Dissociative disorders

Maybe you’ve had the experience of driving on “autopilot.” One minute you got in your car, and the next minute you’ve arrived at your destination, but you can’t actually remember the details of the drive. This is an example of normal, everyday dissociation, a term that describes a mental state of disconnection from what is going around you.

Normally this day-dreamy state doesn’t last very long, and most people can snap out of it if something or someone requires their attention.

But for some people, dissociation is more pervasive, and can’t be turned off so easily.

In fact, the feeling of disconnection may become so intense and happen so often that it stops a person from functioning in their daily life. When this is the case, we say the person has a dissociative disorder.

Dissociative disorders are a group of disorders that cause an impaired awareness of one’s own actions, thoughts, physical sensations, and even identity, which is a sense of who you are. Dissociative disorders tend to stem from trauma, usually early childhood abuse or neglect, and are thought to be a way of adapting to negative feelings and experiences.

Dissociative disorders are divided into three main types: depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder. Each of these disorders fall along a spectrum of severity, with depersonalization/derealization disorder being the least severe of the dissociative disorders, dissociative amnesia falling somewhere in the middle, and dissociative identity disorder being the most severe. Typically, individuals with more severe dissociative disorders may have elements of less severe ones as well.

With v, depersonalization refers to a feeling of detachment from oneself, your own person, while derealization refers to a feeling that the world around you is not fully real.

Those with the disorder often feel as if they are watching themselves from the outside, maybe watching a movie about their life. They might feel emotionally or physically numb, or have a weak sense of self. Individuals with depersonalization/derealization disorder might speak in a deadpan manner, with little emotion, and have trouble forming relationships.

In severe cases, a person may have trouble recognizing familiar places, people, or objects, and this can make it hard to learn tasks.

Other symptoms include an altered sense of time, where things seem to move too fast or slow, brain fog or light-headedness, and being prone to rumination and anxiety.

Dissociative amnesia is when a person blocks out or forgets important personal information that most people would remember for a lifetime, like where they lived as a child, or what their mother looked like. Dissociative amnesia can be divided into four types: localized, generalized, systematized, and continuous.

Most people with dissociative amnesia have localized amnesia, meaning they have trouble recalling a traumatic event. Sometimes the memory loss is broader, and includes months or years surrounding the event.

Generalized amnesia is where a person can’t remember any of their past, even the non-traumatic parts. The onset of generalized amnesia can be sudden, stress-induced, and may be accompanied by a dissociative fugue,

meaning a temporary period of disorientation and wandering or travel. In a fugue state, a person may be confused about who they are, or they may believe they are someone else. They may also temporarily lose deeply-ingrained skills. For example, a computer engineer might forget how to use a laptop.

In systematized amnesia, a person only forgets a category of information which is in some way associated with a trauma, like forgetting everything about a certain person, or a specific location, even if it was a significant part of their life.

And finally, continuous amnesia happens when a person forgets each new event after it happens, and retains nothing but the present moment-- a bit like the fish Dory in the movie Finding Nemo.

And continuous amnesia doesn’t always relate back to psychological trauma.

The third type of dissociative disorder is dissociative identity disorder, which used to be called multiple personality disorder. Dissociative identity disorder can be broken down into two types: covert dissociative identity disorder, and overt dissociative identity disorder.