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Dissociative disorders

Explains dissociative disorders, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.

What is dissociation?

Your sense of reality and who you are depend on your feelings, thoughts, sensations, perceptions and memories.

If these become ‘disconnected’ from each other, or don’t register in your conscious mind, your sense of identity, your memories, and the way you see yourself and the world around you will change. This is what happens when you dissociate.

It’s as if your mind is not in your body; as if you are looking at yourself from a distance; like looking at a stranger.

Everyone has periods when we feel disconnected. Sometimes this happens naturally and unconsciously. For example, we often drive a familiar route, and arrive with no memory of the journey or of what we were thinking about. Some people even train themselves to use dissociation (i.e. to disconnect) to calm themselves, or for cultural or spiritual reasons. Sometimes we dissociate as a defence mechanism to help us deal with and survive traumatic experiences.

Dissociation can also be a side effect of some drugs, medication and alcohol.

Many mental health problems, such as schizophrenia, bipolar disorder and borderline personality disorder, have dissociative features.

The different types of dissociation

There are five types of dissociation:

Amnesia

This is when you can’t remember incidents or experiences that happened at a particular time, or when you can’t remember important personal information.

Depersonalisation

A feeling that your body is unreal, changing or dissolving. It also includes out-of-body experiences, such as seeing yourself as if watching a movie.

Derealisation

The world around you seems unreal. You may see objects changing in shape, size or colour, or you may feel that other people are robots.

Identity confusion

Feeling uncertain about who you are. You may feel as if there is a struggle within to define yourself.

Identity alteration

This is when there is a shift in your role or identity that changes your behaviour in ways that others could notice. For instance, you may be very different at work from when you are at home.

What are the different types of dissociative disorder?

Occasional, mild episodes of dissociation are part of ordinary, everyday life. Sometimes – at the time of a one-off trauma or during the prolonged ‘identity confusion’ of adolescence, for instance – more severe episodes are quite natural.

Dissociative disorders occur when you have continuing and repeated episodes of dissociation. These usually cause what many people describe as ‘internal chaos’, and may interfere with your work, school, social, or home life. However, you may be someone who appears to be functioning well, and this may hide the distress you are experiencing.

Dissociative amnesia

This is when you can’t remember significant personal information or particular periods of time, which can’t be explained by ordinary forgetfulness. You may also experience mild to moderate depersonalisation, derealisation and identity confusion.

I didn’t know I had other personalities at first because I wouldn’t remember them taking over – usually people closest to you are the first to know.

Depersonalisation disorder

You will have strong feelings of detachment from your own body or feel that your body is unreal. You may also experience mild to moderate derealisation and mild identity confusion.

Dissociative fugue

You may travel to a new location during a temporary loss of identity. You may then assume a different identity and a new life. Usually this ‘fugue’ will last for a few days, but it can last longer. To people who don’t know you, your behaviour may appear normal.

When your memory of your identity returns, you may have a range of different feelings about what you did while in the fugue, such as depression, guilt, shame, fear and/or confusion. If you experience dissociative fugue, you are likely to have experienced severe amnesia, with moderate to severe identity confusion and often
identity alteration.

Dissociative identity disorder (DID)

This is the most complex dissociative disorder. It is also known as multiple personality disorder (MPD). This has led some to see it as a personality disorder, although it is not. The defining feature is severe change in identity.

I’d look in the mirror and it would be a different face. I was chaotic and unsettled.

If you experience DID, you may experience the shifts of identity as separate personalities. Each identity may be in control of your behaviour and thoughts at different times. Each has a distinctive pattern of thinking and relating to the world. If you also have very severe amnesia, it may mean that one identity may have no awareness of what happens when another identity is in control. The amnesia can be one-way or two-way. Identity confusion is usually moderate to severe. DID also includes severe depersonalisation and derealisation.

Dissociative disorder not otherwise specified (DDNOS)

Each of the five types of dissociative response (see What are the different types of dissociative disorder?) may occur, but the pattern of mix and severity does not fit any of the other dissociative disorders listed above.

Additional problems

If you have a dissociative disorder, you may experience other problems too, e.g. depression, mood swings, anxiety and panic attacks, suicidal thoughts and feelings, self-harm, headaches, hearing voices, sleep disorders, phobias, alcohol and drug abuse, eating disorders, obsessive-compulsive behaviour and various physical health problems.

These may be directly connected with the dissociative problem, or could mean that you also have a non-dissociative disorder. In DID, some problems may only emerge when a particular identity has control of your behaviour, thoughts and feelings.

What are the effects of a dissociative disorder?

Dissociation can affect your perception, thinking, feeling, behaviour, body and memory. If you experience a dissociative disorder you may have to cope with many challenges in life. The impact of dissociation varies from person to person and may change over time. How well a person appears to be coping is not a good way of telling how severely affected they are.

The effects of dissociative disorder may include:

  • gaps in your memory
  • finding yourself in a strange place without knowing how you got there
  • out-of-body experiences
  • loss of feeling in parts of your body
  • distorted views of your body
  • forgetting important personal information
  • being unable to recognise your image in a mirror
  • a sense of detachment from your emotions
  • the impression of watching a movie of yourself
  • feelings of being unreal
  • internal voices and dialogue
  • feeling detached from the world
  • forgetting appointments
  • feeling that a customary environment is unfamiliar
  • a sense that what is happening is unreal
  • forgetting a talent or learned skill
  • a sense that people you know are strangers
  • a perception of objects changing shape, colour or size
  • feeling you don’t know who you are
  • acting like different people, including child-like behaviour
  • being unsure of the boundaries between yourself and others
  • feeling like a stranger to yourself
  • being confused about your sexuality or gender
  • feeling like there are different people inside you
  • referring to yourself as ‘we’
  • being told by others that you have behaved out of character
  • finding items in your possession that you don’t remember buying or receiving
  • writing in different handwriting
  • having knowledge of a subject you don’t recall studying.

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