Dissociative disorders: types, symptoms and causes

A few years ago the series "The United States of Tara" was broadcast, whose protagonist, Tara, a housewife American, shared a house with her husband, her two children and, in her head, her other 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, her 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, in addition to the symptoms and possible causes of them.

• Related article: "Dissociative Identity Personality Disorder (DIDP)"

What are dissociative disorders?

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 involuntarily escape from reality, which causes serious problems in their daily life.

The cause of these disorders is usually traumatic, and their appearance can be interpreted as a consequence of the brain's difficulties in processing certain highly loaded content emotional aversive. On the other hand, it can also be the result of a brain injury or brain malformations.

It must be clarified that dissociation with reality is not usually only of a perceptual or intellectual nature; it is also emotional. For example, there are people who suffer a dissociative symptom known as derealization, in which you have the sensation 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 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 to 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, implying disturbances in the continuum of your thoughts, memory, and sense of identity, aspects that, in general, are processed consciously.

All of us, at some point in our lives, have 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 find out what we are reading, but we are in a noisy environment. By disconnecting from distractions we fully immerse ourselves in the history of the book before us.

Another example would be when we are walking to class or to work and we are thinking about our things, without paying attention to what we find on the way. As it is a journey that we already know, we have it very automated, and we do not pay attention to the details that are along the way. As with the case in the book, these are situations where dissociation is not pathological. It saves 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 it 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 us later remembering what it was doing. This automatism occurs even in situations where you should pay close attention.

Common symptomatology

As there are several dissociative disorders, each of them has characteristic symptoms. However, they do present common symptoms:

• Loss of memory of certain periods, events, people or personal information.
• Feeling of being detached from oneself, physically and emotionally.
• Perception that around is unreal and distorted.
• Stress and inability to cope.
• Relational, personal, work problems and in other important life areas.
• 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 point to 10%. Dissociation can occur in acute or chronic forms. The probabilities that they occur after the experience of 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; sores may appear and disappear at certain times.

Types of dissociative disorders

According to DSM-5, there are three main dissociative disorders, plus a fourth that includes properly dissociative symptoms but that do not fully fit with the other three diagnostics:

1. Dissociative amnesia

The main symptom is memory loss, much more serious than 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, nor about vital events and relevant 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, he wanders in a state of confusion without being aware of what is happening around him.

The episode of amnesia occurs suddenly, and its duration can be highly variable, ranging from a few minutes to years. Usually, 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 be seen frequently in places such as hospital emergency rooms, accompanied by other disorders such as those of anxiety.

• You may be interested: "Dissociative amnesia: symptoms, causes and treatment"

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 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 his mind, with personalities different from his own and that, in situations of stress or in the presence of certain activators, one of those personalities possesses it and becomes her. 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 funny thing about this disorder is that each personality can have its own name, personal history, gender, age, differences in voice, accent or even use of accessories that normally do not need the original personality, such as glasses.

Really, these are not fully formed personalities, but rather represent something like 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 may be revealed.

3. Depersonalization-Derealization Disorder

In this disorder, one or both different situations can occur.

Person suffers a disconnection from himself, giving him the sensation of observing her actions, feelings and thoughts from a distance, like someone who plays 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. Unspecified dissociative disorder

This label is, in clinical practice, the most common diagnosis. These are those cases in which dissociative symptoms occur but do not fully correspond to one of the three previous disorders. For this reason, cases that present highly varied and heterogeneous characteristics are included here, so their treatment is complicated due to the lack of references.

Possible causes

Dissociative disorders are often considered as a defense mechanism to cope with events traumatic, with the intention of protecting the mental integrity of those who have been a victim of themselves.

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 really scary, especially due to the fact that the abuser's behavior is very unpredictable. The little one lives a constant situation of helplessness and stress. Other traumatic situations are having experienced a war, a terrorist attack or a natural catastrophe.

Given that personal identity is something very moldable in childhood, the experience of situations Stressors can affect the child for life, emerging psychopathology once they reach age adult. Also, and because the personality and identity are not yet formed, a child finds it easier to detach from oneself than an adult when observing or being the victim of an event traumatic.

Although, once an adult, it is most likely that what caused the traumatic event no longer exists or can be coped with thanks to having greater freedom compared to when you were a child (p. g., the abusive father is elderly or has died), its use in adulthood is somewhat 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 dissociative disorder in adulthood is having been a victim of physical, sexual or other abuse in childhood, having witnessed traumatic events or having suffered a negligent parenting style. Among traumatic events, in addition to terrorism, environmental catastrophes and mistreatment, is having been kidnapped and tortured, in addition to long hospitalizations.

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

• Self-harm and mutilation.
• Sexual dysfunction
• Consumption of drugs.
• Depression and anxiety disorders.
• Post-traumatic stress disorder.
• Personality disorders.
• Sleep disturbances
• Eating disorders.
• Non-epileptic seizures.

Treatment

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

In the case of depersonalization, the patient is made to try to establish physical contact with someone from your immediate context, or concentrating on an activity such as reading, exercising, or to converse. 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 imagery is also used to re-experience traumatic events. These techniques may seem counterproductive, as they appear to increase the strength of the symptoms. However, the main objective of this type of exposure and reimagining is to make the patient change the valence associated with the memory of traumatic events.

Cognitive restructuring is another procedure that cannot be missed when working with traumatic-based problems. The objective is to modify the thoughts about the experience of the traumatic event, to work on the feelings of guilt and self-criticism that the patient may express and reinterpret the symptom.

Bibliographic 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 the Loss of the Self. New York, NY: Oxford University Press. p. 17. ISBN 0195170229. OCLC 6112309
• Damn R.J. and Spiegel D. (2009). Dissociative Disorders. In The American Psychiatric Publishing: Board Review Guide for Psychiatry (Chapter 22).
• Sackeim, H. A., and Devanand, D. P. (1991). Dissociative disorders. In M. Hersen & S. M. Turner (Eds.), Adult psychopathology and diagnosis (2nd ed., Pp. 279-322). New York, NY: Wiley.
• Steiner, H.; Carrion, V.; Plattner, B.; Koopman, C. (2002). Dissociative symptoms in posttraumatic stress disorder: diagnosis and treatment. Child and Adolescent Psychiatric Clinics North America. 12 (2): pp. 231 - 249.
• Stern, D.B. (2012). Witnessing across time: accessing the present from the past and the past from the present. The Psychoanalytic Quarterly. 81 (1): pp. 53 - 81.
• Waters, F. (2005). Recognizing dissociation in preschool children. The International Society for the Study of Dissociation News. 23 (4): pp. 1 - 4.