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Dissociative Disorders

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Introduction

Dissociative disorders are psychological conditions that affect the memory, identity,

perception, and consciousness of a person. This reduces one's ability to function in daily life and

to perform life activities, thereby impeding one's performance in his or her work, school, or

personal relationships. Most of the time, the person is left feeling detached from self, hence an

added complexity to the daily activities and social interactions of life. In general, such conditions

are coping strategies toward trauma, stress, or psychological conflict. The most prevalent types

of dissociative disorders are those of Dissociative Identity Disorder (DID), Dissociative

Amnesia, and Depersonalization/Derealization Disorder (Maddux & Winstead, 2015). It is good

for one to be informed about these disorders to make a proper diagnosis for the prescription of

relevant treatment. There are standards laid down by the DSM-5 for diagnosing dissociative

disorders, which help mental health professionals with the diagnosis and differentiation among

various dissociative disorders. Generally, the treatment involves psychotherapy, combined with

medications when needed by an individual. This paper shall explain the different types of

dissociative disorders, symptoms, DSM-5 criteria, treatment options, and associated research in

order to describe in general the complexity of this condition.

Description of Dissociative Disorders

Dissociative disorders are characterized by disruption or disconnection of thought,

identity, consciousness, and memory, often resulting from trauma, stress, or psychological

conflict. The main types of dissociative disorders include:

Dissociative Identity Disorder (DID)

Dissociative Identity Disorder (DID), formerly referred to as multiple personality

disorder, is a condition characterized by two or more distinct identities and personality states
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within an individual. Each alter may have its own name, age, history, and characteristics. These

shifts in personalities, also called "switching," may be sudden and have an onset related to stress

or environmental cues. The individuals with DID may experience markedly different memories

of things that happen to them, personal information, and traumatic events, which are not mere

ordinary forgetfulness and cannot be explained by substance abuse or a general medical

condition. The separate personalities can have elaborate interactions among themselves, some

being more aware of the others than others are (Maddux & Winstead, 2015). The fragmentation

of personality can cause a loss of a sense of self, which can sometimes make it difficult to

maintain an individual's sense of identity. DID usually originates from severe childhood trauma,

such as repetitive physical, sexual, or emotional abuse. As a coping mechanism, the mind creates

distinct personalities to handle these overpowering experiences. Diagnosis and the treatment

process involve a series of clinical interviews, and therapeutic treatment aimed at integrating

these separate identities with the ultimate goal of relieving the root cause of the trauma.

Dissociative Amnesia

Dissociative amnesia is difficulty in recalling important personal information that often

happens when trauma or stress is high. Such a memory loss is much more serious than mere

forgetfulness and does not correspond to any medical condition. There are many subtypes to the

disorder, each with its unique properties.

i. Localized Amnesia: This condition refers to loss of memory within a specific event or a

specific period, which is usually surrounding a traumatic incident. For instance, one may

not be able to remember that he was involved in a car accident.

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ii. Selective Amnesia: In this case, the memory for a certain part and no other aspects of an

incident is lost. For instance, he may recollect some part of a traumatic incident but

forget some other important aspects of it.

iii. Generalized Amnesia: It is the loss of memory of the entire life history, including

personal identity. This form can be extremely disorienting and incapacitating.

iv. Systematized Amnesia: Loss of memory about some category of information, such as

all events regarding some person or some place. A person may forget all experiences

with a family member.

v. Continuous Amnesia: It is the ongoing inability to remember new events when they occur.

Here, the formation of new memories is restricted after the disorder develops.

Depersonalization/Derealization Disorder

Depersonalization/Derealization Disorder is distinguished by the perception of

depersonalization or derealization as being persistent or pervasive. The feelings of

depersonalization consist of a feeling of detachment from one's body or self. The sensation is that

of observing one's self from an external point. Derealization consists of a feeling that the

surroundings appear to be unreal, like in a dream, or both. These experiences can be seriously

distressing and can interfere with normal daily life and functioning. The person may feel that he

is living in a fog or a bubble (Maddux & Winstead, 2015). That can interfere with concentration

and memory. Reality testing is not impaired so that the person knows the sensations are not real.

