Dissociative disorder
Updated onJulia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.
More about the experts All content is checked by medical journalists.Dissociative disorder is an umbrella term for certain mental illnesses. Those affected react to very stressful experiences with the splitting off of memories or even entire parts of their personality. In this way, unbearable experiences can be hidden. Dissociative disorders include dissociative amnesia and multiple personality disorder. Read here how to recognize dissociative disorder, how it develops and how it is treated.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F44
Dissociative disorder: description
Dissociative disorder is a complex psychological phenomenon. In response to an unbearable experience, those affected hide memories of it or even obliterate their own identity.
Healthy people perceive their "I" as a unity of thoughts, actions and feelings. In the case of a dissociative disorder, this stable image of one's own identity is broken. Hence the name dissociation (Latin for separation, decay).
Such a split in consciousness is mostly related to a traumatic experience or serious conflict. Dissociative disorder often accompanies other mental disorders such as depression, schizophrenia or borderline personality disorder.
Most dissociative disorders appear for the first time before the age of 30. Women are three times more likely to be affected than men. It is estimated that 1.4 to 4.6 percent of the population suffer from dissociative disorder.
The following disorders belong to the dissociative disorders:
Dissociative amnesia
This is understood to mean a partial or complete loss of memory in connection with traumatic events.
As a rule, the memory loss only affects certain scenes of the stressful experience or the time afterwards. Such a dissociative disorder can occur, for example, after a car accident. The person can no longer remember the accident, or only partially. However, she did not suffer any brain damage that could explain the loss of memory. The memory loss usually gives up just as quickly as it occurred. Relapses are rare.
In very rare cases with dissociative amnesia the memory of the entire previous life is lost.
It is estimated that the risk of developing dissociative amnesia at some point in life is seven percent.
Dissociative fugue
Triggered by a stressful event, the person affected suddenly leaves his home or workplace and assumes a new identity (fugue = flight). He cannot remember his previous life (amnesia). If he later returns to his old life, he usually no longer has any memories of his departure and the interlude in a different identity.
Experts estimate that the risk of developing this dissociative disorder over the course of life is only 0.2 percent.
Dissociative stupor
Those affected hardly move or do not move at all, no longer speak and do not react to light, noise or touch. In this state it is not possible to contact them. However, the person is not passed out because the muscles are not slack and the eyes are moving. The symptoms of dissociative stupor are not due to organic problems, but to psychological distress.
The dissociative stupor rarely occurs. Experts believe that this dissociative disorder occurs in 0.05-0.2 percent of the population over the course of a lifetime.
Dissociative movement disorders
In contrast to the other dissociative disorders, there is no memory loss (amnesia). Rather, those affected are no longer able to move one or more parts of the body at will without an organic cause. The speech muscles can also be affected.
For example, those affected can no longer stand or walk freely, have coordination disorders or can no longer articulate themselves. Paralysis is also possible. Symptoms can be very similar to neurological disorders, which can make diagnosis difficult.
Dissociative sensitivity and sensation disorders
In the case of dissociative sensitivity and sensation disorders, either the normal skin sensation is lost in certain parts of the body or in the whole body. Or those affected are only partially or no longer capable of sensory perceptions (such as seeing, smelling, hearing).
The incidence of dissociative movement, sensitivity and sensation disorders is estimated at around 0.3 percent. Unfortunately, women more often than men.
Dissociative seizures
Dissociative seizures are psychogenic seizures that often have a specific situational trigger (e.g. a stressful situation). They are very similar to epileptic seizures, but differ from them in several ways. For example, they start delayed (protracted) with a slow increase, while epileptic seizures are characterized by an abrupt start. In addition, dissociative seizures are not associated with memory loss for the duration of the seizure - epileptic seizures do.
Dissociative seizures make up about four percent of all new seizures. Women are affected much more often than men. About 1 in 10 people with dissociative seizures also have epilepsy.
Dissociative Identity Disorder (Multiple Personality Disorder)
Dissociative identity disorder is the most severe form of dissociative disorder. It is also known under the term "multiple personality disorder".
The personality of those affected is split into different parts. Each part has its own memory, preferences and behavior. Often the different parts of the personality differ greatly from one another. They never appear at the same time, but alternate - and they don't know about each other.
In many cases, Dissociative Personality Disorder is the result of severe abuse.
You can read more about this in the article Multiple Personality Disorder.
Dissociative disorder: symptoms
Dissociative disorders can express themselves differently depending on the form and often also from patient to patient.
For example, some people with dissociative amnesia just lack the memory of a particular experience, possibly without being aware of this memory gap. For other sufferers, the memory of longer periods of time or even of their entire life is obliterated. In the case of a dissociative identity disorder, the ego splits into different personalities - sometimes of different ages and genders - which then all lead a life of their own. Other people with dissociative disorders have severe physical symptoms. For example, people with a dissociative movement disorder can only partially move one or more body parts or not at all.
The symptoms of dissociative disorder can also change in one and the same person in a moment. Depending on the form of the day, they also often vary in difficulty. In addition, stressful situations can make dissociative disorder worse.
A dissociative disorder can also manifest itself through self-harming behaviors. For example, some patients inflict cuts or burns in order to return to reality from the dissociative state.
Common features of dissociative disorders
Although the symptoms of the various dissociative disorders, from memory loss to physical ailments, vary widely, they have two features in common:
According to the international classification of mental disorders (ICD-10), dissociative disorders do not have any physical illness that could explain the symptoms. And there is a compelling temporal relationship between the symptoms and stressful events or problems.
