Dissociative Disorders

We all dissociate to some extent.  It is a natural state of being – like when you daydream and forget where you are for a few minutes.  For some, it was a creative way to cope with an unbearably traumatic situation that occurred in early childhood and became an adaptive survival strategy.  For these individuals, what may continue to be a coping mechanism as an adult may also become disruptive or confusing. When that happens, it is time to seek help. 

When most people think of Dissociative Disorders, they mostly think of what used to be called “Multiple Personality Disorder,” what we now call Dissociative Identity Disorder (DID).  At one time, this was considered to be extremely rare and unusual. It was actually considered a form of schizophrenia at one time.  We now know that there are several types of dissociative disorders, and they do not all involve having more than one, or “alter” personality.   We also now know that dissociative disorders are not related to schizophrenia, or with being psychotic, or “crazy.”

What is Dissociation? Dissociation is a process in which one’s consciousness produces a lack of connection in the person’s thoughts, memories, feelings, actions and sense of identity.  When a person is dissociating certain information is not available to them as it would normally be – it is cut off from a part of their consciousness, or memory.  For example, during a traumatic experience, a person may dissociate the memory of the time and place of the trauma from his ongoing memory as a coping strategy to be able to continue to function in his everyday life – and to survive the trauma - and this might result in a memory gap surrounding the experience.  Because processes like this can actually produce changes in memory, people who dissociate frequently may find that there are many gaps in their personal history.  For example, someone who witnesses a horrific accident, such as an explosion where many people are killed may dissociate the experience from their immediate memory and may never recall it, or the memory may filter back at a later time, when they can tolerate it.  Some people who have been subjected to ongoing traumatic experiences over a long period of time – like abused children -  may have taught themselves to dissociate and may have created alter personalities in order to have survived the abuse that otherwise they might not have survived emotionally, even if they survived it physically.  By “wishing” to be somewhere else, or by “wishing” someone else could take their place, they in fact “created” an alter ego who did take their place, and their original personality was able to in a way, escape the intolerable situation, if only in their mind.

Most clinicians believe that dissociation exists on a continuum of severity.   As I said earlier, we all dissociate to some extent.  The continuum reflects a wide range of experiences and symptoms.  At one end are very mild experiences common to most of us, like daydreaming or missing our exit on the highway because we got distracted, or getting “lost” in a good book.  At the other end is “chronic dissociation” such as DID, which I explained very briefly above.  But even people with extreme DID can be highly functioning and hold very responsible jobs in a variety of professions.  Many appear perfectly normal to friends and coworkers and they should; they are not “crazy;” they merely developed a creative strategy to cope with a very, very bad situation they got stuck in when they were a very young child.  The ability to dissociate to the extent of creating an alter personality usually happens before the age of 4 or 5 years, and it usually happens in very bright people.   There is a great deal of overlap of symptoms and experiences among the various dissociative disorders, including DID.  I will refer to Dissociative Disorders collectively.  It is best to consult a mental health professional who has training in this area for answers to specific questions. [Please see the Resources Page for links to websites for more information on this and other disorders.]

What are some symptoms of Dissociative Disorders?

There are many symptoms, and it is easy to misdiagnose this disorder.  Symptoms include: depression, mood swings, suicidal tendencies, sleep disorders (such as insomnia, night terrors, sleep walking), panic attacks, phobias, flashbacks, substance abuse, rituals and compulsions, auditory and visual hallucinations and eating disorders.  However, many of these symptoms pertain to other disorders, and taken individually, have nothing to do with dissociative disorders.  So the context of the symptom must be carefully considered.  People with dissociative disorders also might complain of “losing time” – that is, they don’t know what happened for a few hours or maybe even a few days; they might feel as if the are not in their body; they might look in a mirror and not recognize themselves some of the time; the might feel numb from the neck down, as if they cannot feel their body.  They might hear voices in their head (as opposed to outside of themselves); these voices may be the voice of a child crying or talking, or a persecutory voice, telling them they are bad or stupid, etc. But for accurate diagnosis, it is important to consult a professional who has training in diagnosing and treating dissociative disorders.