Dissociative Disorders

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According to the DSM-5, "dissociative disorders are characterized by a disruption of and/or discontinuity in the normal integration of consciousness, memory, emotion, perception, body representation, motor control, and behavior" (American Psychiatric Association, 2013).¹

The DSM-5 contains the following dissociative disorders:

• Dissociative identity disorder
• Dissociative amnesia
• Depersonalization/derealization disorder
• Other specified dissociative disorder
• Unspecified dissociative disorder

Positive symptoms of dissociation are experienced as "unbidden intrusions into awareness and behavior, with accompanying losses of continuity in subjective experience." Examples include the subjective sense that one contains multiple states of self ("fragmentation of identity"), the sense that one isn't real ("depersonalization"), and the sense that the world around oneself isn't real ("derealization")(American Psychiatric Association, 2013).¹

Negative symptoms of dissociation are experienced as an "inability to access information or to control mental functions that normally are readily amenable to access or control." Examples include amnesia (American Psychiatric Association, 2013).¹

Dissociative symptoms are often present after traumatic situations, and posttraumatic stress disorder and other trauma-and-stressor-related disorders often contain dissociative features (American Psychiatric Association, 2013).¹ Other disorders that can include or cause dissociative experiences include borderline personality disorder (American Psychiatric Association, 2013)¹, anxiety disorders, mood disorders, schizophrenia (Mula, Pini, & Cassano, 2007),² eating disorders, obsessive-compulsive disorder, and trichotillomania (hair-pulling disorder), especially in individuals who experienced childhood trauma (Lochner et al., 2004)³ or who have more severe symptoms. Dissociation is also associated with migraines and epilepsy (Mula, Pini, & Cassano, 2007).² 

¹ American Psychiatric Association. (2013). Dissociative Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). http://dx.doi.org/10.1176/appi.books.9780890425596.dsm08

² Mula, M., Pini, S., & Cassano, G. B. (2007). The neurobiology and clinical significance of depersonalization in mood and anxiety disorders: A critical reappraisal. Journal of Affective Disorders, 99(1-3), 91-9. doi: 10.1016/j.jad.2006.08.025

³ Lochner, C., Seedat, S., Hemmings, S. M. J., Kinnear, C., J., Corfield., V. A., Niehaus, D. J. H., ... Stein, D. J. (2004). Dissociative experiences in obsessive-compulsive disorder and trichotillomania: Clinical and genetic findings [Abstract]. Comprehensive Psychiatry, 45(5), 384-391. doi: 10.1016/j.comppsych.2004.03.010

"When I dissociate, I feel like I'm floating behind my body. Everything is either harsh and discordant or distant and hard to process. My thinking feels slower and less organized. Physically, it feels like ice water is being poured down the back of my brain. I get a headache that feels like a dull, claustrophobic ache. I've been told that when I'm dissociated, I look like I'm sick or about to fall asleep. It worries me that people can tell when I'm dissociating even if they don't realize what it means. It always feels like a vulnerability, and it's much worse when others know about it and could take advantage of it."

-Star