Dissociation (Psychology): Different Types Of Dissociative Disorders

Dissociation refers to the phenomenon of feeling disconnected from our thoughts, feelings, behaviors, and surroundings. While dissociation can be a common occurrence—most of us experience dissociation from time to time—in some cases, it can be a sign of a serious and chronic mental health condition. Dissociation can cause an individual to become detached from reality, experience memory loss, or develop alternate personalities, which can lead to serious challenges when it comes to everyday functioning and mental, emotional, and physical well-being. Below, we’re going to discuss the definition, examples of, and treatment of dissociation and dissociative disorders. 

What is dissociation according to the American Psychological Association?

Following a distressing event, an individual might compartmentalize their negative emotions and intrusive thoughts in order to avoid difficult feelings. 

Dissociation (psychology): A sense of departing from reality

Dissociation is facilitated by complex processes in the brain. Recent research shows that nerve cells in the posteromedial cortex of the brain start firing to initiate dissociation. Studies on mice have shown that a specific protein type called an ion channel plays a role in the firing of these nerve cells.

You’ve likely experienced mild forms of dissociation frequently in your life. Perhaps you’ve started daydreaming during a meeting and missed what was being discussed. Or maybe you’ve made it through a few paragraphs of a book before realizing you hadn’t retained any information. While these disruptions may cause frustration, they are likely harmless as long as they do not significantly impair your ability to function or affect your health. For many, though, dissociation can cause severe symptoms that seriously impact their life. 

Dissociation (psychology): Understanding dissociative disorders

Chronic and severe dissociation can occur in various ways. Some people develop alternate personalities, while others lose time with dissociation. When dissociation becomes persistent and severe, it can be a sign that an individual is experiencing a dissociative disorder. Dissociative disorders are serious mental health conditions characterized by disruptions to an individual’s feelings, behaviors, memories, thoughts, and self-concept.

Other types of dissociative disorders: Dissociative amnesia and derealization disorder

While many people have heard of multiple personality disorder (the outdated diagnostic term for dissociative identity disorder), the other two dissociative disorders—dissociative amnesia and depersonalization/derealization disorder—may not be as well understood. 

Dissociative disorders including dissociative amnesia

There are three primary dissociative disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5): dissociative identity disorder, dissociative amnesia, and depersonalization disorder.

Dissociative identity disorder (DID)

The main symptom of dissociative identity disorder—previously called multiple personality disorder—is the presence of multiple, dissociated identities within a single individual. Generally, each identity has its own unique characteristics and voices. This dissociative disorder often develops as a coping mechanism after an individual has lived through violent, traumatic, or otherwise distressing events. 

The different personality states generally do not shift on demand but arise involuntarily and suddenly, which can cause significant confusion and distress in the individual while also impacting those around them.

For a diagnosis of dissociative identity disorder, two or more unique and separate identities have to be present. This mental illness is considered the most severe of the three dissociative disorders, and typically, someone living with dissociative identity disorder will also have dissociative amnesia.

Dissociative amnesia

When someone experiences dissociative amnesia, they may have trouble remembering things about themselves. Dissociative amnesia is different from someone who just happens to forget something. With dissociative amnesia, the person may have difficulty remembering a stretch of time or an event from their life; and, in some rare cases, they can forget their identity entirely.

Dissociative amnesia can also come about as a result of a specific traumatic event or occurrence. An episode of amnesia can last anywhere from a few minutes to several days—and, in some cases, dissociative amnesia can last for years. There are typically no warning signs prior to an episode, which can occur suddenly. It is not uncommon for an individual to have several dissociative episodes in their lifetime.

Depersonalization disorder

This mental health condition causes an individual to feel detached from the world and the reality surrounding them. People with depersonalization-derealization disorder report feeling like they are in a fog or a daze and often have difficulty connecting with their own thoughts and emotions. They may frequently feel like they're looking in on their life from the outside. They might watch themselves going to work, doing the dishes, or spending time with their children, but none of these experiences feel real to them. While their physical body is carrying out the actions, emotionally, they may remain detached, dissociated, and removed from the situation. 

Depersonalization-derealization symptoms can last for a few minutes or longer. They can occur at any time and may recur periodically over an individual’s lifetime. Up to 75% of people may experience a depersonalization-derealization episode at least once in their lives. Only 2%, however, experience chronic dissociative episodes.

Dissociative disorder symptoms: Detachment from reality

Although each type of dissociative disorder has specific symptoms, some general characteristics of dissociative disorders are:

• Memory loss and an inability to remember people, places, or events 
• Depression, anxiety, or other mental health challenges
• Feeling disconnected from one’s physical self, as though watching life from the outside (i.e., having an out-of-body experience)
• Difficulty with self-identity

Dissociative disorder and its impact on mental health

As with many mental health concerns, an individual living with a dissociative disorder may not realize they’re dissociating. Often, early warning signs are noticed by family, friends, or loved ones. If this is the case, it is advised that family and loved ones approach the topic of mental health in a sensitive, gentle manner while encouraging the individual to seek professional help for their disorder.

Comorbidities of dissociative disorders, including post-traumatic stress disorder

Additionally, dissociative disorders can be comorbid with certain conditions, including bipolar disorder, post-traumatic stress disorder, and borderline personality disorder. 

Diagnosis and treatment for mental health

If you feel like you may be experiencing symptoms of a dissociative disorder but you're unsure of how to proceed, a healthcare professional can provide you with screenings and determine whether further testing, a diagnosis for a dissociative disorder, and treatment are necessary.

Diagnosing dissociative disorders with a mental health professional

The healthcare professional you see may make their diagnosis of dissociative disorder based on the symptoms you are experiencing, along with your family and personal history. Physical tests like blood tests or an MRI might be carried out to make sure some other factor like a brain tumor or burst blood vessel is not at play. Once a physical ailment is ruled out, the professional may refer you to other medical or mental health specialists. 

Treating and managing dissociative disorders may involve psychotherapy (e.g., cognitive behavioral therapy, dialectical behavioral therapy), medication, (e.g., antidepressants), or both. While there is currently no way to cure a dissociative disorder, treatment can help you manage your symptoms. 

How can online therapy help with dissociation?

Individuals experiencing symptoms of dissociative disorders may be hesitant to seek out mental health care services in person. Those with anxiety, for instance, may fear going out in public or feel uncomfortable in a clinical setting. Online therapy may be a better option in these cases of dissociative disorders. Many people feel more comfortable discussing their symptoms in a web-based environment. Plus, online counseling can be reached from home, making it more convenient.  

There are a significant number of studies pointing to online therapy as a beneficial method of helping individuals who are seeking to address dissociation-related mental health concerns, such as trauma. In one study, published in the journal Cognitive Behaviour Therapy, researchers examined the effectiveness of online cognitive behavioral therapy (CBT) for PTSD, finding that participants’ symptoms were significantly reduced following treatment. Cognitive behavioral therapy is a widely accepted form of treatment that helps individuals replace negative, intrusive thoughts underlying unwanted behaviors and emotions so that potentially triggering situations can be better managed. 

Prioritizing mental health with a dissociative disorder

If you or someone you love is living with a dissociative disorder, online therapy platforms can provide useful tools for managing your dissociative symptoms. With online therapy through BetterHelp, you can work with a qualified therapist remotely, which may be helpful if dissociation causes you to lose track of time. BetterHelp works with a team of licensed mental health professionals with diverse specialties, so you’ll have a good chance of connecting with someone who can address your specific concerns regarding dissociation, trauma, or other challenges.