Dissociative disorder: causes and risk factors
Dissociative disorder usually occurs in connection with traumatic life experiences. Severe stressful situations such as accidents, natural disasters or abuse overwhelm the psyche. The symptoms of dissociative disorders are a stress reaction to this excessive demand.
But not everyone reacts to stressful situations with a dissociation. The individual personality and environmental factors have an influence on the development of dissociative disorders. Among other things, the bond with the parents influences how resistant children are to stress. Children who lack the necessary security and security in their parents' home are more prone to dissociative disorders.
Negative experiences can also have biological effects: Severe stress can change structures in the brain. For example, too much of the stress hormone cortisol 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 clarified.
Dissociative disorders are sometimes also referred to as conversion disorders, because mental content is converted into the physical. This mechanism is called "conversion".
Dissociative Disorder: Causes of Different Forms
How the various dissociative disorders arise exactly is the subject of research. For example, the split in consciousness (dissociation) is considered to be the cause of amnesia and fugue. In this way, stressful or traumatic experiences can be saved in such a way that they are no longer accessible to the person concerned. Experts believe that this is a protective mechanism. If the psyche cannot process a situation because it is too threatening, it relieves itself through the separation.
The exact causes of the stupor, in which patients do not react to the outside world, have not yet been adequately researched. Some experts compare the symptoms of dissociative stupor with the play dead reflex in animals - a survival strategy that some animals use when they can no longer find a way out of a threatening situation. This could also be the case with people with dissociative stupor: a threatening situation makes those affected freeze all over their bodies.
The primary cause of multiple personality disorder (dissociative identity disorder) is severe abuse experiences in childhood. The division 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 adequately supplied with everything it needs. A dissociative disorder can therefore be triggered by a lack of sleep, too little drinking or a lack of exercise.
Dissociative disorder: investigations and diagnosis
Important for the diagnosis of a dissociative disorder are the symptoms that the person concerned reports about to the doctor / therapist in the initial consultation (anamnesis). The doctor / therapist can also ask specific questions, for example:
- Are you missing memories of certain parts of your life?
- Do you sometimes find yourself in places without knowing how you got there?
- Do you sometimes feel like you've done something that you can't remember? For example, do you find things in your home that you don't know how got there?
- Do you sometimes feel like a completely different person?
Background questions can also be helpful, for example about the current life situation, family background and possible psychological problems in the family. Information from third parties (e.g. previous medical reports, for minors: reports from parents and teachers) can also support the diagnosis.
The doctor / therapist can also use special questionnaires or predefined discussion guidelines ("diagnostic interviews") during the anamnesis discussion.
During the conversation, the doctor / therapist pays attention to possible signs of a dissociative disorder in the patient. Frequent gaps in memory that a patient shows during visits to the therapist / doctor can, for example, indicate a dissociative disorder.
Exclusion of organic causes
A dissociative disorder can only be diagnosed if organic causes for the symptoms can be ruled out. Because signs such as seizures, movement disorders or disorders of sensory perception can also be triggered by epilepsy, migraines or brain tumors, for example.
That is why the doctor examines the eyes, smell and taste buds, for example, as well as the patient's movements and reflexes. In some cases, detailed cross-sectional images of the brain are also made with the help of computed tomography (CT).
In the case of minors, the doctor also looks for possible signs of mistreatment or abuse, among other things.
Dissociative disorder: treatment
Dissociative disorders are treated as part of psychotherapy. The goals or contents of the treatment are to stabilize the patient, reduce dissociative symptoms and deal with traumatic experiences. Depending on the severity, duration and severity of the symptoms, patients with dissociative disorders are treated on an outpatient, day-care or in-patient basis.
Dissociative disorder: stabilization and symptom reduction
At the beginning of the therapy, the therapist explains to the patient in detail about the clinical picture of the dissociative disorder. Even if the patient cannot be addressed, the therapist informs him of the disorder. Psychotherapists refer to this information as psychoeducation.
In the further course, the patient learns to be aware of his feelings and to relieve tension in good time. In order to reduce dissociative symptoms, the therapist works with the patient to develop strategies that will help them cope with stress.
In addition, the patient learns to notice signs of upcoming dissociative symptoms in good time and to take action against them. If the patient nevertheless falls into a dissociative state, the therapist brings them back with the help of breathing and thought exercises. Strong smells or loud music are also used to bring the patient back to reality.
Dissociative disorder: dealing with the trauma
If there are traumatic experiences in the past, they are dealt with in therapy. If they are very stressful for the patient, the therapist ensures that the topic is dealt with step by step in order not to overwhelm the person concerned. The therapist uses various techniques so that patients do not fall into dissociation again during trauma processing. For example, the person concerned should stand on a shaky surface while he talks about the memories.
In order to bring hidden memories (such as dissociative amnesia) to the surface, the therapist can hypnotize the patient. As soon as access to the buried memories is established, the person affected can begin to work through the trauma with the help of the therapist.
Dissociative disorders of movement, sensation, or sensitivity
People with dissociative movement disorders or dissociative sensation or sensitivity disorders usually seek help from a doctor and not from a therapist because they believe that their symptoms are physical. Many also do not want to be confronted with the fact that their problems may be psychological, which makes treatment difficult. The therapist communicates to the patient that the symptoms are real, even if they have no physical (organic) cause. Only when the patient is convinced of this can the psychogenic cause of the symptoms be tackled as part of psychotherapy.
Dissociative disorder: disease course and prognosis
Often a dissociative disorder starts suddenly, triggered by a stressful event. Symptoms usually go away after a few weeks or months. In severe cases, however, those affected suffer from the symptoms for the rest of their lives or experience relapses again and again. Patients in whom the dissociative disorder has been untreated for a long time and who also have other mental disorders have a higher risk of an unfavorable outcome.
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