It is just perceptual. It is often a reaction to extreme stress, trauma, or anxiety and can occur in

conjunction with other mental health issues such as depression or an anxiety disorder.

Appropriate treatment will include some form of psychotherapy, such as cognitive-behavioral

therapy, to manage symptoms effectively and provide better coping mechanisms.

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DSM-5 Diagnostic Criteria

The DSM-5 outlines specific criteria for diagnosing dissociative disorders:

Dissociative Identity Disorder

Dissociative Identity Disorder is characterized by the distinctiveness of two or more

personality states or, in the case of an identity, states in an individual. Such states may be

associated with their names, ages, personal histories, and characteristics. In DID, the individual

repeatedly has impairment in the recall of everyday events, personal information, and traumatic

events beyond what can be explained by routine forgetfulness. These recurring memory gaps are

long-lasting and serious. Symptomatology of DID causes clinically significant distress or

impairment in social, occupational, or other important areas of functioning (Maddux &

Winstead, 2015). The disturbance is not part of a broad cultural or religious practice that is

accepted by a community. And the disturbance cannot be explained by the direct physiological

effects of a substance or another general medical condition. DID typically develops as a response

to severe trauma often experienced during early childhood, such as serious physical, sexual, or

emotional abuse. Appropriate diagnosis and treatment involve careful clinical evaluation and a

therapeutic approach tailored to integrate the multiple identities and treat the underlying trauma.

Dissociative Amnesia

Dissociative Amnesia is characterized by an incapability to recall important

autobiographical information, usually the result of trauma or stress. The memory loss does not

follow ordinary forgetting and is often profound, covering considerable personal information or

entire periods of the life of a person. Symptoms, such as those of dissociative amnesia, bring

with them a characteristic state of marked distress, or markedly interfere with the ability to

function well in one or more important areas of functioning, which means a significant
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interference in daily life and in relationships (Maddux & Winstead, 2015). In dissociative

amnesia, the memory loss is not restricted to the physiological effects of a substance, including

drugs or alcohol, or to a neurological or other medical condition, and the loss cannot be better

accounted for by other mental health conditions. Examples of these mental health conditions

include Dissociative Identity Disorder (DID), Post-Traumatic Stress Disorder (PTSD), acute

stress disorder, somatic symptom disorder, and major/mild neurocognitive disorders. This often

includes psychotherapy for the recovery of lost memory and treatment of underlying trauma,

with support and coping strategies for the disorder.

Depersonalization/Derealization Disorder

Depersonalization/Derealization Disorder is characterized by the persistent or recurrent

experiences of depersonalization or derealization, or both. Depersonalization is a persistent

feeling of being detached from the body or oneself, like an observer from the outside. The

feeling is that the surrounding environment is unreal, dream-like, or distorted. Despite these

rather disorienting experiences, the person with this disorder still has an intact reality. They are

very well aware that these perceptions are not real but only a distortion of reality ( Maddux &

Winstead, 2015). These symptoms cause significant distress or impair social, occupational, or

other important areas of functioning, hence, interfere with daily life and activities. It is not

caused by the physiological effect of a substance like drugs, alcohol, or another medical

condition. Moreover, the symptoms do not occur exclusively during another mental disorder,

such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, PTSD, or

another dissociative disorder. Psychotherapy is the most effective treatment for this disorder and

usually takes the form of cognitive-behavioral therapy, which can help an individual manage and

improve symptoms as well as coping techniques.

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Treatment Options

Treatment for dissociative disorders often involves a combination of psychotherapy and

medication.

