Dissociative Disorders
What is it?
These mental disorders involve individuals experiencing a disconnection and fragmentation in their memories, thoughts, identity, behaviours, and surroundings. People with these disorders enter a state of detachment from reality, which is beyond their control, detrimental to their well-being, and hinders their ability to function in daily life.
Dissociative experiences are often characterised by sudden beginnings and endings, but they are rarely noticeable outside of controlled settings such as hypnosis or therapeutic techniques like abreaction. Most dissociative states, particularly those triggered by traumatic experiences, tend to resolve within a few weeks or months.
However, if the dissociation is associated with personal impasses or interpersonal challenges, it may persist for a longer duration, leading to chronic symptoms like paralysis or numbness.
Dissociative states that have persisted for over a year or two before seeking psychiatric help can be resistant to treatment. Although there is a strong suspicion of psychological factors playing a role, obtaining definitive evidence to establish causation can be challenging.
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Types and Symptoms
Dissociative Amnesia, the main indication of this condition is the presence of memory loss, specifically concerning recent and significant events. This memory loss is not attributable to an underlying mental disorder and exceeds what could be considered normal forgetfulness or fatigue.
The amnesia experienced is usually partial and selective, with a specific focus on traumatic situations like accidents or unexpected losses. It is uncommon for the amnesia to be complete and affect all aspects of memory. Alongside the memory loss, individuals may exhibit confusion, distress, and varying levels of attention-seeking behaviours.
However, in some cases, a sense of serene acceptance may also be observed. This condition primarily affects younger individuals, with men experiencing the most severe cases, particularly those subjected to combat-related stress.
Dissociative Fugue, in addition to exhibiting all the typical features of dissociative amnesia, this condition involves a deliberate and purposeful departure from one’s home or workplace, while still maintaining self-care abilities. In some cases, individuals may assume a new identity, which can range from temporary and short-lived to prolonged and remarkably thorough. During this state, organised travel may occur, often to familiar places that hold emotional significance.
Dissociative Stupor, Among the various types of stupor, dissociative stupor is the least prevalent, but it is important to note that other types exist as well. Symptoms of dissociative stupor pose significant difficulties and challenges in treatment. During dissociative stupor, individuals remain motionless and unable to move, but they are neither unconscious nor asleep.
Trance and Possession Disorders, During episodes of this condition, individuals experience a temporary loss of both their sense of self and their complete awareness of their surroundings. In some cases, they may display behaviours that resemble being taken over or possessed by another personality, spirit, divinity, or power.
Attention and consciousness may be focused solely on one or two aspects of the immediate environment, and there is often a repetition of specific movements, postures, and vocalisations.
Dissociative Disorders of movement and sensation, This condition involves the loss of or disruption in movements or sensations. It encompasses various manifestations such as dissociative motor disorders, dissociative convulsions, dissociative anaesthesia, and sensory loss. These symptoms reflect a disconnection between the mind and the body, resulting in abnormal or impaired motor function and sensory experiences.
Dissociative Motor Disorders, The most common manifestation is the inability to fully or partially move one or more limbs. The movements that can be performed may be weak or sluggish, indicating partial or complete paralysis. Incoordination of movements, particularly in the legs, can result in an unusual gait or an inability to stand without support. Excessive trembling or shaking may affect one or more extremities, as well as the entire body. These motor symptoms contribute to the overall picture of the condition.
Dissociative Convulsions, In dissociative convulsions, uncommon occurrences such as tongue-biting, severe bruising from falling, and urinary incontinence are typically absent. Loss of consciousness is either absent or replaced by a state of stupor or trance. It is worth noting that dissociative convulsions can bear resemblance to epileptic seizures in terms of the movements exhibited.
Dissociative Anaesthesia and Sensory Loss, The boundaries of anaesthetic skin patches often align with the patient’s personal understanding of how their body functions, rather than being based on scientific knowledge or consensus.
Causes
The exact causes of dissociative disorders are not fully understood, but they are believed to result from a combination of various factors. Some potential causes and contributing factors include :
- Trauma and Abuse : Severe or prolonged trauma, such as physical, emotional, or sexual abuse, particularly during childhood, is considered a significant risk factor for developing dissociative disorders.
- Psychological Defense Mechanism : Dissociation is thought to be a psychological defence mechanism employed by individuals to cope with overwhelming stress, traumatic experiences, or situations that threaten their sense of self.
- Genetics and Family History : There may be a genetic predisposition to dissociative disorders, as they sometimes run in families. However, more research is needed to understand the specific genetic factors involved.
- Neurobiological Factors : Certain brain regions and neurotransmitter systems involved in memory, emotion regulation, and self-identity may play a role in dissociative disorders. Altered brain connectivity and abnormalities in neurochemical pathways have been observed in individuals with dissociative symptoms.
- Childhood Attachment Issues : Disruptions in early attachment relationships, such as neglect, inconsistent caregiving, or lack of secure attachment, may contribute to the development of dissociative disorders.
- Sociocultural Factors : Sociocultural factors, such as living in a highly stressful or unsafe environment, experiencing societal violence, or cultural beliefs and practices regarding dissociation, may influence the development of dissociative symptoms.
Treatment
The treatment for dissociative disorders typically involves a combination of psychotherapy, medication, and support from a mental health professional. Here are some common approaches used in the treatment of dissociative disorders :
- Psychotherapy : Psychotherapy is the primary treatment for dissociative disorders. Several types of therapy may be used:
- Trauma-Focused Therapy : This form of therapy focuses on processing and resolving traumatic experiences that may have led to the development of dissociative symptoms. It aims to promote integration and healing by addressing the underlying trauma and its impact on the individual’s sense of self and identity.
- Cognitive-Behavioral Therapy (CBT) : CBT can help individuals identify and modify maladaptive thoughts, beliefs, and behaviours associated with dissociative symptoms. It aims to improve coping skills, manage distressing emotions, and promote a more integrated sense of self.
- Eye Movement Desensitization and Reprocessing (EMDR) : EMDR is a specialised therapy often used for trauma-related dissociative symptoms. It involves the use of bilateral stimulation to facilitate the processing of traumatic memories and reduce distress associated with them.
- Medication : In some cases, medication may be prescribed to manage specific symptoms related to dissociative disorders, such as depression, anxiety, or sleep disturbances. Antidepressants, anti-anxiety medications, and mood stabilisers may be used under the guidance of a healthcare professional.
- Stabilisation Techniques : Learning grounding and stabilisation techniques can help individuals manage dissociative symptoms and maintain a sense of safety and stability. These techniques may include mindfulness exercises, deep breathing, sensory grounding exercises, and self-soothing strategies.
- Creating Safety and Trust : Establishing a safe and trusting therapeutic relationship is essential in the treatment of dissociative disorders. The therapist works to create a supportive and non-judgmental environment where the individual feels comfortable exploring and processing their experiences.
- Integration and Coherence : The goal of treatment is to help individuals integrate their fragmented identities and experiences into a more cohesive sense of self. Therapeutic techniques may focus on promoting communication and cooperation among different dissociative parts, working towards internal collaboration and unity.
- Education and Psychoeducation : Providing education about dissociative disorders and their underlying mechanisms can help individuals understand their experiences and reduce feelings of confusion or self-blame. Psychoeducation may also involve teaching coping skills and strategies for managing dissociative symptoms.
- Supportive Care : Ongoing support from mental health professionals, support groups, or peer support networks can be beneficial in the long-term management of dissociative disorders. Having a supportive network can provide validation, understanding, and encouragement throughout the recovery process.
