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People with dissociative disorders chronically escape their reality in involuntary, unhealthy ways ranging from suppressing memories to assuming alternate identities. The patterns of dissociative disorders usually develop as a reaction to trauma and function to keep difficult memories at bay. Up to 7 percent of the U.S. population may experience a dissociative disorder in their lifetime.
The dissociative disorders most often form in children subjected to chronic physical, sexual or emotional abuse or, less frequently, a home environment that is otherwise frightening or highly unpredictable.
Personal identity is still forming during childhood, and during these malleable years a child is more able than is an adult to step outside herself or himself and observe trauma as though it's happening to a different person. A child who learns to dissociate in order to endure an extended period of his or her youth may reflexively use this coping mechanism in response to stressful situations throughout life.
Children and adults who experience other traumatic events, including war, natural disasters, kidnapping, torture and invasive medical procedures also may develop these conditions. However, it rare that adults may develop dissociative disorders in response to severe trauma.
Posttraumatic Stress Disorder (PTSD), widely accepted as a major mental illness affecting 8% of the general population in the United States, is closely related to Dissociative Disorders. In fact, 80-100% of people diagnosed with a Dissociative Disorder also have a secondary diagnosis of PTSD. The personal and societal cost of trauma disorders is extremely high. Recent research suggests the risk of suicide attempts among people with trauma disorders may be even higher than among people who have major depression. In addition, there is evidence that people with trauma disorders have higher rates of alcoholism, chronic medical illnesses, and abusiveness in succeeding generations.
What are the types of dissociative disorders?
There are four major dissociative disorders:
Dissociative amnesia
Dissociative identity disorder
Dissociative fugue
Depersonalization disorder
What are the signs and symptoms of dissociative disorders?
Symptoms that are common to all 4 types of dissociative disorders include:
Memory loss (amnesia) of certain time periods, events and people
Mental health problems, including depression and anxiety
A sense of being detached from yourself (depersonalization)
A perception of the people and things around you as distorted and unreal (derealization)
A blurred sense of identity
Each of the four major dissociative disorders is characterized by a distinct mode of dissociation. Dissociative disorder symptoms may include:
Dissociative amnesia. Memory loss that's more extensive than normal forgetfulness and can't be explained by a physical or neurological condition is the hallmark of this condition. Sudden-onset amnesia following a traumatic event, such as a car accident, happens infrequently. More commonly, conscious recall of traumatic periods, events or people in your life — especially from childhood — is simply absent from your memory.
Dissociative identity disorder.
This condition, formerly known as multiple personality disorder, is characterized by "switching" to alternate identities when you're under stress.
In dissociative identity disorder, you may feel the presence of one or more other people talking or living inside your head.
Each of these identities may have their own name, personal history and characteristics, including marked differences in manner, voice, gender and even such physical qualities as the need for corrective eyewear.
There often is considerable variation in each alternate personality's familiarity with the others. People with dissociative identity disorder typically also have dissociative amnesia.
Dissociative fugue.
People with this condition dissociate by putting real distance between themselves and their identity.
For example, you may abruptly leave home or work and travel away, forgetting who you are and possibly adopting a new identity in a new location.
People experiencing dissociative fugue typically retain all their faculties and may be very capable of blending in wherever they end up.
A fugue episode may last only a few hours or, rarely, as long as many months. Dissociative fugue typically ends as abruptly as it begins.
When it lifts, you may feel intensely disoriented, depressed and angry, with no recollection of what happened during the fugue or how you arrived in such unfamiliar circumstances.
Depersonalization disorder.
This disorder is characterized by a sudden sense of being outside yourself, observing your actions from a distance as though watching a movie.
It may be accompanied by a perceived distortion of the size and shape of your body or of other people and objects around you.
Time may seem to slow down, and the world may seem unreal. Symptoms may last only a few moments or may wax and wane over many years.
Dissociative disorders survivors often spend years living with misdiagnoses, consequently floundering within the mental health system.
They change from therapist to therapist and from medication to medication, getting treatment for symptoms but making little or no actual progress.
Research has documented that, on average, people with dissociative disorders have spent seven years in the mental health system prior to accurate diagnosis.
This is common, because the list of symptoms that cause a person with a dissociative disorder to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who are diagnosed with dissociative disorders also have secondary diagnoses of depression, anxiety, or panic disorders.
How are dissociative disorders treated?
Psychotherapy is the primary treatment for dissociative disorders. This form of therapy, also known as talk therapy, counseling or psychosocial therapy, involves talking about your disorder and related issues with a mental health professional.
Your therapist will work to help you understand the cause of your condition and to form new ways of coping with stressful circumstances.
Psychotherapy for dissociative disorders often involves techniques, such as hypnosis, that help you remember and work through the trauma that triggered your dissociative symptoms. The course of your psychotherapy may be long and painful, but this treatment approach often is very effective in treating dissociative disorders.
Other dissociative disorder treatment may include:
Creative art therapy: This type of therapy uses the creative process to help people who might have difficulty expressing their thoughts and feelings. Creative arts can help you increase self-awareness, cope with symptoms and traumatic experiences, and foster positive changes. Creative art therapy includes art, dance and movement, drama, music and poetry.
Cognitive therapy: This type of talk therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other people or situations — determine how you behave.
Even if an unwanted situation has not changed, you can change the way you think and behave in a positive way.
Medication: Although there are no medications that specifically treat dissociative disorders, your doctor may prescribe antidepressants, anti-anxiety medications or tranquilizers to help control the mental health symptoms associated with dissociative disorders.
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