Dissociative disorder: description
Dissociative disorder is a complex psychological phenomenon. In reaction to an unbearable experience, those affected blank out memories of it to the point of erasing their own identity.
Healthy people perceive their “I” as a unity of thoughts, actions and feelings. In a dissociative disorder, this stable image of one’s own identity breaks down. Hence the term dissociation (lat. for separation, disintegration).
Such a split in consciousness is usually associated with a traumatic experience or serious conflicts. Dissociative disorder often occurs concomitantly with other mental disorders such as depression, schizophrenia or borderline personality disorder.
In most cases, dissociative disorders first appear before the age of 30. Women are affected three times more often than men. It is estimated that 1.4 to 4.6 percent of the population suffers from a dissociative disorder.
Dissociative disorders include the following disorders:
Dissociative amnesia.
This refers to a partial or complete loss of memory related to traumatic events.
In very rare cases, dissociative amnesia results in the loss of memory of the entire life to date.
It is estimated that the risk of experiencing dissociative amnesia during a lifetime is seven percent.
Dissociative fugue
Triggered by a stressful event, the affected person suddenly leaves his home or workplace and assumes a new identity (fugue = escape). He can no longer remember his previous life (amnesia). If he later returns to his old life, he usually has no memories of his departure and the interlude in other identity.
The risk for this dissociative disorder over a lifetime is only 0.2 percent, experts estimate.
Dissociative stupor
Affected individuals move little or not at all, stop speaking, and do not respond to light, sound, or touch. In this state, it is not possible to make contact with them. However, the person is not unconscious because the muscles are not flaccid and the eyes are moving. The symptoms of dissociative stupor are not due to organic problems, but to psychological stress.
Dissociative stupor rarely occurs. Experts suggest that this dissociative disorder occurs in 0.05 to 0.2 percent of the population over a lifetime.
Dissociative movement disorders
For example, affected persons can no longer stand or walk freely, have coordination problems or can no longer articulate. Paralysis is also possible. Symptoms can closely resemble those of neurological disorders, which can make diagnosis difficult.
Dissociative sensitivity and sensory disorders.
In dissociative sensitivity and sensation disorders, either normal skin sensation is lost in certain areas of the body or over the entire body. Alternatively, affected individuals are only partially capable of sensory perception (such as seeing, smelling, hearing) or are unable to do so at all.
The frequency of dissociative movement, sensory and sensation disorders is estimated at about 0.3 percent. Women unfortunately suffer from it more often than men.
Dissociative seizures
Dissociative seizures are psychogenic seizures that often have a specific situational trigger (e.g., a stressful situation). They strongly resemble epileptic seizures but differ from them in several ways. For example, they have a delayed (protracted) onset with slow onset, whereas epileptic seizures are characterized by an abrupt onset. In addition, dissociative seizures are not accompanied by memory loss for the duration of the seizure – epileptic seizures are.
Dissociative Identity Disorder (Multiple Personality Disorder)
Dissociative identity disorder is the most severe form of dissociative disorder. It is also known as “multiple personality disorder.”
The personality of the affected person is split into different parts. Each part has its own individual memory, preferences and behavior patterns. Often the different personality parts differ greatly from each other. They also never appear at the same time, but alternate – and they know nothing about each other.
In many cases, Dissociative Personality Disorder is the result of severe experiences of abuse.
Read more about the topic in the article Multiple Personality Disorder.
Dissociative disorder: symptoms
Dissociative disorders can manifest differently depending on their form and often from patient to patient.
The symptoms of a dissociative disorder can also change from one moment to the next in one and the same person. They also often vary in severity depending on the time of day. In addition, stressful situations can aggravate a dissociative disorder.
Dissociative disorder can also manifest itself through self-injurious behaviors. For example, some patients inflict cuts or burns on themselves to bring themselves back to reality from the dissociative state.
Commonalities of dissociative disorders
Although the symptoms of the various dissociative disorders vary widely, from memory loss to physical symptoms, they share two characteristics:
According to the International Classification of Mental Disorders (ICD-10), there is no physical illness present in dissociative disorders that could explain the symptoms. And there is a convincing temporal relationship between the symptoms and stressful events or problems.
Dissociative disorder: causes and risk factors.
Dissociative disorder usually occurs in the context of traumatic life experiences. Severe stressful situations such as accidents, natural disasters, or abuse overwhelm the psyche. The symptoms of dissociative disorder are a stress response to this overload.
Negative experiences can also have biological effects: Severe stress can alter structures in the brain. Too much of the stress hormone cortisol, for example, damages the hippocampus, which is essential for our memories.
Researchers also assume an innate tendency to dissociative disorders. However, the role of genes has not yet been clearly elucidated.
Dissociative disorders are sometimes referred to as conversion disorders because mental content is transposed into the physical. This mechanism is called “conversion”.
Dissociative disorder: causes of the different forms
Exactly how the various dissociative disorders develop is the subject of research. For example, splitting of consciousness (dissociation) is thought to be the cause of amnesia and fugue. Stressful or traumatic experiences can be stored in this way in such a way that they are no longer accessible to the person affected. Experts assume that this is a protective mechanism. If the psyche cannot process a situation because it is too threatening, it relieves itself through dissociation.
The cause of multiple personality disorder (dissociative identity disorder) is considered to be, above all, severe experiences of abuse in childhood. The splitting into different personalities is a protection against such unbearable experiences.
Dissociative disorder: risk factors
The susceptibility to a dissociative disorder increases if the body is not sufficiently supplied with everything it needs. Therefore, dissociative disorder can be triggered by lack of sleep, not drinking enough, or lack of exercise.
Dissociative disorder: examinations and diagnosis
Important for the diagnosis of a dissociative disorder are the symptoms that the affected person reports to the doctor/therapist during the initial consultation (anamnesis). The doctor/therapist may also ask specific questions, such as:
- Do you miss memories of certain periods of your life?
- Do you sometimes find yourself in places without knowing how you got there?
- Do you sometimes have the impression of having done something that you can’t remember? For example, do you find things in your home that you don’t know how they got there?
- Do you sometimes feel like you are a completely different person?
The physician/therapist can also make use of special questionnaires or predefined discussion guidelines (“diagnostic interviews”) during the anamnesis discussion.
During the interview, the physician/therapist pays attention to possible signs of a dissociative disorder in the patient. For example, frequent memory lapses exhibited by a patient during visits to the therapist/physician may indicate a dissociative disorder.
Exclusion of organic causes
Dissociative disorder can only be diagnosed if organic causes for the symptoms can be ruled out. This is because signs such as seizures, movement disorders or sensory disturbances can also be triggered by epilepsy, migraine or brain tumors, for example.
For this reason, the doctor checks, for example, the patient’s visual, olfactory and gustatory nerves, as well as his movements and reflexes. In some cases, detailed cross-sectional images of the brain are also made with the help of a computer tomography (CT) scan.
In minors, the doctor also looks for possible signs of mistreatment or abuse, among other things.
