Understanding Dissociative Disorders

     Dissociative Disorder is a mental health condition where a person might feel disconnected from their thoughts, memories, feelings, surroundings, or even their sense of identity.  It's like parts of their experience of self get separated, and they don't always feel in control of it.  It often develops as a way to cope with really stressful or traumatic events.  Kind of like the mind's way of protecting itself from painful memories.  But instead of helping, this disconnect can start to cause problems in everyday life, like trouble focusing, remembering things, or feeling present.

     There are 3 main types of Dissociative Disorders: Dissociative Identity Disorder (DID), Dissociative Amnesia, and Depersonalization/Derealization Disorder.  There's also something called dissociative fugue, which can happen with dissociative amnesia.  That's when someone suddenly forgets who they are and might even travel or end up somewhere without knowing how they got there.  Since these disorders are often linked to trauma, many people who have a dissociative disorder also deal with other trauma related health conditions like:

                         - PTSD (Post Traumatic Stress Disorder)

                         - Borderline Personality Disorder 

                         - Substance use issues

                         - Depression

                         - Anxiety 

     Anyone can develop a dissociative disorder, no matter their age, background, or income level.  Women are often diagnosed more than men.  The risk is especially high for people who went through physical or sexual abuse during childhood.

     Depersionalization is when you feel disconnected from yourself like you're not fully in your body or like you're watching yourself from the outside, kind of like watching a movie of your life.  You might feel emotionally numb or like your thoughts and actions aren't really yours. The world around you feels strange or unreal.  People, places, and things might seem distant, foggy, or dream like.  Time can feel off too, like it's moving too fast or too slow.  

     Even though these experiences feel very strange, you're still aware of what's going on and you know somethings not right.  It's not how things are supposed to feel.  Symptoms can start pretty early in life, sometimes even in childhood.  On average, the first episode happens around age 16.  It's pretty rare for someone to have their first episode after the age of 20.

     Some people experience just depersonalization, some just derealization, and others go through both.  These experiences can be really upsetting and confusing.  The symptoms might last for a short time, like a few hours or days, or they might come and go over months or even years.  For some people, they can become a more constant part of life. 

     Some other common symptoms might include:

                         - Having blunted or numb emotions

                         - Trouble remembering things or feeling forgetful

                         - Episodes of amnesia

                         - Your environment seeming distorted or unreal

                        - Feeling like you're in a movie

                        - Sensations of leaving your body and then coming back, sometimes with flashes of light

                        - Feeling strangely connected to your dreams, like they bleed into real life

                         - Describing visual things using physical feelings or textures, like you can almost "touch" what you're seeing 

     We don't fully understand what causes DPDR yet, and researchers are still looking into it.  However, a few possible triggers are:

                          - High levels of stress

                         - Past trauma

                         - Childhood abuse

     DPDR also seems to be connected to things like, anxiety, depression, and sometimes substance abuse.  Treatment can include psycho therapy and medication.  

     Another common symptom is having memory gaps.  Someone might not remember things that happened during the day, personal details, or past trauma.  How much these symptoms affect someone's life can vary.  For some, it only causes mild disruptions.  For others, it can really interfere with day to day living.  

     Dissociative Amnesia is the most common dissociative disorder.  The main sign is memory loss that's more serious than just forgetting where you put your keys.  It's not caused by a medial issue, and it usually involves forgetting personal information like details about yourself, people you know, or things that happened to you, especially if those things were traumatic or emotionally overwhelming.   This kind of memory loss often comes on suddenly.  It might last just a few minutes or hours, but in rare cases, it can go on for months or even years.  Sometimes, the memory gaps are tied to an specific event, like something that happened during a war or after a major accident.  This kind of amnesia really affects your daily life and relations or work.   

     Dissociative amnesia is usually diagnosed through self reported symptoms and assessments that look for signs of dissociation.  But one of the tricky parts is that people often aren't aware they're experiencing memory loss while it's happening, which can make it harder to recognize and diagnose. 

     There are a few different types of memory loss with this condition:

                         - Localized amnesia: This is the most common.  You can't remember a specific event or a chunk of time, often something stressful or traumatic.  

                         - Selective amnesia:  You remember parts of an event but not all the details

                         - Generalized amnesia:  This is very rare, but it's when someone forgets their entire life history even who they are.

      Sometimes, the person going through it doesn't even realize they're missing memories, or they might have only a vague sense that somethings off.  Usually, its close friends or family who first notice the memory gaps.  

    In rare cases, someone might forget almost everything about who they are.  And occasionally, a person may suddenly travel or wander off, feeling confused about their identity and where they're supposed to be.  This is known as dissociative fugue.

     Dissociative Identity Disorder used to be called multiple personality disorder.  It involves switching between different identities or "parts" of yourself.  It might feel like there are two or more people living in your mind, each with their own thoughts, feelings, and even voices.  Sometimes, it can feel like you're being taken over or "possessed" by one of these identities.  

     Someone with Dissociative Identity Disorder has two or more distinct identities: The main personalty, the one they were born with, is often called the "core" identity.  The other identities are called "alters", and they develop as a way to cope, often with trauma.  Each alter has its own unique way of thinking, acting, and remembering things. They might have different likes, dislikes, and even different voices or body language.  People around them might notice when an alter is present because the person may seem noticeably different. Switching between alters usually happens suddenly and without the person choosing to do it.

     People with this disorder often have gaps in their memory, sometimes forgetting things that happened while another identity was in control.  They might also find themselves in places without knowing how they got there, which is known as confused wandering. 

