non-realization or the feeling that reality is not real.

      4. Unspecified dissociative disorder

      This label is, in clinical practice, the most common diagnosis. These are the cases in which it is they exhibit dissociative symptoms but do not correspond at all to any of the above three disorders. For this reason, cases with very varied and heterogeneous characteristics are included here, so their treatment is complicated due to the lack of referents.

      Possible causes

      Dissociative disorders are often seen as a defense mechanism for dealing with traumatic events, with the aim of protecting the mental integrity of those who have suffered from them.

      One of the most common causes is witnessing or experiencing childhood physical, emotional, verbal and sexual abuse, which is common in domestic violence situations. The child experiences these domestic situations as something really frightening., Especially because the behavior of the abuser is very unpredictable. The little one lives in a constant situation of helplessness and stress. Other traumatic situations have been experienced by war, terrorist attack or natural disaster.

      Since personal identity is a very malleable thing in childhood, the experience of stressful situations can affect the little one for life, a psychopathology that emerges once he reaches adulthood. Also, and because personality and identity are not yet formed, it is easier for a child to detach from himself than for an adult to observe or be the victim of a traumatic event.

      Although as an adult it is more likely that what caused the traumatic event no longer exists or can be treated with greater freedom than when you were a child (e.g. use in adulthood is a pathological thing.If the danger no longer exists, there is no objective reason to continue to use it, since the psychological integrity of the individual would no longer be in danger.

      Risk factors

      The main risk factor for developing dissociative disorder in adulthood is being a victim of physical, sexual or other abuse as a child, witnessing traumatic events, or experiencing neglectful parenting. Traumatic events, in addition to terrorism, environmental disasters and abuse, include being kidnapped and tortured, in addition to lengthy hospital stays.

      Having a dissociative disorder is also a risk factor for other disorders and health problems:

      • Self-harm and dismemberment.
      • Sexual dysfunction.
      • Drug use.
      • Depression and anxiety disorders.
      • Post-traumatic stress disorder.
      • Personality disorders.
      • Sleep disorders.
      • Eating disorders.
      • Non-epileptic seizures.

      treatment

      The treatment of dissociative disorders is complicated, because during the amnesic episode, depersonalization, derealization or manifestation of another personality, the level of consciousness of the individual can be significantly decreased. This makes it difficult to start therapy during the time these symptoms appear. However, yes certain techniques have been developed to try to cope with these same symptoms.

      In the case of depersonalization, the patient is asked to make physical contact with someone in their immediate context, or to focus on an activity such as reading, exercising or conversing. Also, to counter the memory of a traumatic event, the patient is led to try to remember a pleasant experience or to visualize a place that he considers safe.

      Another technique used, very common in anxiety disorders, is deep breathing training, in addition to the different forms of exposure.. Guided imagination is also used to relive traumatic events. These techniques may seem counterproductive, as they give the impression that they will increase the strength of the symptoms. However, the main goal of this type of exposure and re-imagining is to change the patient’s valence associated with memory of traumatic events.

      Cognitive restructuring is another must-try procedure when working with traumatic issues. The aim is to change thoughts about the experience of the traumatic event, to work on feelings of guilt and self-criticism that the patient may express and to reinterpret the symptoms.

      Bibliographical references:

      • American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
      • Simeon, D; Abugel, J (2006). Feeling unreal: depersonalization disorder and loss of self. New York, New York: Oxford University Press. p. 17. ISBN 0195170229. OCLC 6112309
      • Maldonando RJ and Spiegel D. (2009). Dissociative disorders. A The American Psychiatric Publishing: Board Review Guide for Psychiatry (Chapter 22).
      • Sackeim, HA and Devanand, DP (1991). Dissociative disorders. In M. Hersen and SM Turner (Eds.), Psychopathology and Adult Diagnosis (2nd ed., Pp. 279-322). New York, New York: Wiley.
      • Steiner, H .; Carrion, V .; Plattner, B .; Koopman, C. (2002). Dissociative symptoms in post-traumatic stress disorder: diagnosis and treatment. Psychiatric clinics for children and adolescents in North America. 12 (2): pages 231 to 249.
      • Stern, DB (2012). Testimony through time: access to the present of the past and the past of the present. The quarterly psychoanalytic. 81 (1): pages 53 to 81.
      • Waters, F. (2005). Recognize dissociation in preschool children. The International Society for the Study of Dissociation News. 23 (4): pages 1 to 4.

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