Definition

Dissociative disorder, also known as conversion disorder, is a mental disorder in the form of loss of normal integration between thoughts, memory, identity, and body movements. A person with a dissociative disorder generally has certain unhealthy and unconscious ways of escaping reality. This can interfere with daily living functions.

Dissociative disorders often arise due to trauma and can be worsened by stressful situations. They occur when a person tries to erase bad memories from their mind. Symptoms of dissociative disorders vary depending on the type but can include amnesia and having multiple identities.

Causes

Dissociative disorders can develop due to past trauma, such as physical, sexual, or emotional violence, as well as stress, war, and natural disasters.

A person's identity is still developing during childhood. This makes it easier for young children to detach from themselves and view a traumatic experience as if it happened to someone else. Children often learn to dissociate from traumatic events to cope and move on.

Risk factor

Risk factors for dissociative disorders are:

• Children who experience physical, sexual, and emotional violence during childhood.
• Children and adults who experience traumatic events, such as war, trauma, violence, torture, medical procedures, and natural disasters.

Symptoms

Symptoms of dissociative disorders vary depending on the specific type, but may include:

• The person is experiencing memory loss related to specific periods, events, individuals, and personal information.
• Feeling 'detached' from yourself and the emotions you feel.
• Having the perception that the people and environment around you are not real.
• Doesn't recognize your identity.
• Experiencing significant problems and stress in relationships, work, and other important aspects of life.
• Unable to adapt to emotional or professional stress.
• Experiencing other mental disorders, such as depression, anxiety, and suicidal ideation.

Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are three types of dissociative disorders, including:

Dissociative amnesia. Dissociative amnesia is a condition where a person experiences memory loss that cannot be attributed to other medical causes. It is more severe than simple forgetfulness and can affect people's ability to recall information about themselves, events they have experienced, and people in their lives, particularly during traumatic situations. In addition to memory loss, dissociative amnesia is often accompanied by a dissociative fugue, which is when a person travels to an unfamiliar place. This condition can occur anytime, from a matter of minutes to years.

Dissociative identity disorder. Dissociative identity disorder was previously known as multiple personality disorder. It is a condition where a person can have multiple identities or personalities and switch between them. The condition is characterized by two or more voices or identities in one's head, which can make the individual feel like they are being 'taken over' by another personality. Each identity has a unique name, personal history, characteristics, voice, gender, and physical qualities.

Depersonalization-derealization disorder is a condition that involves experiencing episodes of feeling disconnected from oneself. This condition can cause a person to observe their behavior, feelings, and thoughts from a distance as if they are watching a movie. Some people may experience this disorder in a dream-like state, known as derealization. These episodes can occur over a short period or last for several years.

Diagnosis

To diagnose dissociative disorder, the doctor will ask about your main complaint, the symptoms you are experiencing, and the history of previous conditions. A psychologist or psychiatrist diagnoses this condition.

Further examinations for dissociative disorders include:

Physical examination. Doctors will examine to exclude other conditions, such as head injuries, brain disease, sleep disorders, and substance intoxication, that can cause symptoms of memory loss.

Psychiatric examination. During a psychiatric examination, a psychiatrist will ask questions about your thoughts, feelings, and behavior to diagnose dissociative disorders. Input from your next of kin can also be helpful.

Enforcement of mental disorder classification and diagnosis is based on either DSM-5 criteria or Guidelines for the Classification and Diagnosis of Mental Disorders III (PPDGJ III). According to these criteria : 

• Dissociative amnesia is characterized by the selective loss of memory regarding recent important events, which is not caused by other conditions.
• Dissociative fugue is characterized by symptoms of amnesia and traveling to previously unknown places while still being able to take care of oneself (eating, bathing, etc.).
• Trance disorder is characterized by a temporary loss of appreciation for one's identity and awareness of one's environment as if controlled by another personality, supernatural force, angel, or other force.

Management

Treatment for dissociative disorders varies based on the type of disorder experienced, including: 

Psychotherapy

Psychotherapy is the primary treatment for dissociative disorders. This therapy involves interviews, counseling, and psychosocial therapy with professional medical personnel. The therapist will help you find healthier coping methods in dealing with traumatic conditions. As treatment progresses, your therapist will help you talk about your past traumatic conditions.

Cognitive behavioral therapy can help you integrate several identities and have control over the dissociative processes that occur. This therapy can take a long time and be difficult because you have to remember past trauma.

Drugs

Even if there are no specific medications to treat dissociative disorders, your doctor can prescribe antidepressants, anti-anxiety, or antipsychotic medications to help control your symptoms.

Complications

A person with dissociative disorders can experience complications in the form of:

• Injure oneself
• Suicidal ideation and attempts
• Sexual dysfunction
• Alcohol abuse
• Depression and anxiety disorders
• Post-traumatic stress disorder (PTSD)
• Personality disorders
• Sleep disorders such as nightmares and insomnia
• Eating disorders
• Physical symptoms such as headaches and seizures (but not epilepsy)
• Difficulty building personal and work relationships

Prevention

Children who have experienced violence or traumatic events have a high risk of experiencing dissociative disorders. If personal problems or other conditions affect how you treat your child, do the following:

• Consult with people you trust, such as friends, doctors, and family
• Ask therapists and support groups about appropriate parenting methods for children with traumatic experiences
• Look for a community with parenting classes to help you learn healthier parenting methods. If your child has experienced a traumatic condition, immediately consult a professional about this condition. Your doctor can refer you to a psychologist to help your child find healthier coping methods

When to see a doctor?

If someone with a dissociative disorder is having flashbacks of a traumatic event, they may do dangerous things and require immediate medical attention. It is important to take them to the emergency room immediately. If you know someone who is experiencing dissociative disorders, it is recommended to have their condition assessed by a psychiatrist.