     There's a lot of debate around what actually causes DID.  Most of the research focuses on 2 theories:  the trauma model and the fantasy model.   The trauma model is the more widely supported one.  It suggests that DID develops as a response to intense, repeated trauma in childhood.  Like physical or sexual abuse, or severe neglect.  The fantasy model, on the other hand, argues that some people might be more suggestible.  If the idea of DID is introduced to them, they might start to identify with it.  This model even suggests that some people could form false memories of trauma to fit the diagnosis.

     The term Unspecified Dissociative Disorder is used when someone has dissociative symptoms - or symptoms that seem like a dissociative disorder but they don't quite meet all the criteria for a specific diagnosis.  It's often used in places like emergency rooms, where there might not be enough time or information for a full assessment.  It's kind of a place holder diagnosis until more details can be gathered.  

     Other Specified Dissociative Disorder (OSDD) is a diagnosis used when someone is experiencing clear dissociative symptoms, but those symptoms don't fully match the criteria for any one specific dissociative disorder.  A mental health professional might use this diagnosis when there's a clear cause behind the symptoms, even if it's not typical of other dissociative conditions.  It's a broad category meant to cover situations where dissociation is clearly happening, but doesn't fit neatly into other diagnoses.

     There are a few common ways OSDD can show up:

                         - Mixed dissociative symptoms: This can involve identity disturbances, but without memory loss 

                         - Identity disturbances from extreme outside influences: This might happen in situations like brainwashing, cult involvement, or after torture.

                         - Short term dissociative responses to stress:  These are temporary dissociative episodes triggered by stress, usually lasting from a few hours to less than a month

                         - Dissociative trance: This is when someone loses awareness of their surroundings in a way they can't control

     The symptoms of dissociative disorders can vary depending on the type.  Here are some common ones people might experience:  

                         - Feeling like you're outside of yourself or disconnected from your own emotions - almost like you're watching yourself from the outside.

                         - Feeling like the world around you isn't real, or that things seem strange or distorted.

                        - Having trouble knowing who you really are, like your sense of identity is unclear or confused.

                         - Struggling a lot with stress, relationships, work, or just daily responsibilities.

                        - Finding it hard to handle emotional pressure or stress from work or life in general

                         - Gaps in memory - like not remembering certain time periods, events, or personal information.

                         - Dealing with other mental health challenges like depression anxiety, or even thoughts of self harm or suicide 

     Doctors diagnose Dissociative Disorders by looking closely at your symptoms and personal history.  First, they'll usually run some tests to make sure your symptoms aren't caused by something else like a medical issue.  Memory loss or confusion can also be linked to things like:

                         - A head injury

                         - A brain tumor

                         - Not getting enough sleep

                         - Alcohol or drug use

     Once they've ruled out those kinds of medical causes, they'll send you to a mental health specialist who's trained to recognize and diagnose these conditions.  That specialist will talk with you in depth, ask questions, and observe your behavior.  They use the official guidelines from the Diagnostic and Statistical Manual of Mental Disorders.

     Dissociative disorders are usually treated with psychotherapy, also known as talk therapy.  The main goal is to help you understand what's happening, feel more in control, and manage your symptoms better. You'll work with a trained mental health professional like a psychologist or psychiatrist who will guide you through the process.  Therapy can also help your family understand what you're going through and how to support you.

     Some common types of therapy used for dissociative disorders include:

                         - Cognitive Behavioral Therapy (CBT): This helps you look at your thoughts and feelings, identify negative patterns, and replace them with healthier ways of thinking and behaving. 

                         - Dialectical Behavior Therapy (DBT):  This is especially helpful if you have intense emotions.  It focuses on accepting who you are while also working on making positive changes.  You'll learn skills to manage stress, improve relationships, and regulate emotions.

     Therapy can be challenging especially because it often means talking about past trauma, but overtime, it can really reduce symptoms and improve your quality of life.  Additional therapies might also be helpful like:

                         - Hypnotherapy: This uses deep relaxation and focus to help you explore memories or thoughts in a safe, guided way, which can support healing and change. 

                         - Eye Movement Dessensitization and Reprocessing (EMDR): This therapy involves guided eye movements while you think about traumatic events.  It's designed to help you process and move past difficult experiences. It's a newer approach but has shown good results for many people dealing with trauma.

     There aren't medications specifically for dissociative disorders, but if you're also dealing with things like depression or anxiety, your doctor might prescribe medications like antidepressants to help manage those symptoms. 

     Some signs that you might be experiencing dissociation at work include:

                         - Completely zoning out during meetings or conversations with coworkers

                         - Suddenly noticing it's much later in the day than you expected

                        - Forgetting to eat or not realizing you're hungry or thirsty

                        - Struggling to feel connected to the people around you

     You might also notice increased forgetfulness or feel less able to manage work-related stress.  Periods of high stress or working in a consistently stressful environment can make dissociation more frequent or more intense. 

      Here are some helpful strategies to help deal with dissociative disorders.

                         - Splash some cold water on your face: A quick trip to the bathroom to splash cold water on your face can be a simple way to ground yourself.  The sudden sensation can help bring your attention back to your body and the present moment.

                         - Deep breathing:  If you're feeling disconnected, try pausing for a moment to take a few slow, intentional breaths.  Breathing deeply can help calm your nervous system and bring you back into the present.

                        - Grounding techniques:  Grounding techniques are simple tools that can help you reconnect with your body and your environment.

                         - 5-4-3-2-1 technique:  This uses your senses to gently bring your attention back to the present.  It helps you notice small details you might normally overlook.  Theses are the steps:

                                   - Name 5 things you can see

                                   - Name 4 things you can hear

                                   - Touch 3 objects and notice how they feel

                                   - Identify 2 things you can smell

                                   - Notice 1 thing you can taste 

     If you or someone you know may be experiencing symptoms of dissociative disorder, please reach out for support. Help is available, and it's never too late to start the journey toward healing.