Psychotherapy

i. Cognitive-Behavioral Therapy (CBT): Cognitive-Behavioral Therapy (CBT) empowers

persons to identify and change their negative thinking and behavior. It is based on the

connectivity of thought, emotion, and action, and, as a result, it aims to change the thought

and behavior responses that are dysfunctional and are leading to psychic distress. The

therapy is effective in removing symptoms of dissociative disorders, including anxiety,

depression, and trauma-related symptoms (Maddux & Winstead, 2015). Some methods

include cognitive restructuring to challenge distorted thoughts and behavioral activation to

encourage positive activities. CBT also includes stress management and problem-solving

skills related to the causes that trigger the reduction of dissociation episodes and finally

results in the adoption of healthier thinking and better functioning.

ii. Dialectical Behavior Therapy (DBT): Dialectical Behavior Therapy (DBT) works like

standard cognitive-behavioral methods but combines mindfulness. Very helpful to work

with are cases of severe emotional dysregulation and with a diagnosis of Dissociative

Identity Disorder. More specifically, DBT concentrates on four areas: mindfulness,

distress tolerance, emotion regulation, and interpersonal effectiveness. Mindfulness

teaches the individual to stay in the present and thus reduces dissociation. Distress

tolerance teaches the person to cope with overwhelming emotions (Maddux & Winstead,

2015). Emotion regulation teaches the person to manage emotions well enough so that

they do not feel that they are quite so out of control. Interpersonal effectiveness teaches
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the person to communicate better and improve relationships. DBT, through individual

therapy, group skills training, and phone coaching, will aim to provide a comprehensive

support system to increase emotional stability and decrease dissociation for improved

quality of life.

iii. Eye Movement Desensitization and Reprocessing (EMDR): Eye Movement

Desensitization and Reprocessing (EMDR) is used in therapy with clients who have had

traumatic experiences in the past. EMDR is designed to use guided eye movements to help

in the processing and integration of traumatic experiences. In a session using EMDR, a

therapist will guide the eye movement of a client as the client concentrates on some

specific traumatic experiences. This bilateral stimulation is believed to assist in the

reprocessing of these memories and, therefore reduce the affective charge and emotional

distress associated with these memories (Maddux & Winstead, 2015). Another way

EMDR works is through cognitive restructuring, in which the person is able to replace

negative meanings of traumatic events with more appropriate information. Through

repetition of this procedure, the mind is able to change these traumatic experiences that

would consequently lower symptoms such as flashbacks, anxiety, and dissociation. The

eight phases of EMDR are history taking, preparation, assessment, desensitization,

installation, body scan, closure, and reevaluation, allowing for a full course of trauma

recovery.

iv. Hypnotherapy: Hypnotherapy is a therapy technique in which the person undergoing

therapy is brought to an increased state of awareness by means of guided relaxation and

focused attention—what is often described as a trance. This makes individuals access

repressed memories and unconscious thoughts, which they cannot easily find in their
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normal waking state. It is that aspect of hypnotherapy that is considered useful for

dissociative disorders because it helps such people gain access and integration to their

traumatic memories, which may be the reason for the symptoms (Maddux & Winstead,

2015). This whole procedure involves a professional person guiding the particular

individual into the trance state and using different techniques to explore and work on the

targeted psychological issues. These techniques can be anything from relaxation and

visualization to working on memory retrieval. Hypnotherapy is helpful in reducing

symptoms of dissociation and acts as a healing support, but it should be strictly conducted

with a professional to avoid possible risks, such as false memory creation or emotional

distress.

Pharmacological Treatments

i. Antidepressants: Depression and anxiety, which are normally concomitants of

dissociative disorders, are managed by the use of antidepressants, mostly selective

serotonin reuptake inhibitors (SSRIs). SSRIs act by increasing serotonin in the brain,

which then plays a role in the stabilization of mood and clearing feelings of sadness,

helplessness, and anxiety (Maddux & Winstead, 2015). The overall emotional regulation

with the help of such medications will make it much easier to enter psychotherapy and to

do other therapeutic activities. Well-known SSRIs include fluoxetine, sertraline, and

citalopram. Antidepressants can be good, but, just like other medications, they have side

effects and, therefore, must be monitored by a healthcare provider with a lot of care to

minimize the risks and maximize their benefit.

ii. Anxiolytics: Anxiolytic is a class of medication that is designed to reduce anxiety. This

class of medication is commonly used to manage panic attacks and intense anxiety
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symptoms associated with dissociative disorders. They target the central nervous system

in ways that could relax the person or reduce nervous tension. Examples include

benzodiazepines such as diazepam and lorazepam (Maddux & Winstead, 2015). Even

though such drugs are highly effective in the short term, physicians are wary to prescribe

them due to issues related to dependency and withdrawal. Moreover, long-term

prescription is generally avoided and commonly used in combination with other

therapeutic approaches as part of comprehensive management of anxiety.

iii. Antipsychotics: Antipsychotic medications can be prescribed when the dissociative

disorder is comorbid with severe symptoms. The predominant features in which this

medication is indicated are those that have psychotic features, such as hallucinations or

delusions. These medications modify the effects of neurotransmitters in the brain with the

stabilization of mood and reduction of psychotic symptoms (Maddux & Winstead, 2015).

Common antipsychotics include risperidone, olanzapine, and quetiapine. These can be

quite effective at blunting severe agitation, paranoia, and disorganized thinking, which can

all be very disabling. However, the use of antipsychotics is usually monitored due to side

effects such as weight gain and metabolic changes in order to ensure the safety of patients.

Research Article Summary

Paul F. Dell (2019) reconsidered the relation of hypnotizability to dissociative disorders

in "Reconsidering the Autohypnotic Model of the Dissociative Disorders." For Dell, the poor

relationship of dissociation and hypnotizability obtained in correlational studies is

methodologically constrained. Highly hypnotizable individuals using autohypnosis develop a

pattern of dissociative self-protection leading to dissociative disorders in his view. Dell claims

that such subjects are statistically under-represented among the less hypnotizable and the
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subjects with other types of dissociation (Dell, 2019). He points those theoretical models of

dissociation should incorporate both high hypnotizability and autohypnosis. Therefore, the article

relates to the DID diagnosis that is discussed in this paper. An important perspective of Dell

considers the impact of hypnotizability and autohypnosis on the development of DID. This gives

insight into the way several identities come up as a result of trauma. It is therefore very good for

comprehensive assessment with a view of coming up with unique treatment approaches.

Integration of Dell's insights enables the mental health professional to better identify and treat the

patient with a dissociative disorder, and thus the patient has better outcomes.

Conclusion

Dissociative disorders are complex psychological conditions that are in need of deep

evaluation and management. Health workers should be profoundly aware of the DSM-5

diagnostic criteria for these disorders to be able to identify the problem accurately. Knowledge of

different therapeutic modalities, including psychotherapies and medical management, may

support the provision of individual patient care. In symptom reduction and treatment of

underlying trauma, psychotherapies such as Cognitive-Behavioral Therapy, Dialectical Behavior

Therapy, Eye Movement Desensitization and Reprocessing, and hypnotherapy are known to be

effective. Pharmacological interventions with antidepressants, anxiolytics, and antipsychotics

help treat comorbid symptoms and enhance the efficacy of general treatments. Further research

and increased awareness will be important to improve outcomes and care for those with

dissociative disorders. Better understanding of etiology and mechanisms are bound to translate

into new, more potent treatment strategies. Complemented with the use of full assessment tools

and evidence-based treatment, mental health fields are able to better suit the needs of those

affected, thereby improving their quality of life.

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References

Dell, P. F. (2019). Reconsidering the autohypnotic model of the dissociative disorders. Journal

of Trauma & Dissociation, 20(1), 48-78.

Maddux, J. E., & Winstead, B. A. (2015). Psychopathology. Routledge.